Tag: Stress

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How to Reduce Rumination and Stress by Doing More and Thinking Less

Man in Blue Hoody walking through a field
Taking a brisk walk in nature can help you let go of your worries

Ruminating. Catastrophising. Panicking. All describe the breakdown of logical reasoning that happens when we are in such a state of anxiety that our thinking is paralysed. So how is it possible to stop going over and over a source of worry? The answer isn’t more thinking, it’s more doing.

Why Can’t I Stop Thinking and Switch Off My Brain?

The coronavirus has most of the world on edge. It’s limiting our possibilities for movement and making our lives even less predictable challenging us to manage our mental health. And in the social distancing of these new conditions, some find themselves alone and obsessively thinking about the same things over and over, causing them to feel physically sick with worry or having a panic attack. My English speaking clients in this situation plead with me, How can I change my thoughts?

But the key lies not in changing thoughts but changing activities. When a person’s physical stress response is so high, the logical reasoning part of the brain fails and the survival part of the brain kicks in. This is the legacy of our evolution, an animal instinct to withdraw, like crawling back into a shell for protection. Unfortunately when humans withdraw they stop participating in activities that benefit them such as engaging with others and physical movement.

Those of us who have been conditioned by work that uses our brains in preference to our whole bodies try to think-through and problem-solve unpleasant feelings instead of addressing them directly through physical means. But the best way to lower the acute stress response is to get physical and use more of the whole body, not just that little part of the brain behind the forehead that is responsible for cognition (thinking, judging and problem solving).

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How to Escape the Isolation Chamber of Rumination

Ruminating on a problem without the benefit of more information or a different perspective is akin to trying to make a decision from inside an isolation chamber: we have to get out and experience the world through the senses. The solution to rumination and catastrophising isn’t more thinking, it’s more doing. And specifically doing activities that engage the senses. Not only will doing something physical help you to relax, it will loosen up your thinking and help you gain perspective.

Exercise is the obvious first go-to. I don’t recommend high-intensity exercise for stress reduction because it can spike the sympathetic nervous system that is responsible for elevating the body’s stress response. But moderate intensity exercise such as brisk walking, light jogging, kicking a ball around, moderate swimming or dancing can help a person to get out of their head and into the body. These activities will help relax the muscles, releasing physical tension. Even in the middle of winter, many Swedes will go out and walk in the lightest part of the day because they know that moving the body and experiencing the world through different senses is key to lowering the stress response.

The other activities that work well for reducing the stress response are anything that involves hand and eye co-ordination or acts of companionship. Research has indicated that activities involving hand and eye coordination actually repair neural pathways. Sharing time with friends who are experiencing a lower stress response can actually reduce your own anxiety. So what does this look like in practical terms?

Strategies to Treat Acute Stress Response

I’m aware that those who have recently moved to Sweden or other foreign countries do not always have much living space or many friends. So hobbies like car restoration, carpentry or bee-keeping might not be possible. Here are some suggestions for activities that don’t require a lot of space or capital outlay and that you can do alone…

Creative activities that engage the hands and eyes will help you relax and also assist with anxiety and depression. For example: painting, drawing, photography, jewelry making, building things with lego or completing jigsaws, podcasting, making Youtube videos or creative writing. Hobbies like video-gaming, geocaching, collecting antiques, coins, toys or memorabilia, playing chess (even against a computer), learning to program, code or make apps, sewing, knitting, making clothes, cooking, genealogy, learning and playing a musical instrument or learning a language could also take your mind off your worries. If you only have your work or relationship to think about, is it any surprise that your mind has nowhere else to go?

Then there are relaxation treatments such as getting a massage, enjoying a floatation tank, playing with pets (your own or someone else’s), walking in nature, colouring-in books or watching comedy videos on a streaming service. Chilling out is a great way to lower stress response.

And thirdly the companionship of spending time with friends and reaching out to someone you love like a son or daughter or cousin or long-term friend, even if they are in another country, can lead you to feel better. Physically or virtually not being alone is beneficial and it’s amazing how showing interest in someone else can assist you to get out of your head. Try it!

Superman figurine standing in a broken half eggshell

Finally, if you are so stressed up that you are unable to exercise or get into a hobby or reach out to a friend or family member, consider consultating a doctor at the Vårdcentral about medication to assist in the first instance. Some people self-medicate with alcohol or recreational drugs but it is better to get professional support to assist you until you are able to take more steps on your own. Any form of medication is only a short-term fix and does not address the cause of anxiety. The use of prescription medication needs to be monitored by a medically qualified person.

