How to Recover Your Life After Separation or Divorce

hopeful woman

When a partner announces suddenly that they want to end the relationship, the heartbreak is not always immediate. Often it is preceded by shock and decisions around what to do next: how to deal with being alone, returning to dating and getting on with life as a single person.

For an English-speaking person who is separating from a Swedish partner or from another expat or non-Swede, becoming single in Sweden is life-changing and can be traumatic. Often there are children involved and almost always there are decisions about finding accommodation to be made (we all know how hard it is to find rental apartments in Stockholm!).

According to the Swedish government bureau Statistics Sweden, about half of Swedish marriages end in separation. Sweden has one of the highest rates of divorce in the world. Whether married or not, leaving a relationship can be one of the most stressful and devastating life experiences to endure. The emotional consequences can include feelings of hurt, loneliness, regret, powerlessness and anger. These are all commonplace. For some, separation is sudden and final, but many couples have months of instability before they decide to go their own ways. Whatever the circumstances, breakups can be tough and painful.

Dealing with a Breakup

Some people deal with a breakup by going straight out to look for another partner. Others withdraw from friends and family and keep to themselves. There is no standard formula for recovering from separation but whatever you decide to do, it is important to look after yourself both physically and emotionally during this stressful time. Sufficient sleep, adequate nutrition, exercise and a balance of work, rest and play can all make a difference to your recovery (I covered these in detail in my last post, ‘5 Ways to Deal with Stress’). Isolating yourself and withdrawing from other people is usually not so helpful. And throwing yourself into too much partying or use of alcohol may not be either. The first often leads to more depressed mood and the latter to debilitating hangovers or embarrassing regrets!

If you are coming out of a long-term relationship, a separation or a divorce, you might find yourself ‘adrift’, with a sense of feeling lost or not knowing which direction to take. This is quite normal when experiencing such a major life upheaval. Those who have been through similar experiences advise that you should be kind to yourself and give yourself time to work out what is important to you again. And if you are considering returning to dating, remember that it might take some time to get used to doing that as well, if you are ‘out of practice’.

Don’t be Afraid to Ask for Help

Talking about feelings and emotions is one of the best ways to manage stress and overcome heartbreak. Many of my clients fear their friends will tire of listening and have sought out counselling for an impartial perspective. Most counsellors are used to talking with people about separation and marriage breakdown. It can sometimes feel a little uncomfortable discussing your personal life with a stranger, but keep in mind that this is part of the counsellor’s job. I am paid to listen, help you explore your feelings and assist you with strategies and to find the best ways forward or adjust to a new life in Sweden. Whatever you decide, don’t be afraid to ask for help. I work with adults of all ages and nationalities, people who have been in LGBT or same sex relationships as well as those leaving heterosexual relationships.

If you’re struggling with separation or relationship issues and want to get your life back on track, you are welcome to contact me right now. You can come to see me on Södermalm in central Stockholm and we can have an initial chat over a cup of coffee or tea in my consulting room. I usually have appointments available within a couple of weeks. If you are outside Stockholm you can make a webcam therapy consultation. Webcam is convenient and private because you don’t need to travel. In any case, consider your options. People often tell me that they started to feel better as soon as they made their first appointment.

Contact Ash Rehn through email now

Swedish Culture Shock: 5 Practical Ways to Deal with Stress

man with stress

Providing counselling services for expats in Stockholm, I’m often helping my clients to manage and find ways to relieve stress. This stress might be related to cultural factors including the difficulty many report in making friends with Swedes or it could be to do with a close relationship or marriage. It can be associated with a combination of factors, for example work pressure, unfulfilled hopes or plans, perceived expectations or the adjustment to a new life in Sweden. The impact of stress isn’t always obvious.

People come to me wanting new ways to think or ‘mental tools’ for dealing with their circumstances. But regularly I meet people who so stressed-up, they can’t think so easily, in new ways or old. This article is about some very basic things you can do to manage stress. If that interests you, read on.

Stressing out? Ask for a consultation now!

5 Ways to Manage Stress

Here are 5 fundamental steps you can take to start getting back in control of the stress in your life. These tips are recommended by doctors, psychologists and major organisations like the British NHS (National Health Service).

1. Eat well.

When we don’t refuel our bodies regularly, our physiology can go into a stressed state and our more subtle cognitive (thinking) capabilities can be adversely affected. It’s much harder to problem solve when hungry, for example. On the flipside, using food to numb emotions can lead to overeating and unintentional weight gain. Aim for a balanced diet and regular nourishment.

2. Ensure you get enough sleep.

Sleep is regenerative and gives us a chance to let go of tension. It’s the body’s passive way of regularly relieving the effects of stress and becoming refreshed by allowing the brain to go into ‘quiet mode’ so we regain physiological balance. Of course sometimes stress can also interfere with sleep, in which case we don’t get the regular physical and mental refreshment we need. If your sleep is affected, develop a routine to support sleeping (google ‘Sleep Hygiene’). Sleeping tablets are not an ongoing answer, but if you are severely sleep deprived, you might need to discuss this with a GP. There are also gentle herbal treatments that some people find helpful.

3. Take regular exercise.

Exercise is a great way to shake out the effects of stress. When we exercise, we are directly working on our physiology and we can reverse the automatic stress response that happens to us when we are under pressure. For those of us from warmer countries, in the winter it can be difficult to find the motivation to exercise in Sweden and not everyone lives in central Stockholm or has access to indoor gyms and fitness centres. But even a short walk can make a difference and is better than nothing.

