Is Botox a Replacement for Psychotherapy and Counselling?

Does Freezing our Expressions Mean an End to Psychotherapy and Counselling Exploration?

In March 11th edition of The Guardian Mental Health, Jay Watts wrote the following:

“The publication of a new book, The Face of Emotion: How Botox Affects Our Moods and Relationships, by dermatologist and MD Eric Finzi, together with several recent academic studies on the effects of Botox on mood, have generated a spate of phone calls this week from beauty editors to psychologists like me. Is it true, we are asked, that injecting Botox can actually change the way we feel, transforming not just our body image but also the very emotions we experience within ourselves?

The new studies revive the old “motion is emotion” theory to suggest if a woman cannot make certain expressions – such as frowning – she is less likely to feel discontent or depressed. Her brain, the argument goes, will not read muscular movement associated with anger as present, so she will not feel angry. Aesthetic procedures that freeze our expressions can thus affect our emotional lives. Should the depressed be reaching for the Botox? Can facial filler really make us happier?

When parents threaten their grimacing children “if the wind changes, your face will stay like that forever”, they offer it as a threat. Yet the aesthetics industry would see “staying like that forever” as a good thing, providing the face stuck to is one that does not show any sign of ageing, distress or – in this new wave of propaganda – anger.

Most of us think that our facial expressions reflect our feelings, experiences, age, and perhaps when we last went to buy makeup. We also tend to think people’s faces express their more general take on the world. The comedian Jack Dee, for example, has talked about how his “hangdog expression” is seen by most as saying something about his outlook. “The motion is emotion” theory argues the opposite. It is our facial expression that dictates how we actually feel, rather than revealing an underlying state. If a face is frowning – an expression often associated with anger – we may recognise this association and begin to actually feel angry inside. Others may then react to us as if we were angry, producing a reinforcement cycle where people frown back at us and we are caught in a perpetual spiral of rage.

This theory goes back to the early 20th century, when psychologist and philosopher William James argued that “a man does not cry because he is sad, he is sad because he cries”. Emotion here is seen as a reaction in the body – a set of muscular and chemical events. Recent studies have revived these ideas, claiming that freezing emotional expression through using Botox has a positive effect on depression. Journalists are being briefed that Botox may even prove a universal panacea for depression as a facial motion previously associated with anger is no longer possible, which will make us all happier. Should we throw out the SSRIs and rush to Harley Street?

Maybe not yet. All this is based on a very simplistic understanding of emotion. Within the laboratory, a face with a frown may be read as quickly as an angry one, yet our real-world experiences of each other are nearly always in interaction. Our brains pick up cues of how someone else might be thinking and feeling on a second-by-second basis. We do not see a couple of frown lines, a couple of furrows and process “sad face”, “happy face” but rather pick up cues from a mixture of facial expression, gait, voice cadence, posture, context, eye movement, as well as the fantasies and projections we bring with us to every social exchange.

The new “Botox theory” ignores this complexity, seeing emotion as little more than the awareness of a set of physical reactions. It also neglects something crucial described by writers for centuries: the horror of the uncanny. We experience this when we see an actress or woman of a certain age and feel that something is wrong. Perhaps she has the plumped out cheeks of early youth, the ironed-out forehead of Botox, yet also middle-age crow’s feet. If the work is good, we may not know explicitly what is wrong, but we sense instantly that something is awry. There is a gap between the mask we see and what we expect to be in its place.

This will have an immediate effect on how we then relate to that person. Someone may be telling us the saddest story, but if the facial cues are dissonant, we won’t be quite present either. Colleagues tell me of their feeling “something is really wrong” with new patients because they find it difficult to attune to what is going on for them, only later to find out the patient has regular Botox. And this, of course, generates its own paranoia: “Does he know?”, “Is she treating me differently?”, “Can people tell?”.

The misappropriation of the “motion is emotion” theory by a plastic surgery industry that wants to get rid of our angry faces to make us happier forecloses the real issue. People can tell when something is not right with facial expression, and that will leave women feeling more alienated, more alone, more paranoid than ever. Botox might block us from making the expressions we used to make when angry, but it can never get rid of our internal worlds. If there is anger there, why not think about it rather than try to excise it? The Botox route, fuelled by questionable “science”, denies the legitimacy of a woman’s anger, as if de-ageing and depoliticising had become one and the same thing.”

