All posts by Cedric

Four elemental questions for therapeutic psychology: a personal view

In this article, David Zigmond, who is a GP, Psychiatrist and psychotherapist, gives us four fundamental questions to ponder when we see patients for psychotherapy. Zigmond is concerned that the medical model, prevalent in the NHS, does not equip us with the mindset that is necessary for an authentic encounter.

He proposes four fundamental questions for therapists, which “escape subsumption to prepackaged, designatory psychologies”, and are, in his experience, “primal to any likely successful engagement”.

1. What is it like to be this person, to have lived their life?
2. What is the meaning and experience, for them, of this kind of distress?
3. What is the meaning and experience, for them, of me, now?
4. What do I need to understand of their needs that theyvpossibly cannot yet express, or even think about?

Zigmond describes these questions as “naive”, in that they assume very little. Indeed, by asking ourselves these questions as practitioners we are necessarily led to discard accepted theories and conventional perceptions so that we can form an understanding of the person’s presenting needs based on our experience of them, of ourselves as we are in relationship with them, with empathy, curiosity and openness.

The term “naive” is quite important here and I find myself drawn to it. As a psychotherapist and counsellor in London I have, like my colleagues, undergone years of therapy, supervison and training, and I know still that my learning has only begun. Psychotherapist D.W. Winnicott prefaced his book “playing and reality” with the following words: “to my patients, who have paid to teach me”.

It is tempting for many to adopt a top-down approach to psychotherapy for depression, relationship problems or problems such as anxiety. By this, I mean that the practitioner concerns themselves with acquiring an understanding of the symptoms that each condition presents and developing an approach whereby they can track progress in treatment according to criteria of functioning that may have nothing to do with the person, but that are instead taken from a group-level view.

While the latter approach is necessary in driving some areas of research and monitoring outcomes in institutional settings, the former needs adopting in every encounter. By doing this, the practitioner has the better chance of not only fulfilling their role in an institution, but also to meet the person who is suffering as an equal and give them a chance to be understood more fully and more immediately.

Counselling in London for depression

Addressing Depression through Psychotherapy

Depression is the most prevalent of mental health problems. Studies have shown that it occurs in 1 in 10 adults or 10 per cent of the population in Britain at any one time, (Healy, 1998, Hale, 1997). It is quite common to experience a depressive episode as a reaction to an event. It also happens that depression sets in “out of the blue”, and does not seem to go away by itself.

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Nature versus nurture – more grist to the mill

This recent article by the Guardian, “Why do identical twins end up leading such different lives?” adds yet more weight to the argument that even though our genes may predispose us to certain traits, and therefore give us strengths and vulnerabilities, our epigenetic makeup, i.e., the pattern by which certain genes are expressed or not through of our interactions with the world, will make a huge contribution to the building of our personality.

Continue reading Nature versus nurture – more grist to the mill

Psychotherapy for Work-Related problems

Work can be a place and process of true personal realisation. Our work is an expression of our vitality and values and helps us contribute to the welfare of our families and to society – whatever the size of the fish or the pond.

It is precisely because work is so important in our lives that the problems that relate to it can be so debilitating. And in the same way that rewarding work helps create the conditions for a better private life, problems at work always “spill over” into the time we reserve for our leisure, our friends and families.

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In a few words: depression combined with anxiety

Depression with Anxiety: a common problem

Very often, psychotherapists in London and elsewhere will mention under the same breath that they help people with “anxiety and depression”, almost as if it were one and the same thing. This is probably because, according to the ONS, there are almost three times more people who suffer from both depression and anxiety that people who suffer from depression alone. Indeed, depression with anxiety is experienced by 9.2% of people in Britain, while depression without anxiety by 2.8%.

What is the relationship between anxiety and depression?

It is hard to say if unmanageable anxiety triggers depression, or if a state of depression generates anxiety. It depends highly on individual cases and even then It often feels like a circular situation and in my experience it is not helpful to try and find out what came first. The essential is to help the client address these feelings as a whole in their therapy, and to consider anxiety and depression as intricately linked as opposed to separate phenomena requiring different approaches.

An apparent paradox

It sometimes seems paradoxical that depression, whose symptoms are said to be mostly negative (i.e., describing the absence of something), can co-exist with anxiety, whose symptoms are mostly positive (i.e., describing the presence of something). For example, in depression, sufferers experience lowered mood, loss of motivation, loss of meaning and loss of concentration, while in anxiety it is the positive symptoms that seem to prevail, for example, increased heart rate, presence of recurrent unpleasant thoughts and restlessness.

