Understanding relationships

It is worth noting that there are two distinct stages of break up. We shall call these recent and long term.

• Recent – This is when the breakup is still recent and fresh. The person is still dealing with the shock of it. At this stage they are often full of unresolved questions and may even be conflicted about whether the relationship has really ended.
• Long-term – This is when the relationship has been over for a while and the person finds that they are still unable to move on from it. There will tend to be less confusion and doubt as to what the problem is here. For example, it is likely to be apparent that the relationship is genuinely over. Equally, it is likely that there will be only one or two unresolved questions about the relationship.
• Healthy resolution – This is when a person has come to terms with the breakup. They are probably able to see the problems with the relationship and can take balanced learnings from this. This is the point at which they will be able to comfortably consider a new relationship.

Although they are defined by time, there is no specific point at which a person moves from one to another. A person may move to the long-term stage quite rapidly or be stuck in the recent stage for months. Equally, the long-term stage can be very short lived as a person moves rapidly to healthy resolution.

How can hypnotherapy help with a relationship breakup?

The hypnotherapist is likely to take several different approaches to dealing with a relationship breakup. The choice of approach will vary with the individual needs of the person. The goal of therapy is to help move the person closer to healthy resolution. Techniques employed may include

• Counselling and listening – Especially in the early stage of a breakup there may be considerable value in saying aloud what you are thinking. Saying things to another person helps to externalise the thoughts. Externalising thoughts separates them from the emotional context in which they are being had. This allows many of them to be processed in the mind.
• EMDR – This is used when there are traumatic elements to a relationship breakup. A common example of which could be the discovery of infidelity. However, there are far more causes of trauma than infidelity alone and these will be investigated and work on where appropriate. Equally, EMDR can be used to help process the strong feelings which a breakup produces and work through triggers for rumination upon it.
• Systematic desensitisation – In breakups there are usually numerous triggers for rumination upon the relationship. These can be things like places you used to hang out together, music you both listened to, other media you consumed, events you went to and so on. Desensitisation can be used to work through these triggers to reduce their impact.
• Psychodynamic work – Various approaches like regression to childhood, inner child work and parts therapy can be used to help address underlying trends
• Mental organisation and clear out exercises – There work to help provide the foundations of reprocessing which the mind needs to move on from a relationship.
• Acceptance and commitment therapy – Techniques from this school of therapy help provide the framework to establish healthier future relationships.

The next step in get hypnotherapy for my breakup

If you would like to know more please contact Dr Matt Krouwel to discuss or arrange a free consultation. Dr Matt is a long standing member of both the BSCH and the NCH. 

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Very little research done into therapy for Shy bladder syndrome. However, a study of 101 people with shy bladder who underwent a weekend course of exposure therapy. These people were found to have significant benefits when followed up a year later (Soifer, Himle & Walsh, 2010).Personally I’ve found that most patients respond well to therapy. So what might I do to help?

Therapy approaches for pee shy / Shy bladder syndrome?

There are a few technique which I’d consider for Shy bladder syndrome. I would  take a case history from the patient and based upon this make some decisions as to what techniques to use. Sometimes a patient identifies a starting point to the problem or identifies that their internal voice is pressuring them. In these cases I consider what are called psychodynamic approaches.

Psychodynamic approaches in hypnotherapy for shy bladder syndrome

These are approach to resolve an internal conflict or address an unhelpful early life learning. This type of work could include such techniques as:

• Inner child work.
• Parts therapy.
• Regression to childhood.
• Eye movement desensitisation and reprocessing (EMDR).

Sometimes the original cause of the problem is no longer relevant, but the behaviour has become habit. When this is the case, a therapist can move to techniques which help to retrain the mind and body.

Therapy for direct change to habitual behaviours for pee shy patients

Such techniques may include:

• Systematic desensitisation – this is an approach in which the patient is mentally walked through going to pee in a public place whilst the therapist induces deep physical relaxation. In effect this retrains the body to be relaxed in a previously tense situation. This is similar to the graduated exposure therapy used by Soifer, Himle & Walsh, 2010 in their research, but many consider systematic desensitisation superior as it actively looks to retrain the body to be relaxed.
• Relaxation cues – A hypnotherapist may give suggestions to be relaxed as soon as you get in to position to wee.
• Flow visualisations – there are various visualisations which a hypnotherapist may use or teach. Typical examples may include such things as mentally seeing the urine flowing comfortably. A visualisation may be more abstract such as picturing the flow of a gentle mountain waterfall as its flows downhill.
• Amnesia suggestions – Light amnesia may be given for peeing so that you forget that you are in public or that there are people around you. These will be carefully crafted to fit the specific circumstances which affect you.
• Privacy visualisations – The therapist will come up with imagery specific to you which will allow you to feel more private when in public toilets.