4. Put some structure in your day.

We all need to offset work with rest and play. Again, this can be difficult for expats without strong social connections. When we are trying to do the same thing for too long each day, the consequences are usually boredom, frustration and irritability or depressed mood. Everyone has chores they have to do (things like shopping, cooking, cleaning, washing etc), but without the balance of imaginative activities, our stress reactions can take over. Planning some exercise, social activities and time for creative interests around your work and non-negotiable commitments will help to make sure you stay on top of stress.

5. Talk about your problems.

It might sound like a cliche, but sharing problems and feelings really is a release valve for stress. It works differently for different people. Writing in a journal or diary can be one way of expressing thoughts and feelings but it doesn’t necessarily give the sense of a listener being present. Talking with friends can provide an outlet for emotions. However many English speakers tell me they find it difficult to make friends in Sweden and you might not have been here long enough to establish trusting friendships. Or perhaps you want to discuss something you feel you can’t share with a friend and need someone who you can be sure will remain impartial and maintain your confidentiality. That is where a counsellor comes in.

Some people tell me they just want to ‘dump’ what is happening for them, to ‘get it off their chest’ or make a confession about something they have been thinking about or doing. Others want a sounding-board (boll-plank in Swedish). Others want to have a good cry and to express how they feel. Some expats ask for help with decision-making or problem-solving. All of these are fine with me. The most important thing is: Don’t keep the problems to yourself!

Vulnerability to Stress and Building Resilience

Our vulnerability to stress and our coping skills for dealing with it can change with our circumstances. For example, people who have experienced trauma or child abuse when young sometimes have a heightened stress response to day to day events. But moving to a country like Sweden and adjustment to a new culture can involve a lot of stress as well. Building resilience to stress takes time. Don’t leave it too late to get help. If you are struggling with stress, make an appointment to discuss ways forward. If you are not sure, but think that managing stress might be a problem for you, contact me to find out how we might work together.

Email for an appointment time

10 Questions to Ask Your Prospective Counsellor or Therapist Who Works In English

Questions for Therapists

Have you reached a turning point in your life and want to find therapy in English?

Do you need counselling for relationship issues, stress or a break-up?

Or would you like to find an English speaking coach to improve life generally?

Here are ten important questions to ask your prospective counsellor or therapist. I’ve provided my own answers to give you a sense of where I fit according to these criteria:

1. How long was your therapy training?

My therapy training commenced when I started training as a counsellor in 1989 and it has not stopped since! Over the last 20+ years I have undertaken Bachelors and Masters degrees in Social Work, specialist narrative psychotherapy training through the Dulwich Centre in Adelaide, Australia and completed many short courses and workshops in a range of therapeutic approaches. These include CBT (cognitive behaviour therapy), mindfulness, psycho-education (including motivational interviewing), stress management, relaxation strategies, problem solving, anger management, therapy for adult survivors of child abuse and couples counselling.

A good therapist does not stop his or her education simply when a qualification is achieved. Professional development must be ongoing. Each year I attend a number of training activities and conferences and regularly share the outcomes of these with my clients.

2. Under which title, coach, counsellor or psychotherapist would you be allowed to work in your own country?

In both Australia and England, I am allowed to use all 3 of these titles: coach, counsellor and psychotherapist. In Sweden the title ‘psychotherapist’ (or psykoterapeut in Swedish) is a protected title and only practitioners licensed by the Swedish National Health and Welfare Authority – Socialstyrelsen – can use that title. I have not applied to be licensed as a psychotherapist in Sweden and instead refer to myself as a samtalsterapeut (counsellor) or narrative therapist in my work. Psychotherapist training in Sweden is limited to certain methods or approaches and applicants for a Swedish license must demonstrate compliance with particularly Swedish requirements. I have found that most of the people who meet with me are far more interested in the benefits of a therapist who speaks their language and understands their culture than they are in meeting with someone who fits precise Swedish requirements or works through the Swedish healthcare system.

3. How often do you have supervision?

I generally attend supervision at least twice a month and my commitment to supervision meets the recommendations of the AASW and BACP. Supervision for counsellors and therapists is not the same as supervision in a management situation. It means something completely different. It is about discussing professional issues in a structured way and ensuring the counsellor or therapist is taking care of their own well-being. It helps counsellors, psychotherapists, psychologists and social workers ensure their integrity and ethical practice. Counsellors and therapists in private practice will generally be paying for private supervision from a more or equally experienced person. I have such an arrangement with a more experienced practitioner and also engage in regular peer supervision with colleagues.

4. How long have you been practising?

I began practicing as a counsellor in 1989 and have worked across the community, government and private sectors over the years. Since 2005 I have been specialising in mental health counselling and therapy. I commenced private practice as a therapist and mental health counsellor in 2008.

5. What is your theoretical approach?

My practice is informed by a range of theoretical approaches. When undertaking advanced therapeutic work with people, it tends not to be helpful to be limited to a singular technique or method. In Sweden, counselling and therapy is dominated by Cognitive Behaviour Therapy (CBT or KBT) and Psychoanalysis but there are many other ways of working together if these do not appeal to you. I am particularly drawn to dialogical and narrative practices and the work of a number of well-known therapists including Harlene Anderson, Johnella Bird, Art Fisher, David Epston, Michael White. If you would like more information about these approaches, I would be happy to send you some links if you email me for details.