How to approach individual treatment of mixed anxiety and depression

As an experienced counsellor having helped many people deal with issues of mixed anxiety and depression in London, I have noticed that people suffering from this problem fall in three very broad categories:

  • those who feel that they will benefit more from guidance and education, and expect from the therapist clear instructions and coping strategies,
  • those who prefer a non-directive approach and want to explore their experience in an open, unstructured manner,
  • and those who feel that it is most helpful for them to experience both in their therapy.

As an integrative psychotherapist, I believe that it is best to offer my clients what is going to be helpful to them and not just what a specific approach says I should do. This is why I mostly offer my clients a space to be with themselves and also a forum where they can clarify, understand and plan concrete life changes.

Should a psychotherapist be prescriptive with his or her clients?

Cedric Bouet-Willaumez, London psychotherapist, received an email from a person who visited his website (www.london-counselling-psychotherapy.org.uk) and who wrote to him: “My parents sent me a place to be talked out of [my feeling self-conscious] once a week for quite a time when I was very young. It did not good at all”.

Very often there is an expectation of people seeking counselling in London orpsychotherapy in London that the practitioner will ‘do something’ to them to make them feel better. It will be either that the counsellor or therapist will make an unhelpful behaviour stop, or that they will create a new behaviour that can help them feel better in themselves or resolve a situation that appeared stuck. People often feel that if they can be convinced to change the way that they think, their suffering will stop.
Cedric knows from experience that this is not the case. A psychotherapist does give the client an opportunity to change their behaviour and approach life situations differently. What the psychotherapist should not do, in Cedric’s view, is to ‘talk the client out of their beliefs’. Even if the intent is felt to be positive by the practitioner, the effect of this practice is to undermine the client’s worldview and to create a relationship where the therapist is yet another person ‘who knows better’.
So, how does counselling work if the psychotherapist does not seek to replace the client’s views with his or her own?
The therapist will seek to understand the client’s deepest motivations that contribute to creating their worldview and behaviours. The therapist will help the client become aware of these, and will show the client how he or she is affected by them. The therapist’s particular skill, in Cedric’s experience, is to do something for his client that is actually very close to what a good parent should do to a growing child: that is, to be present, interested and allowing the child to grow in a direction that is meaningful to them, and not necessarily to the therapist.

What is integrative psychotherapy?

Defining integrative psychotherapy is a little bit harder than defining other approaches because, in doing so, one has to go against the perception that integrative psychotherapy is a smorgasbord of several other better defined approaches.

The European Association for Psychotherapy says of integrative psychotherapy that it
“affirms the importance of a unifying approach to persons. Thus a major focus is on responding appropriately and effectively to the person at the emotional, spiritual, cognitive, behavioural and physiological levels.”
This statement conveys something important about the focus of integrative psychotherapy, which is that it seeks to address the totality of a person’s experience. In this short article I would like to say more about this, as well as elaborate on what integrative practice looks like.
Clinical philosophy
 
Psychotherapy is integrative in scope and in outcome. It brings together into a consistent, functioning whole, the teachings of different schools of thought (psychodynamic, existential and person-centered) and, similarly, it seeks to help the patient integrate their conscious and unconscious lives.
The integrity of the person, that is, their deep sense of being ‘one thing’ and their ability to enact this consistently, starts developing from conception and is achieved – and tested – over time through interaction in different settings, from family to society and nature.
Where do our problems come from?
Pathology arises because we rarely get from our environment the response that is totally appropriate to our needs. We therefore develop unsatisfactorily and incompletely, and cannot take care of ourselves and others like we are able to. We live without integrity because a large part of our experience does not enter into the way we relate to ourselves and others.
For example, if a child’s parents do not acknowledge and respond well to, say, their feeling sad and being tearful, they will not help the child acquire the ability to acknowledge their own feelings and act accordingly, or to have emotionally satisfactory relationships with others.
How does integrative psychotherapy help?
Psychotherapy is the combination of a process (the conversation) and an environment (the therapeutic relationship) that afford the individual a reparative experience. This is made possible by the constant endeavour of the therapist to respond appropriately to the needs of their patient.
As a result of this, the therapeutic relationship is absolutely central to the healing process, and therefore the therapist works with a constant awareness of self and other. The therapist will seek to model integrity in their presence to the patient, which means calling upon the totality of their experience to help the patient make sense of their own.
It is essential that the therapist take into account the capacity of the patient to engage in psychotherapy and not try and impose a form to the encounter when it does not correspond to a genuine need of the patient. This is why the is no systematic use of transference interpretations, no imposition of a frequency of therapy, and no fixed setup in the consulting room that the patient has to adhere to. The therapist needs to work out what they need to take good enough care of themselves and create their boundaries and practices accordingly, and then enforce them firmly. This requires the therapist to be constantly in tune with themselves, and this is greatly facilitated by their own psychotherapy and supervision.
I apply these principles in my daily practice of psychotherapy inLondon.
Multilingual Psychotherapy