Homework for Pee shy clients

Homework is likely to be a large part of therapy. Typically, homework would be negotiated with the patient. Mostly homework would involve:

• Practicing relaxation and self-hypnosis techniques.
• Using public toilets.

I hope this guide has helped you to understand what sort of things you may encounter if you presented to a therapist for hypnotherapy for shy bladder syndrome. To find out more or book in a free consultation please contact Dr Matt.

The author

Dr Matt is a hypnotherapist based in Birmingham (UK) with a specialism in functional disorders. He is a member of both the NCH and BSCH.

References

Soifer, S., Himle, J., & Walsh, K. (2010). Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach. Social Work in Health Care, 49(5), 494-507.

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Systematic desensitisation – Key features and terms

Trigger.

In this context, a trigger is anything which initiates an emotional or state change. The trigger could be;

• External, like seeing or hearing something,
• Internal, such as imagining or remembering something.

The change induced by the trigger is perceived as swift and automatic.

Relaxation.

In systematic desensitisation relaxation is a deliberately created state. It is common for a therapist to teach relaxing exercises or use a guided relaxation technique to produce relaxation. This kind of relaxation allows the patient to retain a sense of  control and personal agency.

Reciprocal inhibition.

Reciprocal inhibition is the idea that a person can only really experience a single emotional/physical state at one time. This means that if you are anxious you will experience things as anxious. eventually you will come to associate everything experienced with anxiety. Conversely, if you experience something in a relaxed state you will begin to associate that with being  relaxed. So, if relaxation is induced by a therapist and then the anxiety inducing trigger experienced, a new relaxed response will be learnt. This new response will override (inhibit) the previous one.

Graded exposure.

Also called graduated exposure, graded exposure is a process of gentle exposure to trigger stimuli. The triggers are organised in a progressively more challenging way. Normally to achieve this a hierarchy of disturbance is created which is then worked through.

Hierarchy of disturbance.

This is a list of all the elements of a trigger which a person can identify. These are organised from leash difficult to most challenging. An example for a spider phobic might look like this;

1. Knowing there is a small spider in an adjacent room. (least difficult for this hypothetical patient).
2. Seeing a small spider on the far wall (staying still).
3. Seeing a small spider on the far wall (moving slowly).
4. Seeing a medium sized spider on the far wall (staying still).
5. Seeing a medium sized spider on the far wall (moving slowly).
6. Seeing a large spider on the far  wall (staying still).
7. Seeing a large spider on the far wall (moving slowly).
8. A large spider on the floor about 1.5 metres away (staying still).
9. A large spider on the floor about 1.5 metres away (moving slowly).
10. A large spider on the floor about 1 metre away (moving slowly).
11. A large spider on the floor about half a metre away (moving slowly).
12. Touching a spider whilst wearing a thick gardening glove.
13. Touching a spider whilst wearing a plastic glove.
14. Touching a spider. (Most challenging for this hypothetical patient) .

The job of the therapist is then to help create a list of situations of progressively more intense triggers to be worked through.

In life / In the imagination.

The exposure to triggers which is required for systematic desensitisation to work can be done in two ways;

• In real life with the trigger stimulant being either; present in the therapist office or by going out into the world to encounter it.
• In the imagination of the patient.

Both methods have their strengths and limitations. Desensitization in real life is almost certainly the best way but the resources to do it are expensive, time consuming, often specific and difficult to manage. The imagination by contrast is usually very good at conjuring up the required resources but at some point this will have to be consolidated into real life with some real world practice.

Systematic desensitization – uses and limitations.

Systematic desensitization is frequently used by therapists for anxiety responses where the trigger is specific and the reaction is disproportionate to the level of threat. A typical example of this would be a phobia or anxiety induced response like psychological erectile dysfunction or vaginisimus  like . However, frequently the anxiety trigger will have a reason to have come into existence, which may limit progress with systematic desensitization alone. Typical reasons for this are;

• The fear is secondary to another fear. For example a fear of insects can sometimes be a fear of contamination or a fear of heights will often be the result of having the wooziness caused by  vertigo.
• The fear is related to post traumatic stress disorder (PTSD). At some point a powerful experience resulted in an anxiety, it may be that the originating experience needs to be treated before the anxiety can be desensitised.
• Neurological sensitivity to the trigger. Not every bodies sensory experience is the same, substantial numbers of people have a visual or auditory sensitivity which results in apparently normal situations being uncomfortable. Over time the effect of this, combined with other people’s lack of awareness or comprehension of the problem, result in a build-up of tension around it. Overall this means that at best systematic desensitisation will help deal with the build up of tension.

The Author

Dr Matt Krouwel PhD is a hypnotherapist in Birmingham (UK) with over 25 years experience of working with anxieties, panic and related disorders. He is a a member of the BSCH and NCH.

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