Friday, 8 June 2018

Couples Therapy: Addiction

Addiction is a worldwide epidemic. Sugars, nicotine, gambling, pornography; we humans appear to have something ingrained within our nature that makes us become compulsive, and once the habit becomes set it is incredibly difficult to move away from it. Add chemical addiction to a behavioural habit and you have a recipe for a life-threatening condition.  

The addicted individual must genuinely want to make a change. It’s a cliche we have all heard, but one very true and the first step toward making any kind of change. How one fosters that motivation is the million-dollar question. Encouragement, education, doctor’s warnings, bodily dysfunction, scientific facts, threats - each have varying levels of success. Many will just take time to process all the information until they find a point in their life where they just feel ready to change, or sometimes they sadly never will.

Hypnotherapy can’t work without motivation, and neither will prescribed medications.
With couple’s therapy in addiction it is much the same thing. There needs to be motivation to work, but if both people buy into the idea of being free from addiction then the added support that brings through companionship in the journey can be priceless. You want to be free from addiction for yourself and so your partner can be free and healthy too. Often doing something for someone else’s benefit has an even stronger motivating force.

In an ideal world couples will support one another and promote positive change, although sadly this is not always the case and is why professional help is often sought.  

Partners can negatively affect us. Imagine you are trying not to eat biscuits while your partner consumes them in front of you night and day, leaves packets around the house and talks about them non-stop. The routine of consuming sugars is triggered within you constantly by the numerous sensual and visual cues making it all the harder to escape from.

Jealous partners who can’t quit themselves try to make themselves feel better by dragging their other half down with them. At heart we like to share in our addictions, its part of the disease.
A non-addicted partner can also have a negative influence while trying to be positive. Maintaining standards that are too high or having an attitude that does not aid a progressive environment is common. Frustration in progress can manifest with comments like; ‘You will never quit!’ which can leads to self-fulfilling prophecy. Incredulous reactions; ‘I can’t believe your still drinking after what happened to your father!’ ‘You’ve just had a heart attack!’ We hear ‘No’ and our subconscious minds rebel.

That said being perfectly supportive often isn’t enough either – so what is the right approach truly?
The NCBI report that couples therapy statistically works better than individual therapy. This does not surprise me, but it is fascinating nonetheless. From personal experience I have seen favourable results from couple’s therapy in the smoking cessation clinic I run, but why does this happen?

We are social creatures after all, so when we do things together they become more powerful experiences. The reflective period post session becomes greater due to the interactive nature of being able to share upon what transgressed. Perhaps witnessed therapy becomes sessions we cannot escape the truth of.    

The NCBI report talks about addiction being not an individual problem but a family one, where our social interactions reinforce addictive behaviours. Thus by having Behavioural Couples Therapy the problem is being targeted at its root in hope to making the lasting changes we aim for.

For more on couple’s therapy, and finding a therapist:

Friday, 11 May 2018

Online vs Face to Face Therapy

Technology has expanded to such extent that many of us now communicate and interact more through modes of technology than we do via traditional means of person to person contact.

The Smartphone and the wide availability of the internet allows us the freedom to not only talk over a phone line but also to video chat, instant text message, email and even have group meetings and company trainings wherever we are and at any time. These platforms allow people from across the globe to connect in real time and high definition for such low costs it feels free of charge and in many ways without limitations.

Is it any surprise then that we are seeing a shift in health care toward online services?
In the UK there has been a huge push toward online mental health care services. The IAPT (Improving Access to Psychological Therapies) is one clear example of this, where therapeutic services are being offered both in person as well as online to increase the number of patients that can be treated especially for low intensity conditions such as mild depression/anxiety.

In my current role as stop smoking adviser I treat patients face to face as well as through using phone clinics, text message and email services. In this format I have seen first-hand the benefits online services bring.
Many patients are unable to make a physical clinic appointment due to disability/illness or working/childcare commitments but are able to attend a telephone/text consultation. The other side of the coin is this also works for therapists in the same way, who can work from home at their convenience and can therefore offer more flexible clinic times perhaps outside regular working hours. If you live somewhere remote, or are stationed abroad and don’t speak the local language well enough – how else would you receive therapy but through online services?

