It was with great sadness that I heard today of the closure of Relationships Aotearoa, something only decided upon this week as talks between the Government and Relationships Aotearoa broke down. RA is New Zealand's largest psychotherapy and counselling provider, with 60 locations, 183 employees, and 7000 clients. Furthermore, they have been known as specialists in relationships and couple's counselling, having trained many other practitioners in Emotionally Focused Therapy for couples.

Minister of Social Development Anne Tolley has explained the government's position by focusing on dysfunction within RA, and has said that it is not the taxpayer's responsibility to take up the slack for poor financial management by RA. 

Unfortunately this is a scenario that I have witnessed repeatedly under National Governments. Rhetoric about efficiency and hostility towards the public sector from the National Government has put immense pressure on social service and health organisations. I am convinced that the effect of funding and contract uncertainties, and closures, is anything but efficiency. 

It has become normal within counselling and psychotherapy agencies to function under the considerable stress of funding uncertainty, and for the individual employees, loss of livelihood. The National Government would like us to think that this is the market delivering us taxpayers efficiency, through healthy competition.

What I have seen and heard about in many counselling and psychotherapy agencies is clinicians becoming debilitated by dealing with this additional pressure on top of dealing with the stress and pain that their client's bring them to work with. Research on burnout in mental health professionals includes various studies, a UK study showing that 21% to 41% of professionals at any one time report high levels of emotional exhaustion. When these staff burnout, they become more physically and mentally sick, less effective, and become more rejecting and judgmental of those that they are supposed to be able to help. I have seen agencies waste countless hours of their staff's time managing the stress of financial pressures, rather than be able to do what they do best - help their clients. Clients get switched between clinicians due to closures or difficulty with staff retention, often negatively impacting their emotional healing. In summary, clinicians are hurt and are less effective due to constant funding uncertainty delivered by the National Government.

By Anne Tolley's own admission, these sorts of "efficiencies" are likely to continue. Whilst the RA closure is nation-wide, Christchurch is particularly in need of steady and effective support whilst in post-earthquake recovery. Tolley mentions the shift of funding to families and young children. While this is supported by our increased understanding of developmental neurobiology, what we have also learned from this field is that babies and young people do not develop in isolation. I am sure that the clinicians at Relationships Aotearoa have helped thousands of young New Zealanders by ensuring that they never have to be impacted by their parents abusing each other or physically fighting. 

Mental Health professionals play an absolutely vital role in New Zealand society. We rightly expect high standards of them, when the lives or the happiness of those we love are at stake. Do we give them the support they need in order to fulfill our expectations?

Having recently been practicing counselling and psychotherapy in Australia, I've noticed that here in New Zealand we are lagging behind in awareness and use of online therapy. I have no evidence to back this up, but I presume that Australians are taking to online therapy because of the difficulties accessing a therapist due to the immense distances and spread out population, once you get outside of the major cities. 

Therapists use various video platforms to work with clients, including popular ones such as skype. My experience has been that after a self conscious first five minutes, and bar the occasional irritating lag or need to repeat a sentence, both therapists and clients quickly forget that they are not in the same room together, and that online therapy really functions very similarly to meeting in person. 

But, you may ask (I certainly did)... does it work as well as meeting in person? Actually, what research I've seen actually says that it works better. This article summarises the findings briefly. Intuitively, I'm not so sure about this, and want to inject a note of caution. The type of therapy studied, cognitive behaviour therapy, is fairly brief therapy that tackles the symptoms but not the causes of the issues. I'm not so sure that deeper therapeutic work would translate so well to working online. 

Still, I think that online therapy is a great addition for people who live in remote areas, those who want to access a specialist therapist who may practice far away, or those who are impeded by shyness or disability from doing therapy in person. At Lucid Psychotherapy we do offer online counselling, so contact us if you're interested.

The relational approach is hot in the therapy world at the moment, but what does it actually mean, and why would those who are not mental health professionals want to know about it? This series of posts will discuss how we do or don’t think relationally about some common mental health issues, and what the implications of this might be.

First we’ll look at one of the most common mental health issues, depression. This is a significant issue in New Zealand, as probably most of us know due to series of education campaigns and some very useful efforts to reduce stigma. Often, however, campaigns to de-stigmatize mental health issues cast those issues in a medical light, presumably because we tend to feel little shame over other medical issues such as a broken leg or a heart condition. When taken to the extreme, this can lead to thinking that equates depression with chemical imbalances in the brain that are really only the responsibility of our doctor to deal with. Just like I wouldn’t advise a neurosurgeon on how to operate on me, coming from this perspective, I might sit back and wait for the medication prescribed by the expert to do its work on my depression.