If, after lowering your stress response, you still have a problem that needs to be solved, you can talk to a professional therapist who can guide you through problem-solving strategies.

To make an appointment for coaching, advice, support or therapy, please contact me.

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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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Relationship Counselling: Ending the Blame Game for Better Communication

How often have you been in a situation where your partner has blamed you unfairly or found fault with everything you say? Constant put-downs and negativity mean criticism is thriving in your relationship. Here are some ideas about how to nip them in the bud and start having better communication with your partner.

First up, let’s talk about language. I prefer not to use terms like ‘critical people’ or ‘blamers’. Anyone can fall into speaking critically of others. Criticism can take the form of always pointing out what is wrong, constant negative comments or picking fights. If it’s coming from your partner, it could be a sign of unhappiness of lack of fulfilment. But don’t take it personally: people who have been taken over by criticism are generally in a bad way!

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Criticism: You Can’t Fight Fire with Fire

When criticism and negativity becomes obvious, it’s time for action. But you can’t fight fire with fire. Imagine reacting to criticism with criticism… it doesn’t work does it? Most of the time when we are burning up with criticism we aren’t even aware of it. Pointing it out can just fan the flames. We need to be a little more strategic.

Start by checking your own reactions. To reduce the physical stress response, breathe deeply into your abdomen and relax your muscles as you listen to what your partner has to say. Accepting criticism is like receiving a gift that you don’t need. There’s no need to take offence. Just don’t catch the negativity being offered. If you react to criticism, you have basically engaged with it. And if you react critically, you have lobbed it back. Ever heard the expression ‘someone is going to lose an eye’? Once we are playing the blame-game, we have already lost perspective.

Non-Violent Communication


One way of changing your response to criticism is to indicate you have heard what the person has said and you need time to consider it. This way, you keep some distance between yourself and the remark. The idea comes from Non-Violent Communication or NVC, an approach developed in the 1960s that involves awareness, expressing feelings and asking for what you need. I recommend the above book ‘Non-Violent Communication: Practical Skills to Connect and Communicate Skilfully in Every Situation‘ that describes this approach in detail. With practice, anyone can improve their communication but it’s important to be assertive and have boundaries. If you are in a situation of physical danger or abuse, don’t stick around. Get out and get help.

There are a few simple things you can start doing now to change the existing patterns of your relationship. If this interests you, read on!

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A repeated scenario I have witnessed in relationships is one partner putting aside their own needs to try to meet the needs of the other. Which of course doesn’t work too well. It usually ends up with the self-sacrificing partner feeling resentful when their own needs aren’t met. But we can’t neglect our own needs!

Does this sound familiar to you?

The situation generally worsens when both partners suppress their feelings and ignore their own needs to try to make each other happy. Both can end up feeling trapped and not knowing what to do. At the same time, the solution isn’t just about looking after one’s own needs. When in a relationship, we have to find a way to be with the other person. We have to be aware of our own emotions and look after our own needs but remain conscious and sensitive to the other person’s feelings and needs as well. It’s not easy, but when both people are generous with each other, it tends to expand the sense of the relationship. If both partners are tight and mean towards each other, everything tends to get worse and worse.

From Blame-Game to Generosity

If you’ve ever found yourself ‘playing the Blame Game’ with someone, you will know the story. We can get caught in a cycle of blaming the other person or blaming ourselves for a silly mistake or the unpleasant emotions we are experiencing. Non-Violent Communication offers a way forward through taking responsibility for – and expressing – our emotions while empathetically listening to the other person’s feelings and needs. Partners can’t always meet our needs. We sometimes have find ways to meet them ourselves but still communicate them to our partners.

Finally, there is always the possibility your partner may be right, even if the way they are saying something is not ideal. Working out what to take on board isn’t always easy. I offer confidential appointments in English in Stockholm, online counselling over Skype and through email. Fill out my contact form to make a start on improving communication. To break the ‘blame game’ pattern in your relationship, contact me today through www.ForwardTherapy.se or call me on 08 559 22 636.

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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.

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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.

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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

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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.

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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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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.

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Anxiety and Regular Therapy in Stockholm: Temporary and Ongoing Solutions

Image of a man with stress associated with cultural adjustment

International 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.