Clients have reported to me that they feel very comfortable in their own home sat in their own armchair without the stress of traveling to an appointment and the awkward waiting room experience. Those with social anxiety can also readily be affected by such factors and prefer the experience of online communications.
Many of my patients openly admit to being ‘secret smokers’, and don’t like the thought of being caught out by being seen attending a smoking cessation session and therefore find online interactions more private and less intrusive. The anonymity of an online therapy may also produce more open interactions as inhibitions can be reduced, thus leading to more accurate and successful outcomes.     

I have also come across various individuals who are far more able to express themselves using the written word, where they have time and space to consider questions and responses, something that is not always possible in conversation during a given weekly time slot. With a text/email service information can be read and re-read an infinite number of times, for the patient to reply at their convenience without pressure.
Online services also opens the patient to a world of options and choices, including more affordable or even free services they would not be able to receive through attending traditional therapy.

To summarise telephone/online therapy is convenient, comfortable, unobtrusive and flexible while offering choice. It is economic also if you factor in the lack of travel costs and the logistics of a therapist potentially seeing a higher quantity of patients.
But do we lose any ingredients from traditional face to face therapy? The University of Wolverhampton UK lists some of the disadvantages.

For crisis situations where a patient is in emergency need of guidance then a physical presence is ideal, especially if a patient represents a risk to themselves or others. Severe mental health problems that require hospital staff and treatment also cannot be easily aided online. If a patient is already isolated from face to face interactions a traditional therapist is also preferential.
Online security is another factor to consider, particularly bearing in mind how often we read about identity fraud and online grooming etc. If we walk into a hospital we can feel a trust and confidence toward the professional we are speaking to; but is that the same in an online scenario? I would always encourage checks to be made and reviews to be read of any therapeutic service online or face to face. Make sure the service you are signing up to is credible.

Some individuals prefer face to face therapy. They like non-verbal, visual communication. Many, especially amongst the elder generation, do not have smart phones or the confidence in the internet and feel more comfortable using traditional means of therapy. A certain level of technological competency (and literacy when using text) is required, unless you have someone with you who might assist on your behalf.
As good as technology is, we still get bad reception at times, lines that crackle or batteries that run flat; which obviously can be frustrating and can lead to misunderstandings or even increase levels of stress that would not happen face to face.

If I currently see a patient in my clinic whose first language is not English I can use language line or visual cues to aid communication which perhaps would not be so easy over the phone/online.
I work with therapists who are adamant that traditional face to face therapies work better through the development of therapeutic rapport. Although I see their point of view, I don’t believe face to face interactions are the only way to build rapport and is more a case of personal preference. After all, don’t people make friends all over the world through communicating solely through instant messaging?

If you are someone at ease with communicating through technology and are open minded enough to try something new then I see no reason why you cannot interact exactly as effectively online as face to face, and if there is any negative difference in quality this is more than offset by all the advantages listed in this article.
All things considered I feel that if used in the right way the advantages of online therapy certainly outweigh the disadvantages. Looking to the future I believe it is a trend we are going to see a lot more of, not only in healthcare but in education, the work place and society in general. I am optimistic this can have a positive effect on global mental health trends, as the flexibility and convenience of modern techniques can enable a higher volume of patients to be treated both efficiently and effectively, with therapist and patient brought together without limitations.

For more reading:

Thursday, 26 April 2018

How Nightmares Can Affect Addiction

How Nightmares Can Affect Addiction

We’ve all had nightmares before. Sometimes, the nightmare is nonsensical, such as being chased by a monster or falling forever. Other times, it’s more grounded in reality. We have a nightmare we lost a relative, or we have a nightmare about losing our jobs. For kids, nightmares are terrifying. For adults, most of us wake up, realize it was just a dream, and move on with our days.

However, if you have an addiction, nightmares can affect it greatly. First, let’s look at what causes nightmares in the first place.

The Causes of Nightmares

Nightmares can happen anytime, but there are circumstances that can make them more likely. If you’re stressed, you may have a nightmare. Grieving over a loved one can lead to nightmares. If you have a fever, this can cause some strange dreams. Eating before bed can increase your likelihood of having a nightmare as well.

Then there is withdrawal. If you’ve been addicted to something, and you try to get off it, nightmares can happen. This can happen regardless of the drug. Sleeping pills, cigarettes, alcohol, and hard drugs can all lead to nightmares.

Drug Dreams

Drug dreams, also known as narcotic nightmares, are when you have nightmares about relapsing, or anything else related to the drug itself. If you’re recovering from alcohol addiction, you may have a dream about drinking alcohol. Perhaps the dream will be positive, or be about you going into a drunken rage. Whatever the case, drug dreams can be dangerous.