Just because we do not show an expression does not mean that the cause of depressed or upsetting feelings has gone away. Sometimes help to discover and understand these causes is needed and professional psychotherapy support is required.

The three psychotherapists at The cavendish Psychotherapy Practice at 121 Harley Street, London, are professional, experienced, confidential and ethical and can work with you to uncover the roots of your difficulties.

Men are Less likely to Seek Psychotherapy or Counselling than Women

Men are More Reluctant to Seek Psychotherapy and Counselling help than Women

In a recent article published in the BACP’s monthly magazine, ‘Therapy today’, Colin Penning writes, “Many people think men’s emotional literacy and ability to articulate their feelings is less than that of women. The question then is, do these assumptions about men reflect a stereotype or a reality? This was the question that Relate and the Men’s Health Forum set out to explore in their new report Try to See it My Way.

We know that men are more reluctant than women to seek support and advice when relationships run into difficulties. Far fewer men use telephone advice and helpline services. We also know that men are less likely to access counselling services generally. Men make up just 36 per cent of referrals to the Improving Access to Psychological Therapies (IAPT) programme. They are also under-represented in relationship support services: just 44 per cent of Relate’s clients are men.

So why can’t (or won’t) men seek help for emotional problems? The first and most obvious answer is that men are socialised not to admit to vulnerability, which is a prerequisite of securing help. The second is that maybe we aren’t offering the kind of support that men can relate to and that they find helpful.

The report suggests work is a key factor. Men’s tendency to work longer hours can cause relationship problems and conflicts around the life–work balance; financial difficulties can increase pressure on the man, who is often still the primary breadwinner in the family.

One of the key findings of the report is that men and women have very different approaches to communication. Insights generated by two focus groups of Relate counsellors found that men have a tendency to want to ‘solve problems’ while women want to discuss change and understand why things have happened. So men are coming to counselling with unrealistic expectations.

But the Relate counsellors told us that men may have become more open to the idea of relationship counselling in recent years. And they told us there may be things we can do to reach out to and engage men in taking better care of their own emotional health.

Our report makes a series of recommendations. Some are to national Government around raising men’s awareness of the importance of emotional health and making personal, social and health education a statutory requirement in schools. ”

Admitting to finding things difficult and seeking help is not a weakness. The therapists at The Cavendish Psychotherapy Practice have many years experience working through issues presented by male patients in order to discover what lies at the root of their difficulties.

The Cavendish Psychotherapy Practice is found at 121 Harley Street, London.

Psychotherapy Support for Actors

Research Shows Psychological Vulnerability in Actors

A recent study by California State University looked at the psychology of the sort of people who choose to become actors. The results imply that these people tend to be imaginative but also emotionally vulnerable.

Paula Thomson and S. Victoria Jaque wrote in the Psychology of Aesthetics, Creativity and the Arts journal that “Our study adds to the body of research that suggests there is a psychological cost for participants engaged in the creative arts”.

Their study looked at 41 professional actors living in Cape Town. Toronto and Los Angeles and compared them with people from other artistic groups such as athletes and art lovers.

What they discovered was that, “Even though there was no difference between the two groups for past traumatic events, more actors were unable to maintain narrative coherence when discussing memories of past trauma and loss.” The actors struggled when attempting to discuss past traumas which the researchers felt suggested that they find it harder to resolve these traumas.

The researchers illustrated how the actors had an increased ability to “remain engaged, regulated and coherent during the interview process”, however, they were also more likely to show signs of confusion, prolonged silence or “unsuccessful failures to deny a traumatic or loss event”. Thomson and Jaque argue that this suggests “a greater vulnerability for psychological distress”.

Thomson and Jaque give a note of caution to those thinking of an acting career in therapeutic terms: “Actors may have enhanced their imagination through the practice of acting or they may have entered a career that supports their heightened predisposition for fantasy.”

For those who do choose to become actors, there is psychological support available in the form of talking therapies such as psychotherapy and counselling. This can help develop an understanding of past traumas and resolve feelings surrounding them.

The psychotherapists at The Cavendish Psychotherapy Practice on London’s Harley Street, work with people of all backgrounds, including members of the performing arts who struggle with emotional and psychological problems.