6. Do you offer a 50 or a 60 minute hour?

My standard appointments are 60 minutes but longer appointments (75 minutes or longer) can easily be negotiated. I generally leave at least 15 minutes between appointments and, if I have more time available, I usually don’t mind if we continue a little longer if it is helpful to you.

7. What do the initials behind your name actually mean?

Currently the initials after my name are: BSocWk, MA, MAASW (acc.). They stand for Bachelor of Social Work, Master of Arts and Member of the Australian Association of Social Workers (accredited).

8. Are you an accredited member of a professional organisation?

Yes, as above, I am an accreditated member of the AASW in Australia. This accreditation means I have a qualification awarded by a professional association as a specialist mental health provider and can offer focussed psychological services under the Australian government Medicare program when I am meeting with clients in Australia (similar to the services provided by psychologists that are reimbursed by the government there). The AASW supports my practice in Europe and represents my professional interests, however unfortunately Medicare will not reimburse appointment fees unless we meet in Australia.

9. Do you have insurance?

Yes, I hold both professional indemnity and public liability insurance.

10. Are you registered for tax in Sweden?

Yes, I am fully registered with Skatteverket, the Swedish tax authority and required to invoice moms (consumption tax) on my services in Sweden. If you require your invoice made out to a particular company name, please advise me in advance.

Extra question: How old are you?

Some people want to know how old I am and I am quite open about my age. I was born in 1969 so at the time of writing this, I am 43 years old.

You can read more on the About Ash Rehn page. If you are interested in making an appointment, please contact me by email or phone. I’m happy to answer any further questions you might have.

Life Coaching in English to Turn Your (Swedish) Life Around

motivation and life coaching in Sweden 2013

Not adjusting to life in Sweden? Worried about your mental health? Can’t concentrate and think you have ADD or ADHD? Struggling with the winter? Don’t let the darkness, Snökaos (snow chaos) or winter blues drive you to depression. Whether you choose to do it in-person or by webcam, you might just need a few sessions of life coaching to get back on track.

Here’s how therapy and life coaching with an English speaking coach and counsellor might make a difference to life in Sweden.

Bollplank, Sounding Board or Reflective Surface

Talking with your partner sometimes is not enough. Sometimes we are just too close to someone to offer a different perspective and it can seem like a lot of pressure if a sambo, husband or wife is the only one to talk with. The Swedes have an expression ‘bollplank’ which in English is akin to ‘sounding board’, someone or something we can throw our thoughts against to test them out. (Literally it is a plank of wood for kicking footballs against). In my work I call it the Reflective Surface.

There are many ways to employ a reflective surface: some people keep a journal or diary, video blog, artwork, cooking, craft… In fact any activity that combines structure and imagination with a product can provide a means to reflect your identity and ideas back to you in a positive, affirming way that supports change. A conversation can also be a reflective surface. In my office I use a whiteboard which is a literal reflective surface and sometimes I use it to hold onto the expressions or words that come up in a session. But even without the whiteboard, meeting with a coach serves the same ends because you hear yourself saying things and the coach can hold onto your words and ask you about them. A life coach can help with:

  • Sharing what has been happening
  • Working out what is important
  • Making goals
  • Following through with intentions
  • Acknowledging and celebrating progress.

If everything seems to be going well for your partner but not for you, don’t take it out on your sambo. Make it you New Years Resolution to get your own ‘bollplank’ and let the relationship be what it should be.

Seasonal affective disorder (SAD)

A lot of people approach me thinking they have ADHD because they can’t concentrate at home or work, or both. And there is a lot of discussion at the moment about ADHD, particularly in Sweden where there is a huge expectation that people are on time, focussed and ‘get with the program’. The norms of behaviour in Sweden are very influential. If you have seen preschoolers being marched around the city in pairs, you will get what I mean. This is a society where, to a large extent, cooperation and compliance are unspoken rules. I mention this because it is important to understand that cultural influence and social expectations can play a part in how we feel and how quickly we adjust.

But difficulty concentrating can also be a symptom of depression. When we feel low, unmotivated, frustrated or insignificant, it can be harder to stay on task. In a way this is our instinct or animal side at work, trying to get our bodies moving again. Movement and exercise to treat Depression has been recommended.

Here are some other signs and symptoms that you might not be alright:

  • You are spending all day inside and not going out at all
  • Mood swings or constant irritability
  • Feeling like a zombie or not feeling anything at all
  • Eating constantly and more than you need to (or a loss of appetite)
  • Drinking alcohol everyday or most days on your own
  • Not engaging with friends
  • Ruminating thoughts, ‘overthinking’ and dwelling on failure
  • Less attention to self care or neglecting basic hygiene (not showering, brushing teeth or changing clothes)

The good news is that you don’t necessarily need a psychologist or to go on medication simply because some of these are present. The benefit of working with me is you can tell your friends / family / sambo that you are seeing a coach for adjusting to life in Sweden. You can even meet me online, over webcam or for instant message counselling if you don’t want to take on the snökaos or you are living in Uppsala, Västerås, Nyköping or otherwise on the outskirts of Stockholm. Likewise if you are in Malmö, Gothenburg or Umeå or somewhere more remote, online coaching means you save the travelling time and can get help from the warmth and comfort of your own home.