Sure, it’s just a nightmare. You didn’t actually consume anything. However, a drug dream can make you want to have the experience again. This can lead to relapse, and you don’t want that.

Analyzing the Dreams

With that said, a drug dream can be an interesting look into your mind. Your dream may contain secrets that need to be looked at critically, such as triggers. In the dream, what caused you to want to take that sip or use that drug? Where was the setting? By looking at these circumstances, you can try to avoid possible triggers into relapse and keep yourself clean.

Write down your dreams and look at them later. Sometimes, the dream will fade fast, so as you wake up, write it down and look at it later. Also, if you’re stumped about the meaning of these dreams you can talk about your dreams to a therapist, who can figure out why it is you’re having these dreams, and what you can learn from them.

Since the dawn of humankind, we’ve tried analyzing our dreams to find meaning in them. Sometimes, there is no meaning. But for drug dreams, there usually is a secret your mind is trying to tell you.

Preventing Drug Dreams

They will go away on their own as the drugs leave your body. In the meantime, you can reduce your chances of drug dreams by:

  • Working out. Exercise can help calm the body and prevent you from having nightmares.
  • Try relieving any sources of stress you may have. Too much stress can lead to nightmares.
  • Relax before you rest. Dedicate an hour to unwinding. Take a hot bath, read a book, or do whatever it is that calms you down.
  • Don’t eat too close to bedtime. This can stimulate your mind and lead to nightmares.
Of course, there’s always a chance you may still have a nightmare even if you do all these things, but it can reduce your chances.

By conquering your nightmares, you’ll take one step closer to achieving sobriety. Don’t give into your nightmares.

By Marie Miguel

Marie Miguel Biography
Marie Miguel has been a writing and research expert for nearly a decade, covering a variety of health-related topics. Currently, she is contributing to the expansion and growth of a free online mental health resource with With an interest and dedication to addressing stigmas associated with mental health, she continues to specifically target subjects related to anxiety and depression.

Thursday, 8 March 2018

Five Issues Facing Higher Education in 2018

2018 brings difficult challenges to higher education. Most of these challenges are interrelated. As one issue arises, it impacts all the others.

Five Issues Facing Higher Education in 2018

Higher education in America retains an implicit trust and faith in our culture. It is the support of knowledge and learning. It is the gateway to good jobs and a prosperous life for many of us.

Universities and colleges have always dealt with challenges and issues particular to a time and place. The now-familiar student unrest movements of the 1960s were largely played out on university campuses. As we head into 2018, higher education will face a particular set of challenges and issues.

Each of these issues are highly specific, yet they all impact and interact with each other.

In this article, we're going to dive into five specific challenges universities are facing today.

Issue One: The Rising Cost

One of the primary issues facing higher education is the rising cost of education balanced against the benefit of a college degree.

As valuable as a college education is, the cost is often the first and most important factor people face in weighing the value of universities.

Forbes reports that the rising cost is amplified by a diminishing field of well-paying job opportunities. The result? Many recent graduates are underemployed and face massive student loan debt.

Though success in the workforce usually requires a college education, the ability to pay for college has become difficult for many.

During the recession years, the cost of education actually rose at a higher percentage than today, where it is just over 1.5%.

However, the net cost - the cost balanced against grant aid and tax benefits - are actually costing people more than during the 2008-2009 recession years.

One thing is certain: if the cost of higher education continues to outpace the ability of middle and working class families to pay, the problem will snowball into other areas of higher education.

Of course, colleges are very aware of this issue and doing everything in their power to provide creative financial solutions for strapped students. For example, many colleges are offering online classes so that students don’t have to pay for on-campus housing, a meal plan, etc. The goal is find ways to give students an outstanding, cost-effective education.

Issue Two: Declining Completion Rates

With increasing costs for college, it shouldn't come as a surprise that there's also a rise in the number of students who don't complete their degrees.

Less than fifty percent of students complete their degree within six years. Although many of these students transfer and complete their education at another university, a large number never finish. This includes both two-year and four-years institutions. As many as one in three students drop out entirely and never finish their degrees.

Even as there is an overall rise in enrollment, completion rates have not kept pace.

A college education is considered the primary mark of a well-educated workforce. The low completion rates is an indicator that the United States lags behind other countries with higher rates of completion.