Multilingualism, self-experience and psychotherapy: a lecture and seminar at the contemporary Training in Psychoanalytic Psychotherapy

As part of my ongoing academic work in psychotherapy and counselling, gave a lecture and facilitated a seminar on multilingualism, self-experience and psychotherapy, which was titled “The multilingual experience in psychotherapy”

My aim was to show that a person’s ability to use different languages has a profound impact on the way their relationship to themselves and to others, and that it was possible and even indispensable to address this meaningfully in psychotherapy.
In a first part of this lecture, I showed that the process of language acquisition that we go through as infants, toddlers, children and then later as adults is entirely based on relationships: the relationship to self and the relationship to others. By acquiring a language, we learn to relate to ourselves, to the world and to the people around us. And this is something that we learn from the people closest to us. This means that each and every individual word that we use has a story and an emotional charge, and that every time that we use such and such word, we make a connection to the time and place that we learned it and to the person(s) that we learned it from.
In the second part of the lecture I described what it meant for this process to involve more than one language. I showed that the basic principle of language acquisition still applies, and that each language then brings with its own set of experiences, of relationships to self and to others. In summary, I suggested, as I have done in earlier research, that people who speak different languages engage with and manifest different aspects of their self according the the language that they live in at any given time.
I looked in the third part of this lecture at the consequence that this had on the process of psychotherapy for the multilingual individual. I showed through examples that people could use their bilingualism in a defensive manner, to keep painful things at bay, but also to make it possible for them to relate to a part of themselves that would be too painful if experienced in a first language.
The final part of the lecture focused on how multilingualism in the therapeutic relationship, whether it is the multilingualism of the patient, the therapist, or both, deeply affects the way psychotherapy unfolds. I described different ways of working with this meaningfully, and lively discussions ensued with the students I was teaching to challenge and further develop the points I was making about this. This workshop was very well received. I trust it will contribute to the students’ understanding of psychoanalytic psychotherapy, and how this intersects with the phenomenon of multilingualism.
As a psychotherapist in London I am committed to my personal development and research of this kind is essential to my practice, especially given that I practice in French and in English with equal ease.

Workshop at the annual conference of the College os Sexual and Relationship Therapists

Cedric Bouet-Willaumez, Harley Street psychotherapist, workshop leader at the annual conference of the College of Sexual and Relationship Therapy

London psychotherapist Cedric Bouet-Willaumez was invited by the College of Sexual and Relationship Therapists (COSRT) to run workshops for its annual conference on 19 and 20 May 2012. The conference had as a central theme the importance of considering race, culture and language in sexual and relationship therapy. Cedric ran four workshops to a good reception by the conference delegates
 
(PressReleased) May 31st, 2012 – psychotherapy and counselling can greatly help people suffering from problems in their relationship and in their sexuality. In the case of couples psychotherapy and couples counselling, the couple jointly attend appointments. The role of the therapist is, quite simply, to provide a place for the couple to try and meet, so that they can see what it is that they are doing together.
In the case of relationship therapy or relationship counselling, one person attends the consultations and brings their issues for working through with the help of the psychotherapist.
Cedric knows from his extensive experience of working with couples and individuals who suffer from relationship and sexuality problems that it is the breakdown in communication that is the most telltale sign that something urgently needs to be solved between the partners with the help of an impartial third party.
Communication breakdown happens when two partners are unable to convey to one another what they think and feel. This may manifest as silence, violent communication, and/or repeated misunderstandings. The space offered by the therapist aims to facilitate communication and to help the two partners see each other with more understanding and clarity, and to make informed decisions about where to take their couple.
This work is made more complex when the couple has a multicultural and/or multilingual aspect to it. When this is the case, communication can be made even harder, and the Divide between the partners can seem to be beyond bridging. Cedric has researched the topic of multilingualism and given lectures and run workshops to help people with two things :
  1. to understand how their multilingualism can affect the way that they see and understand themselves (or not!)
  2. In the case of non-multilinguals, to “walk a mile in the shoes of the multilingual individual” and to get a feel of how it is to be them.
Cedric practises in two languages and has years of experience helping people communicate better and make sound decisions about their couple, their marriage or their sexuality, whatever that decision may be.
Cedric Bouet-Willaumez is a qualified psychotherapist and has three clinics in Maida Vale, Central London and Harley Street. Should you wish to seek help or make an appointment, the clinic hours are from 9:00 Am to 8:00 PM.
For more information on psychotherapy, counselling, vacancies and fees please contact +44 (0) 7876 035 119 or send an email to cedric@cbwpsychotherapy.com. You can also visit the website www.cbwpsychotherapy.com for further details
Cedric Bouet – Willaumez MA, Dipl. Psych | 07876 035 119
Psychotherapist and Counsellor