As seen during lunch time run break.
Healthy to break the day with short exercise in nature
As seen during lunch time run break.
Healthy to break the day with short exercise in nature
In the beginning of my career as a psychologist I worked in Hackney – East London NHS mental health trust, at a schizophrenia and bi-polar multi-disciplinary team. We worked mostly with young black males who were diagnosed with schizophrenia in hugely unproportionate numbers in comparison to their percentages in the general population.
It was a big question to us as to why that is happening.
So we got together, 4 young psychologists and did a piece of research about 4 ethnicities in Hackney. Vietnamese, Orthodox Jewish, African-Caribbean’s, and Turkish. What we found through semi structured interviews was that access to talking therapy was full of barriers.
The main themes in the qualitative research identified were: 1) Confidentiality and trust was an issue, creating a sense of shared understanding with mainly white middle class therapists was problematic; The development of the therapeutic relationships required further attention and was not straight forward; and lastly – belief around mental health and help seeking were stopping these BME communities from seeking therapy.
At the discussion part of the research, we made certain recommendations:
Transparency and choice throughout the process of therapy was seen as particularly important.
Explicitness around confidentiality, and open negotiation of therapy contracts and endings.
Supportive partnership, working with community organisations was suggested as well.
This could ensure therapist’s sensitivity and respectfulness around cultural and religious differences.
This research is now 12 years old. And things still have not completely changed.
While I am no longer working for the NHS, my impression is that BMEs in the UK are still suffering from Access to talking therapy.
I am working at Harley Street area, in a co – op of therapists and psychiatrists, “The Green Door Clinic”. I am thinking particularly about one lady, Afro – Caribbean by origin who struggled so much while working for a large financial institution in the city of London. She suffered indirect, highly ‘hidden’ and ‘polite’ racism, was not mentored properly, was left out of coffee breaks and pubs after work-informal meetings. Her work was under evaluated, and eventually she got so stressed she had to sue her employers, and they settled out of court. Over that time, I supported her via therapy. Being the highly educated lady that she was she knew to seek help, and she received it well enough. However, what she experienced was on another facet level of society, not dissimilar to the young black males of Hackney that I met 13 years earlier. We still have to go a long was as a society to break barriers of stigma around both BMEs and mental health.
Happy mental health day to all of us, clinicians and clients alike!
Morgan, Khan, Mc Farlane, Thomas and Ram du Sautoy, (2009), Access to talking therapies: The views and experiences of people from Black and minority ethnic communities in secondary care in East London, Clinical Psychology Forum, nu 196. Pages 37 – 40.
I would like to explain how and what we do while working in an integrative holistic therapeutic way from a psychological perspective.
Integrative therapy refers to the bringing together of the affective (emotions), cognitive, behavioural, and physiological systems within a person, with an awareness of the social and transpersonal (above the personal, can be spiritual) aspects of the systems surrounding the person”
In our clinic we utilise embodiment work (such as Iyengar yoga and the breath via mindful meditation). These are practiced with compassion focused therapy emphasising the quality of understanding with courage and kindness particularly towards the self. This is mixed with some Dialectical Behavioural Therapy (developed by L Marshall in order to work with clients of Borderline Personality Disorder or Emotionally Unstable Personality Disorder). Additionally, we emphasise Emotional Focus Therapy, a therapy that is based on attachment theory and states that relationships are at the base of any human conflict.
The combination of the above mentioned with yet another third wave therapy ACT Acceptance and Commitment therapy is effective and useful. ACT is about our values and goals as well as the tenacity / behavioural activation that are needed in order to get to achieve those higher values in small steps. We merge it with some ‘deep CBT’ i.e. schema work, in which we are exploring our core beliefs and rules for livings/ assumptions about life. These rules often lie underneath or daily thoughts and behaviours and may need challenging and acknowledgment.
The integration of all these therapies with a lot of awareness to the body movements, to the breath, while practicing some postures via yoga-therapy, examining one’s nutrition, practices of walking, running, clean water, toxins coming into the body, is the wholistic part of our work. We regard these physical measures to be one with the mind. We also
Weave in socialising, charity work, and spiritual dimension if the client is so inclined to complete the discussions.
