What I Can Help With
Emotional and Social Difficulties
We owe our survival to our emotions. They guide us in deciding what to do, what to pursue and what to avoid. Our emotions are the product of millions of years of evolution in a remarkably adaptable species. Yet the challenges we face today are very different from those we faced for much of our existence, and they are changing so quickly that the mechanisms we evolved with struggle to keep up.
People who seek help from a psychologist often do not meet the diagnostic criteria for a mental health disorder. Even so, they may experience real distress or find themselves acting in ways that do not help, because they are struggling to contain or process intense feelings.
You might seek help with emotional difficulties, problems in your relationship or in your interactions with family, friends or your community, difficulties in everyday life (for example, at work or in expressing yourself), or rigid patterns of behaviour that are hard to change even when they are no longer helpful.
Psychotherapy can be particularly helpful in these situations. It can help you reconnect with yourself and address the problem that brought you to therapy. It can also support personal growth and help you work through other difficulties in your life.
Cognitive behavioural therapy starts with a specific problem or symptom. From there, we develop a formulation that connects the problem to your broader patterns of thinking, feeling and behaving. This formulation provides the basis for an integrated therapy plan and guides the work you and your psychologist do together. We can draw on different techniques depending on your needs and the problem you are facing, while the formulation keeps the work focused and consistent.
Therapy may be brief when you are dealing with a temporary difficulty. It may take longer when similar difficulties recur in different situations and are linked to more enduring personality patterns.
Mood Disorders
Life is full of sadness as well as moments when our spirits lift. These emotions can tell us when to step back and recover, or reward us and encourage us to keep going. When sadness or elation is a response to something happening in our lives and is proportionate to the situation, it is part of being human. When these feelings become unusually intense, last too long or seem out of proportion to what is happening, they may be signs of a mood disorder.
Broadly speaking, mood disorders involve changes in mood that are unusually intense, persistent or out of proportion to the circumstances. Sadness or euphoria may follow a real event but be more intense or last longer than you would expect. Sometimes these feelings seem to come out of nowhere, with no clear link to what is happening around you.
The most familiar and widespread mood disorder is depression. It can take the form of a single depressive episode, recurring episodes or a persistent low mood, often less intense, known as dysthymia.
Bipolar disorder can involve episodes of depression alongside episodes of mania or hypomania. These episodes can vary in severity and duration.
Comorbidity, meaning that two or more conditions occur together, is common. For example, a depressive disorder may occur alongside an anxiety disorder and/or a substance use disorder.
Depending on the condition, psychotherapy may be used on its own or alongside medication. Medication can help manage symptoms during a difficult period and may also have a longer-term role. Psychotherapy can support recovery and help reduce the risk of relapse. For bipolar disorder, psychotherapy is generally used alongside medication.
Anxiety Disorders
Anxiety is a constant companion in life. It is part of a mechanism that helps us survive and develop. Unfortunately, the pace and intensity of change in our lives have outstripped the ability of these mechanisms to adapt through evolution. Modern life is full of challenges and sources of stress that pose little threat to our survival or our future, yet we often react as though they do. When these reactions happen too often or are unusually intense in relation to what is happening, they may be signs of an anxiety disorder.
Anxiety disorders are a broad and varied group. A general tendency towards anxiety can make people more susceptible, and stressful events or periods of life can play a role. The way these difficulties show up varies considerably.
A persistent sense of anxiety and excessive worry can take the form of generalised anxiety disorder. The anxiety is present much of the time, while the situations and thoughts that trigger it often change.
Acute episodes of panic, often accompanied by a fear of losing control, passing out or dying, may point to panic disorder.
When intense fear or anxiety centres on particular objects or situations, it may take the form of a phobia.
Obsessive-compulsive disorder (OCD) is common and can take up a great deal of time and emotional energy. It involves intrusive thoughts, known as obsessions, which often centre on the possibility of harm. These thoughts can trigger anxiety, which the person tries to manage through compulsions, such as ritualised actions or repeatedly going over things in their mind.
A severely traumatic event or a prolonged period of traumatic experiences can lead to post-traumatic stress disorder (PTSD). A response that made sense at the time of the trauma may persist long afterwards, even when the threat has passed.
These difficulties can occur together in different combinations.
Anxiety disorders can respond to psychotherapy, either on its own or in combination with medication.
Addiction and Substance Misuse
We humans, like other species, tend to seek changes in our state of consciousness, especially when they bring pleasant sensations. We also seek reward and relief. Psychoactive substances and certain behaviours can meet these natural needs, but turning to them can carry risks.
The term ‘addiction’ is most often used when someone’s use of psychoactive substances has got out of control, though it can also apply to behaviours. One way to understand how our relationship with a substance or behaviour can change is to look at three patterns: use, misuse and addiction.
Use may be occasional and under control, without causing distress or noticeable social or health problems. Even so, it can develop into misuse or addiction. Misuse involves excessive use that starts to cause problems in everyday life. The person still has some control, although it may be harder to exercise. With addiction, the substance or behaviour can come to dominate daily life, cause problems in several areas and become very difficult to control. In the case of substances, withdrawal symptoms may also occur.
Addiction can be severe and persistent. Many factors play a part. Two worth highlighting are how readily we can find reasons to use a substance or return to a behaviour, and the biological mechanisms that reinforce the urge to do so.
Addiction can also develop around behaviours. One particularly serious example, and unfortunately a common one in Bulgaria, is gambling addiction. Some of the processes that lead to and sustain gambling addiction are similar to those involved in substance addiction. There are also similarities in how we work with them in psychotherapy.
Psychotherapy is usually the only route to lasting remission or recovery from addiction. According to the body of research on the subject, the likelihood of relapse after medically assisted withdrawal without follow-up therapy is close to 100%. Despite how difficult addiction can be to overcome, a range of therapeutic approaches, together with active support and strong motivation on the part of the person struggling with addiction, can lead to recovery.