Of course, if you are at any serious risk or your health is deteriorating quickly, you should not hesitate to consult a GP.

From Therapy for Depression or Adjustment to Coaching for Life Goals

When life seems to be stuck or falling apart, it can help to talk it over, make a plan and have someone to engage with and help you to monitor progress. A lot of people start to meet with me for therapy around a particular issue and end up feeling better to the point that our sessions become more about coaching and moving forward. Recently I have been speaking with people about:

If you have found me through ForwardTherapy.se price and cost of coaching might not be your main concern. You are probably more interested in finding a professional who understands what you are going through and offers the advantage of sessions in English. But just send me an email (preferred) or call and leave a message for a callback if you would like more information about my fees and payment options.

Engelsktalande Samtalsterapeut (English Speaking Counsellor): A Word For Spouses and Sambos

If you think your partner, wife or husband might benefit from coaching, kognitiv beteende terapi / cognitive behaviour therapy with an english speaking coach (kbt på engelska) or just a bollplank with someone other than yourself, feel free to send me an enquiry. I am used to working with people in relationships where one partner is struggling with culture or climate or relocation adjustment and there is some conflict in the relationship as a result. There is more information here på svenska.

Next year I will be relocating my office from Kungsholmen to Södermalm in Stockholm. But you can make a start now and put yourself on a better track for 2013. Start making your New Years Resolutions.

Write to me and I will send you full details of availability, fees and answer any questions you have. Please let me know if you prefer in-person (face to face in Stockholm) or online consultations.

Therapy for a Broken Heart, Separation or Relationship Breakdown

woman looking over mountains

How do you overcome a relationship breakup?

Dealing with heartache. Coping with rejection. Recovering after splitting up. These are subjects about which I am regularly consulted as an English speaking therapist in Stockholm. And I wish there was a simple solution that worked for everyone. The good news is that most people find it helps to talk over matters of the heart. It’s even better when the person you are talking to really listens and asks some questions or offers some perspectives you hadn’t thought about before.

Whether you have left a long term relationship or are struggling after a series of short romances that went bad, sharing the hurt and making sense of it can be part of getting your life back together.

More information about separation counselling in Stockholm or online

The Shock and Pain of Separation

How long does it take to heal from a separation?

There are no rules about the time it takes to recover from splitting up. In these situations it can help to throw out expectations about what is normal. Maybe you are dealing with loneliness or emotional pain and looking for coping strategies. And it can help to have some of these if you want to keep working, you have children to care for or you are just trying to hold your life together! But my experience is that coping techniques work best when they are adapted for each person. If they were the same for everyone, it would be easier to read a self-help book than see a relationship therapist.

“Ja visst gör det ont när knoppar brister”  Karin Boye, Swedish poet

A Coffee and a Chat, A Walking Companion or Making a Game Plan

Private counselling is an opportunity to speak in confidentiality about things that you might not be ready to tell anyone else.

The same approach to counselling or therapy doesn’t work for everyone. All kinds of people come to see me to discuss their relationship breakdowns – engineers, creatives, lawyers, psychologists, business people, researchers, teachers, athletes – and they are at all different places in terms of separating from their partners. Some people want advice about dating, some ask for CBT (cognitive behaviour therapy). Some are fine to talk (and sometimes cry) over a cup of tea or coffee. Others want to make a game plan about their recovery and I have a whiteboard in my room we can use for that purpose (you can even take a photo of it at the end of the session). And if you don’t feel like sitting still, you don’t have to; we can take a walk together and talk in the fresh air. I also work over webcam, so we can meet in Stockholm or online from wherever you are in Sweden or elsewhere in the world. My approach to talk therapy is flexible and responsive to the circumstances you bring to the consultation and your personal preference for the appointment.

Don’t let doubt or indecision stop you considering your options or getting your life back. Contact me now for more information about my fees and services.

Dealing with fears, feelings and emotions can be a collaborative process. Regardless of whether you have just separated from your sambo, are going through a divorce with your husband or wife, just adjusting to being on your own or ready to start dating again, conversations are therapeutic. Narrative Therapy offers an approach to talking about relationships that is quite unlike other therapy. People tell me that their friends always have advice but it is another thing altogether to confide in a therapist or work together to start feeling better.

If you are unsure, you are welcome to write to me using this email form, and ask me any questions. You can also call and leave a message on 08-559 22 636 if you would prefer to speak in person (let me know the best times to return your call). I look forward to hearing from you.

Counselling for LGBT People in Stockholm: 5 Reasons to Choose a Gay Therapist

Rainbow Illustration

Rainbow IllustrationWhen expats move to their new country, it can be an opportunity to make a new start. Sweden, with its relatively inclusive attitudes to lesbians and gay men, would seem like a natural choice for gay expats hoping to live their identity more openly. But coming out is often more of an ongoing process than a point in time.

 

LGBT expats in Sweden experience the same difficulties as other immigrants with adjusting to Swedish culture, climate and maintaining relationships. But some aspects of the transition to Nordic life are often unexpected. It’s been suggested that the ‘Law of Jante‘ has Swedes downplaying differences in favour of viewing everyone as equals. And living in a city such as Stockholm where being gay or lesbian is generally not regarded as anything unusual might also mean that it is less likely previous difficult experiences will be acknowledged. One way of getting recognition of what you have endured is to speak to a counselling therapist who is understanding and supportive of gay identity.

