Tag: Mental Health

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Keep Your Head: Managing Mental Health During Coronavirus in Sweden

Uncertainty about COVID19 in Sweden has lead to a decline in mental health and increase in anxiety conditions

Mental Health has become a buzzword expression around the world since the COVID19 pandemic began. When the coronavirus keeps us socially distant, how can we manage to keep it together?

The coronavirus COVID-19 is a source of stress for many English speakers in Sweden. While health authorities in the UK, Australia and San Francisco enact policies such as of ‘lock-down’, containment, quarantine and ‘shelter-in-place’, the Swedish government proceeds with a business-as-usual approach, emphasising personal freedom and relying on the Swedish culture of collective responsibility. Expats and other English speakers immigrants in Stockholm, Gothenburg and Malmo are understandably worried. When your adopted country follows a policy dramatically different to most others and at odds with many scientists it makes sense that you might feel vulnerable.

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If you are alone, confused and unsure what to do, the first thing is to focus on what is within your control and let go of what isn’t. That’s part of what I call ‘keeping your head’. Everybody has the capacity to lower their own stress response, although knowing this isn’t enough. We start by becoming aware of what is going on in the body and then act to change how we feel. That takes practice but it is the first step in improving your mental health.

Symptoms of Coronavirus Pandemic Stress

Both irritability and withdrawal from contact with others are common signs of acute stress and declining mental health. These parallel the ‘fight or flight’ response that has evolved to protect us. You might be experiencing one or the other or both. The usual symptoms of anxiety and depression – difficulties with concentration or memory, restlessness, panic, a sense of hopelessness or doom, sadness and feelings of worthlessness – might also be present. If you take the time, you will notice their corresponding sensations.

Take a few moments now to sit in silence and notice what is happening in your body. Where do you feel tension? How busy are your thoughts? What sensations do you feel when you pay attention to your breath or your heartbeat?

Forgetfulness, trouble focusing and an inability to solve problems or know what to do are signs that anxiety has affected your cognition. The Acute Stress Response (also known as ‘Fight or Flight’) has another manifestation: Freeze. This is the kind of paralysis of both thought and action we might experience when a stressor starts to shut down cognitive functioning. To the body, it’s the same phenomenon as an animal might experience when suddenly confronted, like a deer that freezes at the realisation it has been seen or the ‘rabbit-in-the-headlights’ response of a beast on a road at night. When a stressor becomes overwhelming, our capacity to reason and use logic drops away and our animal self reacts in self-protection.

The Importance of Self Care during COVID19

I work with expats and English speakers around the world and have noticed the impact to mental health is similar whether the person is in Birmingham, Bahrain or Beijing. People are on edge with the ongoing changes to public health ‘rules’ as well as the uncertainty about the virus itself. Many are WTF (working from home), whether by choice or obligation, and this is putting pressure on relationships and disrupting well-being routines that were taken for granted. Even those in the ‘open’ cities of Sweden – Stockholm, Gothenburg, Malmo, Uppsala – are struggling emotionally and physically. As much as the government campaigns might try to convince us otherwise, the coronavirus pandemic and ‘social distancing’ divides us, it doesn’t bring us together. We have to work at staying connected and that takes energy.

The 5 Fundamentals of Well-Being are:

  1. Adequate sleep;
  2. Regular, nutritious meals;
  3. Regular exercise;
  4. A balance between work, rest and play;
  5. The opportunity to talk about problems.

How many of those can you tick off? Checking in with yourself is just as, if not more, important as connecting with others. To know what you need from others, you first need to have good contact with yourself. If you have noticed things don’t feel right, take some time to listen to your sensations and see if you recognise your emotional state. Your body can guide you to what is important right now. Listening to your body is the first step to keeping your head. And if you are struggling with knowing what you need, a conversation with a supportive professional can help.

To make an appointment or find out more about my services, contact me.

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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.

Click Here to Ask a Question or Make an Appointment

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.

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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.

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Walking Talk Therapy for Mental Health in English in Stockholm

A Park to Walk in Stockholm

The 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!