Depression Amongst Sportsmen Suggests More Recourse to Psychotherapy

A Growing Awareness of Sportsmen Struggling with Depression Suggests a Greater Need for Psychotherapy

In a documentary on the BBC last week, ‘The Hidden Side of Sport’, England cricketer Freddie Flintoff explored the depression suffered by high performing sportsmen and why, until recently, little was knows as to the extent of depression suffered amongst this demographic.

We were told that statistically, 1 in 10 sportsmen suffer depression whilst there are more suicides amongst cricketers than in any other sport.

Flintoff described experiencing “unbelievable highs and dramatic lows” during his cricketing career but often asked himself, “What’s wrong with me”, when everything seemed to be going so well, and yet he still felt low. He was winning and yet he still felt depressed.

He put on a show and gave a front of confidence that he did not feel, so that everyone on the outside thought everything was alright, until things started unravelling in 2006-2007.

“I didn’t want anyone thinking there was anything to be got at. I didn’t want people knowing I wasn’t that confident person”, “I was seen as this character who was unflappable”, so he hid behind a “happy go lucky” character.

However, he simply could not escape his feelings and drank in order to find another way of coping with how he felt, but this just exacerbated things. He said he was, “drinking to escape, change how I felt”, but depression was still there and the come down from the drinking and the behaviour during it caused him embarassment and shame; he mentioned how he felt the “disapointment people had in me”.

His fellow team player, Steve Harmison described how he felt that playing sport, throwing himself into it was an escape from his feelings, however eventually this way of avoiding what was going on for him ceased to work as he experienced hyperventiltion and panic attacks. He also mentioned that he didn’t know why he felt that way.

Boxers Barry McGuigan and Ricky Hatton also suffered from depression. They both described how all boxers doubt their ability in the ring and yet they are unable to express their fears. “Never show fear. Never show intimidation” said McGuigan.

Hatton descrided how he thought his depression was triggered by boxing. He had such a pride in boxing and in himself as a boxer, then he started to loose and he had to come to terms with that and the end of his career. The loss of his itentity as a boxer seems to have contributed to his depression.

Hatton too, as with Flintoff, turned to drink to try and resolve his feelings with similar results. He said, “Suffering from depression then add drink to it, its like a  runaway train”. Hatton tried to deal with his problems by himself, in secret, however, Barry McGuigan had a close family to whom he turned. He said that other boxers did not have this and did not wish to seek help from a counsellor or psychotherapist. Hatton backed this up by stating, it is “very very hard for a man to go to someone and say “I need help”. It’s tough”.

Vinnie Jones, another man seen to have been successful in life, described how he came very close to suicide with depression. He said, “You feel so degraded in yourself. Every bit of pride was taken out of me. Why are these people putting up with me?”. He went on to say that there was no one to turn to within sport and that depression was ignored as it was, “taken as a weakness”. Jones was fearful of how admitting to depression would affect those around him and their opinions of him.

In an interview with Piers Morgan, the ex editor described his feelings at the time towards the depression suffered by sportsmen. He thought that a person could not be depressed if they have wealth and fame. It was impossible and, “You know what, get over it…”.

It seems that his attitude was that lucky and talented people have no entitlement to depression. Fortunately, Morgan’s attitude has since changed. Matthew Syed backed this up by saying that in his opinion people assume that if you have money and fame etc then you are in a “psychological nirvna”.  However, it is the fear of this attitude in others that often stops men seeking help for depression in the form of talking therapy, such as psychotherapy or counselling. Dr. Steve Bull, a cricket team psychologist said that attitudes to depression amongst sportsmen are changing but he acknowledged that, as 10% of the population in any given year are liable to experience some form of anxiety and depression, more attention should be given to the mind as well as the body.

He too seems to support Hatton’s feelings that sportsmen are obsessed with what they do, that there is a personal identity with their sport and that it is alright when things are going well but terrible when not. However, he did not think that sport caused depression, seeming to imply that it is more the feelings about the sport and the level of participation in that activity. This could be applied to many activities.

Dr. Bull also thought that there is a greater awareness of depression in sport because of the publicity, not that this is a new phenomenon.

The above experiences of high functioning sportsmen can be applied to the experiences of many men in every walk of life. Even if life seems to tick all the positive boxes, there may still be inexplicable feelings of depression.