Coming Out

Coming out as gay, lesbian, bisexual or transgender is often discussed as if it were an event. But it is more likely to be a series of events or an ongoing process that continues through life. Some would say we never stop coming out. Even in Sweden, we have a society where the heterosexuality is still the considered the norm and the assumption that a person is straight often goes unquestioned. This assumption is part of what has been called ‘Heteronormativity’, a way of thinking that also suggests people fall into distinct genders (man and woman) associated with specific gender roles. The reality of life is, of course, quite different. Humans are as diverse as other species so biologically, sexually, gender-wise and in terms of identity, there can be much individual variation.

Making the decision to share your identity with others is a personal choice and needs to be treated as such. At the same time, the relief that comes with inviting others into your life can reduce anxiety and free up creativity. Talking about who you are and having an audience for your experiences is personally validating. Being able to be yourself around others is one of the rewarding aspects of living in Sweden that might be less possible in certain other places in the world.

Coming Out Later in Life / Gay and Married

For people who are older, coming out can be particularly challenging. I have spoken with many men who have decided, after years of marriage to a woman or having raised children in a traditional family, to explore other aspects of their sexuality and identity. Starting to identify as gay, bisexual or trans in your 40s, 50s or later can seem like entering a new world and an unknown world at that. If you are in this situation, it can be important to remember that you already know a lot about life even if the ‘world’ you are entering seems to have its own set of rules or conventions. Coming out after a straight relationship or later in life is a journey in itself. It can be helpful to have a gay counsellor to assist you to navigate the way forward.

Gay Relationship issues

Many of the individuals who consult with me at my practice at Hornstull or online are going through couples counselling, recently ended a relationship or are dealing with the aftermath of a break-up. It’s quite usual to have a difficult time when a relationship ends, and upset feelings can continue, especially when the end was unexpected or if you had been with your partner for a long time. If you are gay, lesbian or transgender, it can be therapeutic to talk about the feelings and to find a way forward with the help of a professional.

For gay people, finding a partner in a ‘heteronormative’ world is not always easy. Gay Internet dating has become one of the most common ways to look for and find love but some argue that it has turned people into commodities that are marketed. Not everyone finds it easy to ‘sell’ themselves to others over the net. In Stockholm there are a few gay venues, social groups and sports organisations. And many people meet their partners through work or friendship networks. Taking the first step or returning to dating after a break might involve some effort and motivation, not to mention support.

Family Relationships

Lesbian and gay expats in Stockholm and elsewhere in Sweden, even those who have settled into life here, sometimes have unresolved family issues that may or may not be related to their sexuality. In terms of sexuality, it can help to know as much as possible about being gay and gay life in case the time comes when questions are asked. Family members can take time to adjust to a new understanding about their loved ones and people tend to learn acceptance at their own pace anyway. For those who are struggling with particular relatives, geographic distance can be both a blessing as well as a barrier to resolution. Having the ‘sounding board’ of a gay therapist might make a difference when exploring options.

Dealing with Workplace Homophobia

I’ve just attended the Nordic LGBT Business Leadership Forum, an event organised in Stockholm by IBM to promote discussion about how organisations can maximise the power of diversity in the workplace and translate it to success in the market. Companies based in Sweden are generally much more inclusive of transgender, lesbian and gay employees than in other countries but that doesn’t mean homophobia and transphobia in the workplace does not exist here. Workplace equality and inclusion also means being able to talk freely about what you did on your weekends (if you choose to). Dealing with workplace harassment or simply feeling at ease with your colleagues can be dependent on a number of factors and it is important not to blame yourself if you feel uncomfortable. If your job is stressing you out, make an appointment to talk about it and get it off your chest so that you can work out what to do.

Finally, it is common for people to wait to come to see me until the point comes that they feel really bad about things. My advice is to act now instead of waiting. Often when you start discussing problems with a therapist, difficulties do start resolving themselves.

Counselling in English in Stockholm has advantages and gay, lesbian, bisexual and transgender people are always welcome at Forward Therapy Stockholm. Just contact me by email or leave a clear message on 08-559 22 636 if you are interested in meeting at my office, walking talk-therapy or online counselling.

Anxiety and Regular Therapy in Stockholm: Temporary and Ongoing Solutions

Image of a man with stress associated with cultural adjustment

Person with Anxiety at work in StockholmInternational relocation to Sweden is a major life change for most people, particularly if it is the first time they have moved somewhere English is not the first language. But for a person with persistent anxiety, the stress of finding accommodation, dealing with visa issues, trying to make friends and maintain relationships can make pre-existing worries feel much worse.

How can regular counselling appointments help Anxiety?

The advantage of building a relationship with a professional therapist or counsellor is that when things go ‘pear-shaped’, you have someone who knows you and can work in ways that suit your background and personality. Uncertainty coupled with the frustration of being in an unfamiliar place can lead to mood swings, irritation and sometimes a sense of despair or hopelessness. It can be reassuring to know there is someone in Stockholm or online who is willing to listen and help you through the transition of settling into life in Sweden or assist to deal with anxiety over the long-term, if that is what you want.

Sometimes I am asked the question: Which is better, brief counselling or ongoing therapy? The straight answer to this is that they can both be helpful in their own ways. It really depends on what you are looking for. ‘Counselling’ is often the term to describe a series of appointments with a particular goal in mind like getting strategies to make it easier to talk to people at parties or ways to manage mood swings after a relationship break up. Sometimes particular methods like CBT (cognitive behaviour therapy) or breathing techniques can be employed to meet specific objectives. Counselling appointments can also be a means to access health education or relaxation techniques. A series of counselling appointments might last 6-12 sessions over 2-3 months.