There have been efforts at universities to address this problem and there is some evidence of success. As a report on the declines noted:

Indeed, one might easily conclude that without them the declines could have been even worse for particular types of students or institutions, given the demographic and economic forces at play.

As we continue to stay out of a recession, we should expect to see completion rates go back up, but sustained policy at the local, state and federal levels are required to fully address the challenge.

Issue Three: Growing Privatization of Public Colleges and Universities

State funding for colleges and universities has steadily decreased since the beginning of the 21st Century.

For example, the University of California state system dropped 37% from 1990 to 2004.

This trend is nation-wide and is expected to continue. As funding for higher learning institutions decrease, universities must seek funding from private sources. Some universities have even made some of their high-profit programs, like business schools and law schools, fund themselves through a combination of student tuition, businesses and other private sources.

This creates a pattern of privatization of the public college and university system. The source of funding is no longer the institutions of higher learning but private business interests.

These programs, and therefore a substantial part of the university system itself, are essentially privately owned at this point. The result? They're no longer subject to the same systems of regulation, admission and even academic requirements as rest of the public state system.

The growing privatization of the public higher education system is a growing concern for scholars and administrators. The main concern is that as private interests take over a public university, their business interests may not serve the public good.

Educators and administrators worry that the benefits we've come to expect from the public university system will be diminished as this move toward privatization continues.

Of course, as noted above, universities are working hard to make their programs more financially accessible to students, which in turn could raise admissions and lessen the funding worries that cause them to turn to private businesses.

Issue Four: New Methods and Curricula

In other matters, the changes in teaching methods and curricula brings challenges. By and large, teaching methods are moving away from the old-fashioned model of lectures aimed at passive audiences.

Students are now much more interested in interactive and self-guided approaches. With so much information online and available for free, universities and colleges are restructuring curricula to stay current and equip students to work with emerging technologies.

Universities also recognize that uniform methods of learning and evaluation are becoming outmoded. More student-centered forms of criteria are being used to evaluate learning and success. Things like individual response systems in the form of clickers are being used to allow students to participate directly and immediately.

Team teaching and peer-led teaching models are also emerging as alternatives to the old professor/student dynamic.

For tenured, long-established professors, new curricula and methodologies can be difficult to incorporate into their long established teaching practices. They can find themselves frustrated by having to use teaching methods they don’t like and not knowing how to most effectively implement the new curricula.

In fact, these challenges are becoming so widespread and important that universities are granting leave time for faculty to explore and develop new teaching methods.

Issue Five: The Role of the University, Free Speech and Campus Civility

As is apparent to anyone who watches the news, these issues aren't going away anytime soon. The university has historically been an oasis of freedom of speech and freedom of expression for students and faculty alike.

As centers of learning and research, the university has always been a place where new and potentially threatening ideas often emerge.

It's been the mission of higher education in the United States to ensure that these freedoms are treasured in institutions of higher learning.

However, recent events have challenged these ideals.

The current political climate and the potentially violent threats which have emerged not only on university campuses but also in cities across the country have put university administrators in a difficult place.

They must strike a balance between free speech and maintaining a secure and safe environment on university and college campuses.

Free speech has always been an essential part of college life, and we should expect to see universities working hard to create safe environments for the discussion of various opinions. Additionally, universities are often on the forefront of new ideas, making them easy targets for opponents of free speech. Look for universities to take increasingly strong stands on this issue.


The shape of global culture and economic balances have shifted as we made our way into the 21st century.

The strict divide between public and private has been blurred and new relationships between the private sector and public sector have unfolded in response to global changes.

These shifts and changes are reflected in some of the issues and challenges facing higher education as we enter 2018.

Additionally, the cultural and political climate of the country is being challenged at some fundamental levels, and with this comes disagreement and conflict.

These issues, disagreements and conflicts also present challenges to higher education for the coming year.

Of course, universities have always faced a variety of challenges and have always managed to find solutions. We should expect that to be the case with these challenges. Thankfully, we live in a country where learning matters. We can be confident that universities will be present to both educate us and enlarge our minds.

On top of this, it’s essential to remember that education is critical. Those who miss out on higher learning often find their opportunities limited. Even though many universities are confronting challenges, we shouldn’t expect to see a decline in higher education.


Because it’s an essential part of our country’s fabric, and without it, we’ll all be worse off.

By Jason Allaire on January 15, 2018