Supportive Counseling & Therapy – When?

„When it becomes difficult to progress alone …“

Professional psychological support can significantly alleviate the distress and suffering resulting from difficult life situations or severe life events. Every individual has a unique perception of a “difficult situation”.

Following, some of the most prevalent psychological “disorders” and their corresponding basic treatment approaches will be outlined. The treatment approaches are explained in more detail under “Treatment & Therapy”.

Psychosomatic complaints

There are interdependencies between body and soul. Physical illnesses frequently result in psychological complaints or even illnesses, e.g. depression and anxiety disorders. Vice versa, prevailing psychological burdens often contribute to physical complaints or even illnesses, e.g. fatigue, dizziness, hypertension and gastro-intestinal illness.

Efficient psychological therapies provide alleviation and crucial support in terms of better coping strategies. With tailored psychological support individuals can learn efficient alternatives to deal in a more positive fashion with new challenges. Efficient intervention comprise psycho-education, treatments in the light of mindfulness-based cognitive behavior therapy and meditation- and relaxation techniques.

Anxiety Disorders

All of us are familiar with anxiety as a natural and precious protection mechanism in objectively dangerous situations. However, when fear and anxiety are out of proportion and occur in objectively not dangerous situation people might get into a vicious circle of “fear of fear”. The wide spread implications are avoidance, withdrawal and disengagement as an attempt not to get into such “dangerous” situations. Avoidance and social withdrawal in turn imply the inherent risk of increasing isolation and severe reduction of the quality of life,

The most prevalent anxiety disorders comprise Generalized Anxiety Disorder (free floating anxiety), Phobias (e.g. arachnophobia, agoraphobia, claustrophobia and social phobia), Panic Disorder (with sudden onsets of extreme anxiety) and Obsessive Compulsive Disorder (with unpleasant obsessive thoughts and/or compulsive behavior).

Psychological treatment focusses on evidence-based efficient techniques which strengthen the resources for alleviating and autonomy-enhancing coping strategies with the anxiety and, thus, contribute to happiness and (regained) quality of life.

Phobias predominantly result from dysfunctional learning processes, i.e. they are conditioned. With psychological therapy we can again “unlearn” such unpleasant responses to certain stimuli. To achieve this one has to confront oneself several times with the phobic, anxiety-inducing situations, objects or encounters. Systematic desensitization with subsequent exposure and confrontation represent highly effective and liberating techniques to “unlearn” such acquired phobic reactions.

Depression

Depression is an “affective disorder”. This focuses on the emotional world, which is impaired for various reasons. When someone suffers from depression, their mood is usually depressed, their enjoyment of everyday things is reduced, and their drive for activities at hand is reduced. Depression is often triggered by critical life events such as traumatic experiences, the loss of a loved one, job loss, or extreme stress at work.

Depression is widespread: Between 20 and 25% of people in Austria and Germany experience a depressive episode once in their lifetime (lifetime prevalence). Depression very often occurs together with anxiety disorders (comorbidity). Depressive symptoms of a psychological nature are loss of interest, feelings of worthlessness, social withdrawal and unjustified feelings of guilt. In addition, physical symptoms such as insomnia, nervousness, loss of appetite, gastrointestinal complaints, and decrease in libido often occur with depression.

The three multifactorial causes of depression include: (1) a genetic disposition (vulnerability) – with low availability of the neurotransmitters serotonin and norepinephrine; (2) psychological factors – such as problematic personality styles, dysfunctional schemas, and problematic beliefs; and (3) social factors – for example, unsatisfactory social support.

There has been a marked increase in depressive and anxiety disorders. On the one hand, a higher level of awareness plays a role; however, the increase also reflects increasing demands for adaptation in the professional and social context – with rapidly changing structures and (perceived) insecurity and unpredictability. Added to this are the ideal images portrayed by the media of the fearless, always successful and pleasure-maximizing individual – ideal images for which humans are not made evolutionarily and archetypically.

Treatments within the mindfulness-based cognitive-behavior therapy have proven very efficient for the prevention, cure and relapse prevention of depressive episodes. The treatment approaches fosters identification and deliberate cessation of negative automatic thoughts and fruitless rumination. It activates the perception of positive stimuli, events and social encounters.   In turn, this positive framing provides our thoughts, emotions and behavior with more positive and optimistic accentuations. Simplified and as Martin Seligman has put it, a transition from “learned helplessness” to “learned optimism” is possible – even within challenging life situations.

In addition to psychological therapy, exercise and sport are means to induce mood-enhancing effects. Physical activity increases the availability of neurotransmitters (such as serotonin, norepinephrine and dopamine) in the synaptic cleft and also the production of endorphins – as runners experience it by means of the “runners’ high”. Exercise in the company of others – such as team-sports and dancing – have also a positive social component.

In cases of severe depressive episodes, mania and bipolar disorders, the usage of psychoactive medication prescribed by psychiatrist has to be considered in addition to psychological therapies.