The word ‘therapy’ is usually used when people describe a process that takes place over a longer period, for example, from several months to a year. Therapy for anxiety can involve talking about previous life experiences and retelling these in ways that reflect new understanding or reveal skills and abilities that may not have been previously acknowledged. Or it can mean developing new approaches to fears or worries, putting these into practice, refining and modifying them over time while checking in with a therapist who helps monitor progress or maintain a sense of achievement. Of course some people choose to continue with their therapist even beyond a year. In this way, a therapeutic relationship can be akin to meeting regularly with a personal trainer, nutritionist or accountant. Ongoing therapy appointments aren’t just about solving problems. They can also be a way of maintaining your overall well being.

These are generalisations of course. You can attend therapeutic appointments with me in Stockholm or have coaching and counselling over Skype webcam for as few or as many sessions as works for you. Both approaches are more than just listening, and ideally are more than just being given skills or techniques by the therapist. Counselling and therapy work best when they are a collaborative process where both you and I work together.

What happens in Anxiety Therapy?

The answer to this question really depends on you, your preferences, experiences, hopes and expectations for the appointments.

I don’t work from a manual because people are not machines. While some of us have common experiences, we also have unique histories that require unique outcomes from therapy consultations. You might be someone who responds well to cognitive strategies and being offered new ways to think about distress and uncertainty. Or you might be looking for tools to modify your behaviour in  situations when nervousness takes over. Perhaps you just need a sounding board, to have someone hear what you are going through and ask questions so you can explain and understand your worries. Or maybe you just want to talk and get something off your chest?

I work with anxiety and depression every day. I’m used to meeting with people who feel nervous and don’t know what to expect from the appointment. When you come to see me I will do my best help you to feel comfortable and talk freely. You can talk to me in English and take a break whenever you need. What you say to me is confidential and I am bound by ethics and membership of my professional association to maintain your confidentiality. The only exceptions to this are where there is a high risk to a person’s life, when a child is in danger or if the law orders me to report something in particular. But even in these circumstances I will always try to discuss my concerns with you first.

There isn’t a set time frame for anxiety treatment. Adjustment to living in Sweden and culture-shock tend to require shorter term approaches than fears, hang-ups and suspicions that have been carried around for years. My intention is to provide you with a space where you can put down some of your psychological ‘baggage’, go through it with me, and decide what is useful and what isn’t. Together we can try to make sense of whatever is confusing you or holding you back so you can go forward. Hence ‘Forward Therapy’.

Trust develops as we get to know each other. If you have had difficult or unhappy memories of therapy appointments in the past, I welcome you to share these with me to help me provide you with effective consultations.

A Word about Drinking Alcohol and Stress

It is very common for expats to seek help for problems with drinking too much. Alcohol can enable people to relax and unwind, particularly when they are finding their job (or unemployment) stressful, if they feel they are not meeting the expectations of their partner or having other relationship issues. Unfortunately, drinking can also lead to the other extreme, a total absence of control, anger and more regrets. But even when people are struggling with drinking they don’t always want to stop completely. I will work with what you want to achieve in terms of your alcohol use and what you are aiming for, whether it is just a reduction in how much you drink, changing when or under what circumstances you drink or ceasing drinking completely.

We can meet in-person at my office in Stockholm, for Walking Talk-Therapy on Kungsholmen or over Skype webcam. If you would like to make an appointment, please contact me by email or leave a message on 08-559 22 636 for me to call you back.

Walking Talk Therapy for Mental Health in English in Stockholm

A Park to Walk in Stockholm

A Park to Walk in StockholmThe advantages of counselling and therapy shouldn’t just be psychological. Walking while talking is a new approach to talk therapy that benefits the body as well as the mind.

As a therapist who personally enjoys exercise and the positive effects of movement, I was not surprised when I read in the Sydney Morning Herald about research that demonstrated sitting was bad for our health.

I’ve written before about how exercise is important to both our physical and psychological health. Sitting for prolonged periods can reduce lifespan so decreasing our sitting time is just as critical to health as taking exercise. But modern lifestyles have many of us spending long work hours in front of our computers. It can be difficult to remember to take regular breaks let alone to keep moving our bodies.

So I am now also offering counselling, coaching and therapy in English in Stockholm while walking outdoors. This is a unique service for Stockholm that fits with making it easier and more beneficial for people to meet with a counsellor.

The Benefits of Walking Therapy

Taking a walk each day can lift mood, free thinking and help us manage emotions. For some people, it can be a reasonable alternative to medication. But there are other advantages to therapy while walking outside as well. We know sunlight is important for production of vitamin D and general health. Talking with a counsellor while taking a walk treats your whole person, body, mind and spirit. The practice of walking itself can quieten thoughts and relieve anxiety. It’s refreshing, relaxing and the rhythm of a walk can also help to sort out problems.

Like other forms of counselling, Walking Talk Therapy is an opportunity to discuss strategies, get things in perspective, or simply get a sounding board for the changes you know you want to make. Being out in nature is conducive to healing and improved mental health. Expats can speak English during the appointment and benefit both from the change of scene and a compassionate listening ear. People who have experienced disappointment, loss or even trauma may find that time spent in nature is therapeutic in itself. Those seeking to improve their physical health and motivation can find active consultations even better than sessions that are office based. So counselling appointments while you walk offer a combined form of treatment.