I’m not advising anyone against anti-depressants, but I am suggesting that there’s more to the picture of depression than this. Two subtypes of depression involve relationships of abandonment/grief, and of intense self-criticism.

If I am suffering the first subtype, that of abandonment, I may be experienced in relationship as very difficult to reach and connect with, and my (sometimes unconscious) expectation of others is that they will readily abandon me. Others, whether recently or in my childhood may actually have abandoned me. Furthermore, I may now act in ways that sustain this pattern, by for instance, retreating from others into a depressive isolation. From this relational perspective, my depression isn’t only a chemical imbalance in the brain, it is a state of sustained and often unacknowledged grief, loss, and appropriately to this, sadness. If I'm depressed and doing therapy from this perspective, therapy isn’t just about kickstarting my brain's chemistry, but about helping me to grieve, and bringing me back into relationship – often starting with a relationship with a warm, reliable, and empathic therapist.

If I am suffering from the second subtype, that of self criticism, it may be extremely painful for others to witness just how much I disappoint myself. Though others may accept me, and I may even long to accept myself in the same way, it is as if an invisible wall exists to stop any of this acceptance easing my pain. A criticising relationship with myself has been internalised. In order for me to break with my loyalty to this self-criticism, in therapy I may need to explore with my therapist where it came from. What were the earlier relationships in my life in which I was criticised or invalidated, and was this criticism valid? Were the standards or the purposes of this earlier criticism compassionate and guiding, or punishing and unrealistic?

In a nutshell, that’s my brief introduction to a different, more relational, and hopefully more human way of viewing depression. Please let me know in e-mail or comments what you think about this. Check in again soon for the next post in this series: a relational approach to borderline personality disorder.

Post by Michael Apathy at Lucid Psychotherapy and Counselling.

Addiction has some common themes, regardless of the object of addiction. It often lives in the middle of intense, mind bending denial. It is fed by and lives in shame and guilt. It is fiercely protected by the person who is addicted, and it is often the very last thing to be sacrificed. It is incredibly contentious, and often better to not call addiction at all - after all, who wants to be the implied "addict." Often in the focus on addiction, those who are missed are the partners, children, and family of the person who is addicted. If that's you, these are some points to consider:

You are powerless over your loved one's addiction, but you are not powerless. You have choices that you may not be able to see, and you may benefit from working with someone who understands relationships and addiction.

You have probably become incredibly adapted to living with the addiction, by small increments, over a long period of time. You may not be living out of your own values at the moment, or even be sure what your values actually are. 

It may help you to take stock of the impact of the addiction. Make a list of the ways the addiction but helps and hurts. You could do this in regard to the ways your loved one is helped or hurt by the addiction, but more importantly, do this list regarding the ways your are helped or hurt by the addiction. 

Last night I saw the movie Pride at the Dendy in Newtown. After a tiring day's work all I wanted was some light entertainment, which it did deliver, but this movie was so much more than that. Pride is based on a true story from 1984 England, when Margaret Thatcher is in power and the National Union of Mineworkers is striking. A group of gay and lesbian activists decide to raise money to support the families of the striking miners. The union, embarassed to receive their support, refuses them. Eventually the activists go directly to a mining village in Wales to make their donation in person. I won't spoil the whole plot, but these two communities form an unlikely partnership.

As much as this was a light laugh fest, the movie also illustrated some significant points about how we heal ourselves individually and collectively - or not. While the title of the movie was pride, a lot of the movie was also about its flipside. Pride's flipside - shame, was displaced and projected on to the gay and lesbian community and working class alike by the mainstream and the elite. Multiple delicate tipping points in the movie showed individuals and groups making a choice to collapse into seperation, disconnection, and shame, or to connect with each other in pride (or in the union's terms, solidarity.) 

A number of the activist characters illustrated the destructive potential of shame. In a moment of frustrated defeat the character Gethin breaks the rules of the group by going out collecting donations by himself, and becomes a victim of hate crime. To the degree that shame is accepted and internalised, it will often be re-expressed in risky or self damaging acts. Another character, the firebrand leader Mark, is powerful in his capacity to throw shame back where it belongs, in this case on to mainstream homophobic society. His later death from AIDS illustrates the fragility of aggressive defences against shame.

While much good therapeutic work gets done individually, or in groups, how much more might be possible if we could recouple personal and social liberation in the way shown in this film?