Due to working interactively and holistically, where one window gets closed another door gets opened: it’s not a ‘one stop shop’: it’s not only CBT or only psychodynamic. While we are informed by psychoanalytical short-term work (ISTDP) and we are aware of Freud, Jung, Adler and Cohut very important work- we are not throwing the baby with the bathwater -but our main practice is science based.
Where our Integrity of therapeutic work lies: where working in this way – it is mirroring the philosophical stance of CAT: Cognitive Analytical Therapy that integrates both a behaviour cognitive behavioural therapy and Psychoanalytical Therapy. This got constructed by Anthony Riley around 1980s. Anthony Riley was a Psychiatrist working in SLAM, South London and the Maudsley NHS Trust. He came up with this theory in which the personality of the individual is made out of many segments just like a pizza and that sort of model means that we think about the person as a multi-layered entity. We are able to think about it like slices of a pizza or a cake. For the Pizza to be whole there is the need to integrate all its parts into a bigger whole and not split into segments that are exaggerated in importance or taken out and never thought about. We may bring that analogy back into the different therapeutic modalities mentioned above. For example: we might follow this by a therapy session in which we are using ACT for Acceptance and Commitment therapy because we are emphasising the goals and the values of life of the individual and then we move into another segment of the personality that might facilitate that behaviourally. For example: “Values -me- part” flows into “Competent-me- part” or “active-me-part”.
Traditional classics CBT in which we might do behavioural activation meaning making the client go for a run or walk, tidy his/her room, and brush their teeth. Often, client may be very much in depression and the ignition of the engine is not ‘on’. The client needs to be activated from the foot down as opposed to from the head down.
Via Dialectical Behavioural Therapy (DBT) There might be another session when the client is getting to integrate the emotional mind with a rational mind as well as the body mind. Noting that they don’t have to choose between one part of themselves to another they can integrated in what initially seems as a conflict. It is actually a one whole me. We do that in order to create emotional regulation and it’s a principal exercise of the DBT theoretical modality. In addition we might work on distress tolerance principles for a client with anxiety Similarly, we may be tapping to phobias work through c b t for Anxiety.
Penultimately, Carl Rogers Person-Centred therapy – C Rogers (1960s) is very much connected to the Attachment-based work that came 10 years prior by John Bowlby (1951). He emphesised the unconditional love from care giver to the child ( client) and the condition that society at large (parents included) place upon the adult. Emotional Focused Therapy (EFT) is very much at the core of our work, and there Dr Sue Johnson (1980s) emphasised how as adults we live and re-live our attachment styles from childhood.
Lastly I’d like to add the illustration of Reilly’s pizza part of the personality as well as a Freuds model of the house of the personality and perhaps Carl Rogers person centred approach as well can be mentioned where the relationship of the mother child the unconditional love is at the heart and at the bases of another kind of structure of personality and that we integrate into the overall therapeutic modality.
What tips would you give to people who find social media is making them depressed or anxious?
Leave social media if you feel it is an unsafe place. You would not go into work with people who are being rude or harming to you. If you walked into a school playground- would you walk into that social circle where bullies are? Or would you go to the other side and avoid? Would you go into a pub that you knew your drink had been spiked before, you would not allow yourself to be in a place of harm again eg cover drinks, keep yourself safe. etc.
Leave the space temporarily. Make a contract internally between you and yourself about what you will allow and permit. A procedure in place EG What do I do if I’m bullied, called fat, called stupid. Who do I go to for support? Who do I share with? How do I protect myself?
Need to address it like a physical scenario- a lot of information about bullying physically is currently available, but not much about social media space about your mental health.
Dr Shani Ram Du Sautoy, Harley Street & Fenchurch Wellbeing Centre
Was written for the literary Salon of Mrs Emily Kazriel, West Hampstead, London with the theme of ‘disguise’.
If you google ‘disguise’ and Psychology what comes up is information about Halloween, hiding our appearance via scary costumes that represent death, and fear. This short talk today will indeed touch on fear and death.