Substance abuse and potential dependency

“Sola dosa venenum facit” – only the dosage constitutes the poison.  Alcohol consumed within health-compatible limits might have relaxing effects and foster sociability. For many stress-vulnerable people, however, alcohol implies the risk of health-detrimental „self-medication“, abuse and, moreover, potential addiction. If one can only relax by means of alcohol consumption, there is the severe risk of addiction with the result of increased anxiety and depression.

The Concept of Self-Control of potential Substance Abuse is based upon the concept of “Control of self-induced Substance Consumption” (“Kontrolle im selbstinduzierten Substanzkonsum” [KISS]), developed in the 1980s by Professor Dr. Joachim Körkel. The treatment approach here is, however, augmented by the implementation of Brief Therapy tools.

The Concept of Self-Control based on the method of Prof. Körkel can be applied to other substance-related and non-substance-related addictions. Examples for the latter ones ate behavioral addictions, e.g. mobile and internet addiction.

Life Events and Crises

We all experience difficult life events such as relationship split-ups, bereavements or the (risk of) redundancy. In addition, we might be subject to a severe accident or experience violence. People have different coping strategies to come to terms with it, to let go and to regain balance and stability.

Sometimes people struggle to overcome such life events and crises on our own – in this case psychological interventions can provide the required support – from supportive counseling to acute crisis support.

Rigid habits and compulsions

Habits are useful since they provide structure an orientation. Too rigid habits, however, potentially undermine adaptive change and progress. In extreme cases such rigidity can lead to Obsessive Compulsive Disorder (OCD) with obsessive thoughts and compulsions. However, the compulsive behavior – e.g. extreme hand washing – only results in brief states of anxiety reduction.

Psychological treatments provide aids and inputs to put liberating and adaptive changes in thinking, feeling and behaving into practice. Doing this step by step is a means to substitute rigid cognitive and behavioral patterns by flexible and functional paths. Severe cases of OCD necessitate cognitive preparation, subsequent

According to the current classification systems DSM-V and ICD-10, personality disorders are characterized by a specific combination of persistent dysfunctional patterns of perception, relationships and thinking processes as well as dysfunctional behaviors, insofar as these are inflexible, maladaptive, situationally generalized and represent a significant impairment of performance and/or cause subjective complaints and suffering.

In addition to narcissistic and obsessive-compulsive personality disorder, emotionally unstable (borderline) personality disorder plays a major role; its characteristics are: Intense yet unstable interpersonal relationships, impulsive yet self-destructive behavior, marked changes in mood and self-image.

It is important that personality traits are on a continuum – if the personality disorder is not fully developed, there is a personality accentuation. These can also have benefits: For example, people with obsessive-compulsive personality accentuation work accurately and are reliable.

The therapeutic procedure is relatively complex because a personality disorder manifests itself in a heterogeneous disorder pattern. Since personality traits are relatively stable, the treatment of personality disorders often requires intensive and long treatment by its very nature. Thus, the efficient treatment of a diagnosed personality disorder is not amenable to short-term therapy. Since there are hardly any efficient treatments with psychotropic medication – except for short-term intervention in acute crises – psychotherapy is considered the most important and effective treatment option. Both psychoanalytically oriented and behavioral therapy approaches have become established.

Personality disorders

According to the current classification systems DSM-V and ICD-10, personality disorders are characterized by a specific combination of persistent dysfunctional patterns of perception, relationships and thinking processes as well as dysfunctional behaviors, insofar as these are inflexible, maladaptive, situationally generalized and represent a significant impairment of performance and/or cause subjective complaints and suffering.

In addition to narcissistic and obsessive-compulsive personality disorder, emotionally unstable (borderline) personality disorder plays a major role; its characteristics are: Intense yet unstable interpersonal relationships, impulsive yet self-destructive behavior, marked changes in mood and self-image.

It is important that personality traits are on a continuum – if the personality disorder is not fully developed, there is a personality accentuation. These can also have benefits: For example, people with obsessive-compulsive personality accentuation work accurately and are reliable.

The therapeutic procedure is relatively complex because a personality disorder manifests itself in a heterogeneous disorder pattern. Since personality traits are relatively stable, the treatment of personality disorders often requires intensive and long treatment by its very nature. Thus, the efficient treatment of a diagnosed personality disorder is not amenable to short-term therapy. Since there are hardly any efficient treatments with psychotropic medication – except for short-term intervention in acute crises – psychotherapy is considered the most important and effective treatment option. Both psychoanalytically oriented and behavioral therapy approaches have become established.

The therapy of borderline personality disorder is considered a great challenge for therapists, as problematic behaviors and symptoms of unstable affect of the patients also show up within the therapeutic setting, which can partly undermine an efficient treatment.

The evidence-based and efficient psychological procedures I use can be found outlined and explained in a little more detail under .“Treatment & Therapy”