With my Walking Talk Therapy in Stockholm, you are welcome to request help with the same kinds of goals or concerns you bring to office based appointments. Many people who come to see me talk about depression or anxiety, family and relationship issues. But the areas I specialise in include:

How Does Walking Talk Therapy Work?

Usually we start the first appointment in my counselling rooms on Kungsholmen in central Stockholm. If you decide to proceed with a walking appointment, we can go to Rålambshovsparken or along Norr Mälarstrand by Riddarfjärden. These parts of the island are quite beautiful throughout the year and provide plenty of open space for private conversations while walking. We can hold onto important points by jotting them down or taking an audio note as we go. Walking Talk Therapy is suitable for therapeutic approaches such as CBT (cognitive behaviour therapy) and narrative therapy.

If the weather is bad we can still meet in the office. The Swedish have a saying “there is no bad weather, only bad clothing” but it is always your choice whether we go out for a walk or sit inside and chat over a cup of tea or coffee.

So why not combine therapy and some exercise? It’s healthy, refreshing and better for both of us! For daytime appointments until 5pm you are welcome to choose a 50 or 75 minute consultation depending on how much time you have available.

My goal is to make it easier for people to see me so, of course, if you prefer to sit comfortably and talk we can still do that. I still offer a range of options including online counselling over webcam from Stockholm or anywhere in Sweden.

Call now on 08-559 22 636 and leave a message if I don’t answer.

Or contact me through the form on my website for more details.

I look forward to us walking together!

Couples Counselling and Marriage Therapy in Stockholm

couple walking together

couple walking togetherLooking to Find a Relationship Therapist Who Speaks English?

As an English speaking therapist in Stockholm I meet regularly with couples who are struggling with aspects of their relationship.

For expats, the stress of relocation and dealing with cultural and climatic differences does put pressure on relationships. Many who consult me have decided to live in Sweden because they have a Swedish partner. Others have arrived in the country with their girlfriend or boyfriend (or husband or wife) to take up a position in multinational company. And some people have arrived in Sweden on their own and met a special Swede (or someone else) in the meantime.

Each of these circumstances brings its own challenges. Within relationships it is not uncommon for everyday pressures to compound and start affecting the way partners relate to each other. Language barriers are obviously a factor here and non-Swedes can be, by necessity, at least for the first year or two, quite dependant on those close to them to get through the bureaucracy and procedures associated with employment, banking, tax affairs and residency requirements (just to name a few!). There is also the question of how to start establishing social connections. As expats, we are not only getting to grips with Swedish culture and language but developing a new identity and sense of ourselves as individuals and as partners.

What might get lost in all of this is the passion or tenderness of the relationship, sex or intimacy, the meaning of a marriage or the easiness of being with each other. Even living with each other as a ‘sambo’ can seem to get harder. The aspects of the partnership that were working previously might seem to have disappeared and even the memories of a shared past might seem very distant.

How Can Couples Therapy Help a Relationship?

There are a number of ways in which meeting with a relationship therapist can be helpful.

Firstly, counselling and therapy appointments provide a space for couples to step outside of the usual positions they take with each other. At my counselling room I try to make these meetings as relaxed as possible and if you could see us talking it might look like we were just having a conversation. But actually, couples therapy and marriage counselling conversations are like building a new platform from which to consider the relationship. A separate place away from the chaos, crises and mess of what has been going on. These therapeutic conversations can be like coming up out of a canyon or ravine and taking a new position at a scenic look-out. I invite people to discuss where they would like to be with the relationship, what they want to let go of and what they want to hold onto in making these shifts. And we also discuss practical ways you might get to this better ‘place’ for real.

Occasionally I am asked about what method or technique I use with couples. The truth is there isn’t one approach that works for everyone. If there was it would be in a single book that we could all read. But perhaps there are a lot of different formulas or approaches others have used and, once I get to know more about your shared situation, I am happy to talk about some of the ideas that couples have shared with me that have been helpful to them. I draw not only from my training, reading and years of experience working with relationships but also from the experiences and journeys that other couples have shared with me.

Resolving a relationship difficulty or crisis in a marriage or other partnership starts with a simple commitment to sit down together in the presence of a third person, the therapist. This in itself is significant because it is an acknowledgement that both individuals are interested in changing the situation. Therapists are witnesses to many of the forces that keep people together: companionship, respect, admiration, shared hopes and passions, sex, intimacy, trust, a sense of parental duty and love of course. When we start talking about what has happened and each person’s hopes or expectations of the appointments, there are a number of things I have noticed start happening. These include acknowledgement, recognition, remembering, recovering, renegotiation, constructing strategies together, making new efforts and regaining balance. Counselling consultations can contain defining moments for couples and the process of therapy can be a rite of passage in itself.

Therapy Together and Separately for Greater Understanding

Occasionally I am asked to act as a kind of umpire or judge as to what is ‘okay’ or ‘not okay’ in the relationship. This isn’t a role I am prepared to play because it denies the couple their own decision making skills (I often say that if I had wanted to be a judge of others, I would have studied law instead of counselling and psychotherapy!). However I am prepared to help explore individual standpoints in relation to what has been going on and create opportunities where each person can be heard with respect. I generally find this approach leads to greater understanding for everyone.

