Anxiety Therapy in Stockholm: Walk and Talk or Talk and Tea… You Choose!

Stress Meter

Treatment for Anxiety is now attracting the same attention given to Depression over recent years. And it’s no wonder. Many people are unaware that Anxiety is affecting their lives and as a result become confused as to how to better approach their symptoms. Talk therapy can offer new ways of responding to Anxiety, and you don’t even have to do it sitting down!

Expat counselling brings me into contact with a wide range of people and personalities. I meet bankers and barmen, teachers and tradies, researchers, roadies and radio journalists. Some come to Sweden for relationships, some for money and some for recognition. It isn’t easy being an immigrant in Scandinavian culture regardless of how advanced Swedish society seems to be. Relocation, cultural differences and relationships are stressors and how we respond to stress affects how well we adjust and how happy we are.

When people come to me, they have often already researched their symptoms on the Internet and tried to diagnose themselves. So what is actually a stress response has been interpreted as ADHD, or OCD, or Depression, or Aspergers Syndrome, or Bipolar. These are the most common diagnoses people are concerned about. It is quite common for Depression to be preceded by Anxiety. However misdiagnosing yourself with the help of the Internet can mean using an ineffective treatment for the condition or falling into a sense of hopelessness. Some even come to the conclusion they have a genetic fault or biological deficiency that cannot be fixed.

I reckon that most people have come to these understandings because we don’t hear enough about Anxiety and how we can respond more effectively to it. Hopefully that is about to change. However this brings another danger: the idea that there is a ‘quick fix’ to Anxiety. My experience is that those suffering from Anxiety are also susceptible to promises about ‘fast results’ or ‘cures’. Taking medication can sometimes help but some drugs are addictive and only worsen the problem. A promise of complete recovery can be much more appealing than the idea that we might have to work at reducing Anxiety or even learn ways to live with it.

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How Can I Reduce Anxiety?

Firstly, most people with Anxiety know that it can affect how their physiology works including changing the way they breathe, their heart rate and the feeling of control over their body. But not so many have learned that the reverse is true as well: you can lower physical and psychological Anxiety through consciously changing your breathing, using relaxation techniques and getting back in touch with your physical being. It is much easier to read about these methods than put them into practice. So getting the help of a therapist to try them out can make a huge difference. Let’s talk about the acute stress response of flight / fight / freeze and how important it is to drop out of that if your really want to get a handle on Anxiety.

Mindfulness Book
Secondly, the practice of Mindfulness. Mindfulness is about being right here, right now. Not in the fear of the future or the regret of the past, but physically present in the moment. It is about focussing attention, without judgement, in calmness and clarity. It is not new but at least 2500 years old and it has stood the test of time. Mindfulness offers you a way of observing your feelings and emotions (including Anxiety) without being pushed around by them. It is highly effective but requires work and practice. This is where the therapist or counsellor can support you by explaining the practices of Mindfulness and helping you monitor your progress. If you are interested in reading about Mindfulness and Stress reduction, I recommend A Mindfulness-Based Stress Reduction Workbook available here on Amazon.

Thirdly you can work with your thoughts. This is why Cognitive Behaviour Therapy (CBT or KBT in Swedish) has become so popular. It can be effective but so much depends on how the therapy is undertaken, the relationship between you and the therapist and, most importantly, whether you are outside of the stress response enough for your cognitive capacities to function properly. There are other approaches to working with Thoughts as well. Deconstructing ideas and concepts and working out how the thoughts arose in the first place can be a significant aspect to talk therapy. Again it requires a degree of trust is established between you and your counsellor.

Walking Talk Therapy

I offer a unique approach to working with Anxiety which I call ‘Walking Talk Therapy‘. Of course, you are always welcome to take a comfortable armchair in my consultation room and chat over a cup of tea (including herbal tea), coffee or glass of water. But if you prefer to walk and talk, we can do that and get some exercise at the same time. It is generally well known that exercise helps alleviate many forms of Depression but it can also be effective for Anxiety. This is at least partly because we are using our whole body when we walk and we can work with the breath in different ways as we walk. These are the most effective means to reduce an acute stress response. It can help us to access a more relaxed sense of ourselves, feel more free and clear our thoughts so we have capacity to think differently.