Identifying with one’s work so that failure is not an option can be similar to how sportmen identify with their sport. Pressure to succeed in work or private life  can add to a sense of being unable to cope. Fear of others attitudes towards depression may prevent men seeking help, such as committing to a course of psychotherapy. Fears of weakness, of social exclusion or feelings of shame may all contribute to not seeking help and support but suffering alone and ultimately may lead to self destructive behaviour, such as drinking (as with Hatton and Flintoff) or drugs. However, as Flintoff said, to “talk about my feelings was good to do”.

“Disappointments as a player I’ve tried to forget, bury my head in the sand a bit. But confronting some things, I think has helped me tackle some of my insecurities head on”.

“I think moving forward I can let go a little bit. I don’t want to have to pretend to be what I’m not. Nor do I want to play up to what everyone wants from me. I think its just time to be myself”.

The therapists at The London Cavendish Psychotherapy Practice provide a confidential therapeutic environment in which to discuss and explore difficult feeings. They provide non judgemental, open minded, professional support.

The Cavendish Psychotherapy Practice is based at 121 Harley Street, London.

Recession, Depression and Psychotherapy

Job Threats can Lead to Mental Health Difficulties and the Need for Psychotherapy

According to a report by academics from Roehampton University and the charity Elizabeth Finn Care, the number of people suffering anxiety, depression and stress because of redundancies, job insecurity and pay cuts is rapidly increasing due to the recession.

The study found that reports of depression jumped by between four and five-fold as fears regarding job security increase. Among people who have lost their jobs in the last year, 71% have suffered symptoms of depression, 55% stress and 52% experienced symptoms of anxiety.

Those ranked as of middle socio-economic status were more likely to experience depression (59.8%) than those from lower (44.9%) or higher groups (46.7%). Those surveyed between the ages of 18-30 were more likely to suffer depression than any other age group.

Principal lecturer at Roehampton University, Dr Joerg Huber said, “What makes our findings worrying is the high percentage of people reporting symptoms of depression, anxiety and stress. This applies even more to those who have lost their job or experienced a major loss of income.”

He goes on the say that, left untreated, depression could turn into “a vicious cycle of related disability and an inability to work”.

A separate report by the Royal College of Psychiatrists, the London School of Economics and the NHS Confederation’s mental health network found that demand for psychotherapy and counselling had increased because of rising levels of debt, home repossessions, unemployment and threat of redundancy.

Prof. Steve Field, chairman of The Royal College of General Practitioners has reported that some patients present to their GP’s with backache or tiredness as a way of discussing the fact that they are actually depressed or anxious.

At The Cavendish Psychotherapy Practice on Harley Street in London, you can talk about your concerns confidentially with a professional psychotherapist in order to work through your anxiety and find a better way to understand and manage it. 

Therapy For Post Miscarriage Mothers

Should Post Miscarriage Mothers Talk To A Psychotherapist

Last week, news of Amanda Holden’s late term miscarriage made the headlines. Losing a baby to miscarriage is hard for all women, and at all times during pregnancy, but there is something particularly tragic when a mother loses a fully formed, and otherwise viable, baby.

In our society miscarriage remains a bit of a taboo, it’s not really talked about, which leaves it hard for women to find the space to grieve. Family and friends often don’t know how to respond. Was this a life and therefore a death? Or was it a foetus, with no real identity? For many mothers, a bond is already formed with the unborn child, especially in the later stages of pregnancy. Dreams are created, hopes are formed, and then the baby dies, leaving an agonising void. Mothers are left bereft and yet often struggle to have their pain validated and understood. They are often expected to quickly pick up and move on, to try again.

Feelings after a miscarriage can be truly overwhelming for a mother and, if these feelings are not explored and shared, they could lead to depression. It’s really important that feelings felt by a mother post miscarriage, are explored and not shut down. A woman needs to find the space to grieve, Often a course of psychotherapy or counselling can really help process the overwhelming and difficult feelings a woman goes through post miscarriage. Talking to a therapist in confidence can offer a mother the space and the understanding that she needs. At The Cavendish Psychotherapy Practice, in Harley Street, the psychotherapists are highly experienced in dealing with post-natal loss. The therapists are compassionate and work entirely confidentially.