In the journey of settling into a new country and all the challenges presented by such a move, we often find ourselves facing personal tests that play into or disrupt our relationships, partnerships and marriages. For example, we might be reconnected with a vulnerability we have not experienced for years. Or revisited by a fear we thought we had already overcome. Most people can name at least one or two such ‘issues’ they have had to deal with at some stage in life. At this point I should say that I often find when the individuals in a couple start sorting out their own ‘stuff’ or ‘issues’ (so as to speak), the difficulties or ‘relationship problem’ tend to just disappear. This might be surprising given popular ideas that relationship counselling always needs to involve the couple seeing a therapist together. I’m not suggesting that the disappearance of the problem or difficulty happens in all situations where each partner attends individual sessions but it is definitely common. So if you are reading this blog post and both willing to try it, going separately to counselling or therapy might also be an option for you.

When I work with individuals and couples, one of the ways in which I work is to help people establish their own connections so they have support outside of the relationship. This can take some of the pressure off the relationship as well as assist to develop or reinforce each person’s own skills, abilities and knowledge.

Relationships change and evolve just like individuals. Changes happen when people move in together, when they are expecting a child or become parents, when someone starts a new job or a business, as we age and simply over the course of time. Meeting with a therapist is a chance to let go of what might have been holding the relationship back as well as to hold onto and acknowledge what is still important to you both.

I work with both straight and gay couples. Couples counselling is available face to face at Hornstull on Södermalm in Stockholm or over the net via Skype webcam. If you would like to give either a try and need more information about my fees and availability, please contact me here or call 08-559 22 636 and leave a message.

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Can Depression that Started in Sweden be Treated with Exercise?

man running

man runningImprovement to mood is one of the most obvious effects of exercise. But can exercise actually be used as a treatment for depression?

An article recently featured in the Stockholm daily newspaper Dagens Nyheter says it can.  Jill Taube, a Swedish psychiatrist, has written a book about how exercise can help to cure mental illness. She points to studies that show the effects of exercise not only last longer than those of antidepressant medication, but physical activity appears to prevent the recurrence of depression better than antidepressants.

Exercise: A Prescription for Depression

Taube’s exercise ‘prescription’ echoes what the health and fitness experts have been saying for at least 20 years: a combination of cardio and strength activities for 30-45 minutes, at least 3 times a week. Obviously those who have not been exercising need to take it easy to begin with and build up to this. But the idea that there is something people can do themselves about depressed mood is great news for those who want to recover from depression and need more hope in their lives (although it might depress the drug companies!).

Antidepressent Use in Sweden, an Increasing Trend

What makes this research so remarkable is that Sweden has one of the highest rates of antidepressant prescription. According to OECD statistics, Sweden has the 3rd highest consumption rate of antidepressants in Europe (after Iceland and Denmark). And antidepressant prescription is on the rise in Sweden. The National Board of Health and Welfare (Socialstyrelsen) has issued guidelines to try to cut the rise of prescribed depression medication and encourage the use of talk therapy. But these changes will take time because the culture around prescribing antidepressants needs to change. A survey of GP attitudes from 2004 indicated that most doctors considered drug treatment with antidepressants alone was effective and sufficient in most cases of depression. Less than half the doctors thought that psychotherapy was required as a complement. This is despite reliable evidence of the effectiveness of talk therapy against moderate depression and the combination of counselling with medication being considered best practice. There is also evidence that effectiveness of antidepressant use really depends on the therapeutic relationship between doctor and patient.

Relief for Anxiety and Depression through Exercising

As a doctor, Taube is concerned with biochemical explanations of how exercise actually works and the article in Dagens Nyheter explains some of this. For the layperson it’s enough to know that it does work. Therapists are familiar with the way depression often goes hand in hand with anxiety (I often describe them as hanging around together, like schoolyard bullies) so it’s no surprise that exercise appears to help relieve anxiety as well.

Taube, who has herself experienced depression, is a dancing enthusiast but explains that other exercise like taking a walk or spin class can give the mind a break from Anxious Thoughts. We know that mental health difficulties can generally lead to poor physical health not only because problems like anxiety and depression stop us from getting out and enjoying life, but because the drugs that are prescribed for them have a slowing down effect on those who take such drugs. So people who are taking medication because they are affected by anxiety, depression and other mental health problems often gain weight and suffer cardiovascular difficulties or musculoskeletal problems because they don’t move themselves as much. Of course it is important to still seek the help of health professionals, particularly if you are experiencing a severe depression or having thoughts of wanting to end your life. Talking together regularly with a doctor, counsellor, therapist or psychologist is a better alternative to just taking drugs on your own.

In 2012 I will be continuing Walking-Talk Therapy  for those who want to have therapeutic and coaching conversations ‘on the go’. Going for a walk together through Rålambshovsparken, along Norr Mälarstrand or around Riddarfjärden is a great physical alternative to sitting down. Of course, if you prefer to talk inside, we can still meet over a tea or coffee in my private consulting room at Fridhemsplan. And for those who are outside of Stockholm or prefer more privacy, online counselling is always available over the internet.

Send me an email or call me on 08-559 22 636 and leave a message if you would like to make an appointment.

Jill Taube’s book “Själ och Kropp” is widely available from book retailers and online, but unfortunately only in Swedish at this stage.