David Malan, a famous psychiatrist from the Tavistock centre, North London came up with the ‘triangle of men/ women’, also known as the ‘triangle of conflict’. Imagine a triangle standing on its corner with two equal edges emanating from the corner. The bottom represents our unconscious sphere of mind, and particularly the emotions and urges that reside there. Malan asserted that because we are unaware of those emotions, they create physiological anxiety in our body, and this is the second corner of our triangle. Now we are (sometimes) aware of this excess anxiety, and in order to ‘deal’ with it we move to the third corner of the triangle – we act to defend ourselves from the uncomfortable feelings but acting psychologically in various ways. Some of these may be denial. And repression of emotions, avoidance of feeling or thinking about what bothers us, or feels ‘wrong’. Dissociating from our emotions is one way in which we disguise from ourselves and the world the way we truly feel. Indeed being invisible is perhaps the best disguise of all rather than pretending to be something you are not.
It is always useful to consider a case study.
I have been working for some years with a lady, in her late thirties. Let’s call her I.R. (*Details have been changed for confidentiality reasons).
She was born as the youngest of four children; her three older siblings were significantly older. Her mother died when she was 6 years old. Her father sent her to boarding school soon after. She had to learn to swim or drown rather quickly. She had made friends and studied well at the boarding school, but when she travelled back home to visit dad over the holiday she did not maintain contact with her school friends. She had learnt to never speak about her bereavement pain, or the loss of mother, as father was not emotionally literate (being an engineer he was a man of deed, not talk), and I.R learnt to split away her different internal parts. Her emotional part had to be hidden away. When she graduated she went on to University, and served in the police force, as well as being a high manager in two high tech companies. She bought herself a soft doll at 18, and kept carrying this ‘transference object’ (an object upon which she poured her soft emotional parts) wherever she went. She got married and had one daughter. Age 38 she tried to commit suicide, as her managerial position did not seem to be a challenge any longer and her daughter went to boarding school and did not seem to need her much. When I met her she was post the suicide attempt, completely dissociated from her body, looking very passive in her reclining chair, nearly closed eyes, very disconnected from her body and the world. She had donned an invisibility cloak to disguise what was happening beneath.
The space is too short to report the journey of therapy, but I will say that the way to lift the disguise was via yoga- psychology, engaging I. R. with her body, making her stand on her head (literally at times!), laughing and giggling about ‘losing control’ and viewing things from an embodied different perspective.
Last but not least, on the topic of Disguise: I travelled to Israel last weekend to visit my 106 years old Grandma Kika (Rivka) Ram who is disguising herself in the body of a very old lady at the moment. She can hardly see, hear or walk, and has no teeth to eat with either. Since she is internally still very young and full of life. She asked me: ‘Shani, how would Grandpa Yaakov recognise me when we meet again up there’?
The second thing she said was: ‘what a shame it is that one has to die’!
So, lets’ keep celebrating life, in transparency (of emotions)!
The Eight limbs of Yoga are the ‘right means’ to achieve the aim of yoga: stilled senses, rested mind, with steady control of the sense and mind. These principles of the yoga philosophy, as collected by Patanjali, in his classical work the Yoga Sutras depict the ‘art of living’ and consists of 8 fields. This eight-fold path offers guidelines for a meaningful and purposeful life. It is a prescription for moral and ethical conduct, and self discipline. In Patanjali’s yoga sutra, the Eight fold path is called Ashtanga (which literally means Eight limbs, Ashta is Eight, Anga is Limb). These guidelines direct attention towards one’s health and help to acknowledge spiritual aspects of our nature. The Eight fields are:
(1) Yamas, five social ethics
(2) Niymas – five personal practices
(3) Asana, postures
(4) Pranayama, mindful breathing
(5) Prathyahara, turning inward
(6) Dharana, concentration
(7) Dhyana, de-concentration
(8) Samadhi, Pure bliss.
Utilising these eight right means helps to ‘poise the soul and enable one to look at life in all its aspects evenly’ (Mahadev Desai , Introduction to Gita according to Gandhi).
This essay will focus on the first two Yamas and Niyamas.
Yama is the first limb. One’s ethical standards and sense of integrity, focusing on behaviours and conduct of self. These five social ethics are the ‘do not do’ self – restraint rules. Yamas are universal moral commandments practices that relate best to the rule ‘do to others as you would have them do unto you’. The five parts of the Yamas will be explained as a principle and as they resonate in my own life.