We aren’t all the same and some of us respond better to some Anxiety treatments than others. So apart from face to face appointments in my consultation room and Walking Talk Therapy, I also offer therapy for Anxiety over the Internet through Skype webcam, Instant Message and Email Exchange. So it doesn’t matter where you are in Sweden or anywhere else in the world, through web technology we can communicate and work cooperatively to reduce Anxiety and change your response to stress.

If you are ready to make an appointment or if you want to know more about my availability and fees, contact me now and let’s make a start. There is more information about me and how I work in these pages but if you have any questions I would be happy to answer them directly.

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I look forward to hearing from you!

Ash Rehn.

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.

Mental Health in Sweden: Normal Behaviour Becoming Harder to Achieve

bar graph image

bar graph imageIs psychological disability in Sweden really stopping so many from working?

(Update from June 2013: This post is actually about the pathologising of human experience: how more and more people are being labelled as ‘disordered’ or ‘deficient’ by the psychiatric profession in Sweden and the expectation that individuals fit with certain norms of behaviour. Some bloggers have attempted to use my words as evidence that Sweden is suffering from collective mental breakdown due to a breakdown of gender expectations and norms. I am certainly NOT suggesting that. If anything, taking a more gender neutral approach in education and other social functions has contributed to greater personal freedom for Swedes. However there is an increasing requirement for individuals to be diagnosed with an illness or disability in order to access support. Read on for more…)

The Swedish newspaper Dagens Nyheter has run a story about the sharp increase in numbers of young people leaving work and put onto disability pensions (known as ‘activity support’ for those under 30 and ‘sickness benefits’ for those 30-64).

Fewer young people are returning to employment after being pensioned off work, a phenomenon that has been referred to as a ‘ticking time bomb’ in view of the fact that many may be destitute by the time they are 30.

Sweden is not alone here. There were increases in young people starting on disability support in other Scandinavian OECD countries between 1995 and 2007. In Finland the increase was 5 percent, in Denmark 10 percent but Sweden had a massive 80 percent increase! That’s almost 30,000 people under 30 in Sweden who are on a disability pension.

Psychiatric Disorders Becoming More Common in Sweden

So why the huge increase? Well 73% of those young people have been given medical psychiatric diagnoses such as autism, ADHD and Aspergers. Could it really be that Sweden had such a rise in psychiatric disorders and mental disabilities compared to our Nordic neighbours? Is it something in the water?

As a counsellor, therapist and coach, I am often asked about such diagnoses and the increases. I think people expect me to say something about teenage computer gaming culture or genetics or to applaud the ‘science’ responsible for discovering such a vast previously undiagnosed population.

But what I see happening in Sweden is that so-called ‘normal’ behaviour is becoming more defined. The goal posts for what is considered normal are being brought closer together. The tolerance for non-conformity and extremes of mood and behaviour is reducing. It is becoming harder to be ‘lagom’!

In Sweden, psychiatric health has been constructed as a medical problem. Both anxiety and depression are treated primarily with medication. But drugs are also heavily prescribed for those whose attention, communication techniques or social skills fall outside what is measured to be the norm. And unfortunately, those norms are progressively less accommodating.

There’s no doubt that the pathologising of human experience is increasing in many countries. More people are being diagnosed as depressed, anxious, having a mental disability or disordered in some way. And this corresponds to increasing expectations that we fit prescribed ways of being and relating to each other. In workplaces and schools across Australia, the United Kingdom and America, more standards of performance are being established and procedures for selection are becoming more sophisticated.

Fortunately, not all mental health, psychotherapy or counselling practitioners favour responding to diversity with drugs or exclusion and many take a more norm-critical approach. Narrative therapy, Open Dialogue and other collaborative therapeutic practices are approaches which honour what people have to say about their own experience, rather than categorise us using medical terminology.

My hope is that eventually the doctors, psychiatrists, psychologists, therapists and others responsible for measuring, diagnosing and categorising people will see the limitation of these practices. I look forward to a new era when Swedish society ceases to be obsessed with locating its deficits and deficiencies but instead acknowledges the unique skills, competencies and abilities of all individuals. A time when the expertise we bring to life’s challenges is respected and valued by the health professionals we consult and diversity is appreciated rather than shunned. Perhaps then we will see more young people participating in the workforce in Sweden.