A). Ahimsa – that means heart opening and non-violence. This means not to kill or be violent but also has a wider meaning of ‘to love’. This love embraces all creations (Iyengar, 1966, p.12). Men either kill for food or in order to protect themselves from danger
‘A vegetarian diet is necessary for the practice of yoga, but is not enough to guarantee that a man is not aggressive or violent, just because he/ she is vegetarian’ (Light on yoga, 1966, p. 12). In my personal life I am a raw vegan and do not wish to inflict death and violence onto animals. In my political affiliation I am left wing and do not support violence as a way to resolve conflicts between social groups or states. As a Jewish woman, Ahimsa reminds me of the commandment of ‘Do not kill’, the sixth from the 10 commandments in the Torah (the first part of the old testament). An example of an event that took place many years ago in Jerusalem, Israel: I was demonstrating with an organisation called ‘women in black’ in central Jerusalem for peace and against the occupation at the west bank, Israel, and some passer by spat on us. We did not react to the provocation.
B) Satya – Truthfulness. Mahatma Gandhi said: ‘Truth is G-d and G-d is truth’. Reality in its fundamental nature is love and truth and expresses itself through these two aspects. Satya presupposes perfect truthfulness in thought, word, and deed. It is echoing the 9th commandment in Judaism: “Thou shalt not bear false witness “ which implies “to be a witness of the truth at all times”. It is extremely important for me to stay honest and truthful, and as transparent as possible with family, friends and clients alike. This stems from a personal experience where in childhood, my biological father died in the Israeli army when I was age 16 months, and my mother’s trauma and shock meant that when she married my step-father, (I was age three years old) she concealed from me the fact that he is not my biological father. The ‘lie’ was revealed when I was 16.5 years old and had to have an Identity card with a surname I did not recognise… the impact of this revelation made me a warrior for truth for the rest of my days.
C) Asteya – Non stealing. The desire to posses and own what another person has drives a person to do evil deeds. (Iyengar, 1966, p. 14) This is also extended to misappropriation, breach of trust, mismanagement, and misuse. The yogi reduces his physical needs to a minimum, believing that if he gathers things he/she does not really need he/she is a thief. This third Yama corresponds to the fifth Yama ‘Aparigraha’.
It also exists in the Eighth of the ten commandments ‘You should not steal’. As a teenager I ‘experimented’ in stealing due to a friendship with an orphan girlfriend who stole. As I grew older I recognised the ethical values I held to more deeply, and acknowledged that no matter how small these offences were, someone worked for those items, and in essence it was fundamentally not inline with my principles to do so. When practicing as a psychologist I am extremely careful not to break the trust that my clients give me. I feel honoured to hold to their inner world secrets, and feel extremely strong about not committing ‘Asteya’ in the sense of breach of their trust. This means that confidentiality is above almost all other issues (apart from self harm).
D). Bramacharya – Means to know the Brahama, to reach the soul, so that the practitioner should practice yoga with complete involvement, with the purpose of reaching the Brahama within (Iyengar, 2001, p. 22). It also means the life of celibacy, religious study and self-restraint. However, it is not about forced austerity and prohibition. It is a man (or woman) who studies the sacred Vedic law and who sees divinity in all (Iyengar, 1966, p. 15). Patanjali lays stress on continence of the body, speech, and mind. This does not mean that the philosophy of yoga is only for celibates. On the contrary, the Smrtis (codes of law) recommend marriage, as without experiencing human love and happiness it is not possible to know divine love (Iyengar, 1966, p. 15). It is important to recall that observance of Brahmacharya brings knowledge, vigour, valour and energy (Iyengar and Iyengar, 2002, p. 88).
The ancient rishis divided life into four parts. The first twenty years of your life, you focus on acquiring knowledge. This is called Brahmacharya. The essence of Brahmacharya is that you should not run after pleasure. One who runs after pleasure cannot acquire knowledge (from: artofliving.org, 2018)
This rule can be interpreted as cultivating moderation, which is an important part of healthy functioning. For example, when a person is facing a lot of stress, finding a path of Brahmacharya will help them to maintain balance (Simpkin and Simpkin, 2011, p. 122). An example of this from my own life is that when I am stressed around work or other issues, I often eat too much telling myself that I ‘deserve it’ because I am so tired/over worked. However, with awareness, I try to be mindful of this, and eat in moderation, and not excessively. I find this practice challenging and that it requires awareness from moment to moment.
E) Aparigraha – Non greed/ covetousness, Non possessiveness, non-grasping. The last of the Yamas seems subject to a variety of translations some of which are included here. Most commentaries, however, seem to interpret this Yama in relation to material possessions and turning away from the seeking and holding of such possessions. In essence advocating a simple life with a lightness of attachment to ‘things’. (Retrieved from: https://www.yogaallianceprofessionals.org/articles/yoga-circle-5-aparigraha-non-possesiveness-non-grasping-3682). Parighara means hoarding or collecting. …The yogi makes his life simple as possible’ ( Iyengar, 1966, p. 16). Often, the need to hold to objects is a transference of insecure attachment to main care givers who had vanished in early childhood of the individual. An example is my dear friends Suzie (name has been changed for confidentiality purposes) who was sent to boarding school age 7, and always wished she could have stayed nearer home. In adulthood after her parents passed away she went back to live in their home, (her childhood desirable ‘object’) and filled that space up to table level (70 cm) from the floor up with collected items such as old yogurt pots, old eggs cartons etc. (‘I might need it one day to create a work of art with my daughters’…, she is an art teacher by education). After this had hindered her life quite severely, and post a few conversations about how her obsessive compulsive hoarding might stem from the above described reasons she was able to start contemplating letting go of this behaviour. However, at times of stress this often returns as insecurity increases.
The Yamas and Niyamas encourage people to act according to values, such as not being greedy or stealing. When people can handle difficulties without violating their ethical principles, they come out of it stronger, with inner confidence. Likewise, therapy can show people how to draw from the strength of standing with their values (Simpkin and Simpkin, 2011, p. 123). I utilise Acceptance and Commitment Therapy that uses exploration of one’s values in order to align the patient with their inner wishes and beliefs and reduce psychological conflict.
The next five are Niyamas…. the ‘Do’ commandments.
Niyamas are the rules that apply to Individual discipline. The five Niyamas listed by Patanjali are: Saucha ( purity), Santosa (contentment), Tapas (Austerity or ardour), Svadhyaya (study of the self), and Isvara pranidhana (dedication to the lord).
A) Saucha – means cleanliness, purity. Purity of the mind speech and body is a basic rule that keeps humans on a path that leads to wellbeing. The practice of asanas tone the entire body, and remove the toxins and impurities caused by over indulgence. (Iyengar, 1966, p. 16). Pranayamas cleanses the lungs, oxygenates the blood, and purifies the nerves. Students of yoga should observe internal cleanliness and bath each cell of the inner body through good blood circulation and flow of energy (Iyengar, 2001, p. 22) . In my personal life internal purity via physical exercise includes meditation, yoga, running, walking mindfully, diet of live raw food. It all clears the mind and keeps the energy flowing.
B) Santosa – Contentment. This means acceptance of others and of one’s circumstances as they are. Good health derived from ‘Saucha’ leads to contentment. We need to be content in order to be able to concentrate. Tranquillity and contentment are states of mind. Differences between people create conflict, which destruct people (for example power imbalance between men and women, poor and rich, educated and uneducated). ‘The wind of desire tempers with the flame of tranquillity’ (Iyengar, 1966, p. 18). In my professional life I often witness power imbalances, and empathize with the conflicts it creates within my client’s minds and hearts. Yet, the golden dialectical rule is to accept the loss that had happened while still wishing to move forward into the desired change. Creating this dialectical space of acceptance while striving for change is in order to allow for relative ‘Santosa’, or contentment. For example while working with women or men who suffer from eating disorders that are highly linked to body issues, we work on acceptance of the body as it is, thinking of the body current shape as ‘good enough’. We are aiming to reduce negative behaviours such as bulimic eating, purging, and the like, and simultaneously striving to construct the desired thinner or healthier body that the client desires. The ‘Santosa’ arrives when the behaviours feelings and thoughts are in balance between the two states of acceptance and desire. It is important for me to stress out that Santosa does not mean acceptance equal to no change. It means acceptance while striving to change.
C) Tapas – (‘Tap’ means burn) Austerity, self discipline. ‘Burning effort under all circumstances to achieve a definite goal in life. ‘Character building’ is the practice of tapas. By tapas the yogi develops strength in mind, body and character. This relates to the three types of tapas: Body, mind and speech. He gains courage, wisdom, integrity, straightforwardness, and simplicity.
In my personal life I had to develop self-discipline due to the diabetes. I have to run or walk for my health, regardless of the weather outside, or my levels of tiredness/wish to exercise. Similarly, during the adoption process of the twins that took 2.5 years it was necessary to utilise perseverance, and carrying on doing our best, when often things went off the rails, and moral questions arose.
D) Svadhayaya – (‘Sva’ means self and ‘Adhyaya’ means education). Hence: study of the self, self-reflection, and introspection of one’s thoughts, speeches and actions. In my professional life my main pursuit and way to help others is assisting them to be self-reflective. In order to do this I have to be ‘hyper’-aware of my own issues, thoughts, and feelings. The premise of western psychology is that self-awareness is a necessary and helpful tool to connect the unconscious to conscious mind, in order to be able to have choice in our actions and reactions of the external (and internal) world. Hence counselling and clinical psychologists have to be in therapy during their training, and keep on being in supervision during their years of professional practice.
I used to write a diary that helped me keep in contact with my inner self, and use my partner and friends to be reflective while hearing myself talking to them about my conflicts. Painting, drawing and photography were also other creative tools that helped me to be introspective, as I was a designer for many years, and via theses creative arts I could stay longer in a reflective mode, around the people/places that were curious for me.
E) Isvara Paranidhana – Dedication to the lord of one’s actions and wills. ‘Attunement to the supreme consciousness’ (Iyengar, 1966, p. 19). ‘The practice and study of yoga with devotional attention on god is meditation’ (Iyengar, 2001 p. 22). As a secular Jewish woman, it is hard for me to relate to the word ‘God’ in its traditional meaning in a monotheistic western society. However, my own personal meaning is a transpersonal entity. I have a sense of attunement to a supreme consciousness ‘power’, and have felt connection to such power in particular existential junctions in my life. For example, when I lost my 39 weeks embryo and woke up into the A&E part of hospital, I felt connected to the universe/cosmos larger powers, and felt that this event/power that had created loss and had taken my fertility ability will also enable me to grow and develop as a result of it. I did not understand the rhyme or reason for it, but could feel that I will have the energies to go further with that or despite that loss.
Another moment in which I connected with this transpersonal consciousness was while sitting by my mother’s bed side during her last night of living. It was 3 am and I was reading Psalms for her, letting her go. It was a form of meditation for me, and I hoped that through the morphine drugs she could feel my presence, and go on her way with peace. In yoga terms I practiced devotional attention through these words of ancient Hebrew Jewish prayer. It was a moment of ‘Isvara Panidhana’.
The belief in higher power as encouraged in the fifth Niyama fosters positive expectations that can serve as a guiding light through dark times. (Simpkins and Simpkins, 2011).
In summary, the Yamas and Niyamas encourage people to act according to values, such as not being greedy or stealing. When people can handle difficulties without violating their ethical principles, they come out of it stronger, with inner confidence. Therapy can show people how to draw from the strength of standing firm with their values (Simpkins and Simpkins, 2011). This is where the convergence between my passion to practice yoga and my professional life takes place.
S R d S. 30 Sept 2018
Dr Shani Ram du Sautoy. C Psychologist.
Yoga, the path to holistic health, the definitive step-by-step guide. (2011) B.K.S Iyengar, Dorling Kindersley, UK.
Basic guidelines for teachers of yoga (2002), B K S Iyengar and Geeta Iyengar, Iyengar memorial yoga institute, Pune.
Simpkins A M and Spimpkins C A (2011) Meditation an Yoga in Psychotherapy, Techniques for clinical practice. Wiley, UK.
https://www.artofliving.org/yoga/patanjali-yogasutra/knowledge-sheet-70, retrieved: 23 09 18)
The ten commandments (According to the Jewish Torah)