The Artist's Frame: Let’s Talk about Boundaries

Boundaries are important for healthy communication and relationships with yourself and others. It is about not carrying others' emotions for them and getting clear on your needs. We can think about boundaries as an artist's frame where we can control only what's on the inside of the frame and how we communicate that to others. Everything else remains outside of us and our control. Before we get into how to start setting boundaries, let's define the word 'boundaries'. 

What are boundaries?

Boundaries can either be physical or interpersonal. These can look different for everybody, depending on culture, the relationships we are involved in, and social context. What is comfortable and natural in one culture doesn't necessarily translate into another. Equally, some people are naturally more comfortable hugging, whereas others may need more space. It is also necessary to consider the social context. Boundaries in relationships with our partners or families may look different from professional ones. Therefore, boundaries are flexible and fluid and can look different for everyone, depending on culture, personality and social context. 

How to start setting your boundaries?

If you are not used to setting your boundaries and speaking your needs, it can take time to get used to. But like with everything else, the more you practice, the easier it gets. It is important to show compassion to yourself during the process if it doesn't come naturally to you. Consistency is key. Let's dive into some examples of boundary setting:

1. Self-awareness

   Being aware of your needs, what you feel comfortable with, and what not is essential so you can start taking the following steps. Notice how you feel after spending time with people? Do you feel energised or depleted? Is that feeling the same with everyone, or does it differ? Suppose we feel exhausted after spending time with some people. In that case, we may have weak boundaries in certain relationships or with ourselves. These can look different, depending on the relationship we are in. Therefore, be mindful of your thoughts, emotions and feelings since it helps to understand what you might need to feel better.

2. How do you want to feel when setting a boundary?

   Think about how you want to feel when interacting with others. Stay true to yourself and be honest with yourself. Starting to set boundaries can often leave us feeling bad and guilty about ourselves. Know that it won't stay like this forever. It's also worth saying that not everything other people say to us is true. Notice that the next time you are spending time with others. Is this something that resonates with you and you know is true, or does it come from their beliefs? Give this time because this clarity may not come overnight. Keep practising this skill and getting to know yourself throughout the process.

3. Learning to say no

   The ability to say no is easier said than done. It might feel scary to say no to someone at first. It may bring up discomfort since it's not something we are used to. As a child, it wasn't safe for you to express your needs. It might've been seen as a weakness rather than a strength which led you to say yes more times than you would've liked to. As adults, we have control over how we respond to situations we didn't have when we were children. It is about learning to say no with warmth and kindness. If others do not respect these boundaries, it can tell us more about the other person. We can then address this with them.

   Moreover, there is no need to explain to the other person why you set a boundary or apologise for establishing one. For example:

   • 'I'd be willing to help you with this task, but not today.'

   • 'I won't be able to make it today. Can we reschedule it for another day?'

4. Expressing your true feelings 

   Expressing your feelings openly and respectfully can be daunting, but it comes with practice and is hugely valuable. Being open about what you are or are not comfortable with—being aware of your needs and staying grounded rather than being triggered to a particular situation. If you get triggered, notice that and remove yourself from the situation to keep yourself safe. You always have options.

   • It is not bad or selfish to express your feelings openly. Sometimes, we are not used to it due to our childhood, where expressing our feelings may not have been allowed.

   • Being vulnerable can bring discomfort if you are not used to speaking your needs. Don't worry. This is natural and will get easier the more you practice.

   • Talking about your experiences honestly (in safe spaces).

   • Addressing problems and conflicts directly with the person involved rather than indirectly with a third person involved.

   Talk about your expectations and needs rather than letting other people try to figure out what you need. Unfortunately, we don't read each other's minds and often can only make assumptions about the other person's thoughts. It is worth addressing this directly with another person, however difficult that may be.

5. Setting emotional boundaries

   Emotional boundaries help us feel empowered and to know what we can and cannot take. For example, not setting emotional boundaries within family relationships or a partnership can leave us feeling drained, exhausted, guilty, or resentful. However, having clear boundaries is for the benefit of you and the others involved. Starting:

   1. Think about which boundary you would like to set.

   2. Communicate that to the other.

   3. Don't over-explain yourself.

   4. Why is that boundary necessary for you?

   You may feel guilty or selfish when first starting to set boundaries. Notice how you are feeling when you start communicating your needs. Are you saying what you're feeling? Is the other person listening to you? You can bring these feelings into therapy, where we can dive deeper into why you may feel that way.

Final thoughts

Boundaries are like a muscle. They require practice and consistency for us to figure out how to communicate more effectively with those closest to us, as well as in professional relationships. Try not to give up after your first try when it doesn't go as expected. Equally, don't forget to respect other people's boundaries throughout the process when interacting with those close to you, be it in family or professional relationships. 

If you feel like you are ready to start therapy, or want to know more about how I work, schedule a consultation call with me below or contact me at arulacounselling@proton.me. I look forward to hearing your thoughts. 

Please note: This is for educational purposes only, and is not to substitute a therapeutic relationship with a mental health professional. If you are in a mental health crisis, please call 112 or your country’s crisis line, where professional mental health workers can help you.

What Happens in Music Therapy?

Music therapy is the clinical and evidence-based use of music interventions. Music is a therapeutic tool to accomplish individualised goals within a therapeutic relationship by a credentialed professional. These interventions address goals such as alleviating pain, managing stress, anxiety and physical symptoms, supporting self-expression, enhancing memory, and improving mood and communication (AMTA, 2022). But what really happens in music therapy, and how can you benefit from it?

What happens in music therapy?

In music therapy, music serves as a medium for processing emotions and feelings. As opposed to talking therapy, the emphasis is more on non-verbal expression, working with an embodied approach. Let's look at how we can use music in therapy sessions.

Music listening

Listening to songs that have a special meaning evokes memories. It may be a song from childhood, a song you listened to on repeat during your teenage years, or something that reminds you of home. Another form is discussing the song's lyrics, meaning, and how these songs make us feel. It can significantly impact your understanding of yourself and your mental health, connect you to your culture and make sense of your early experiences.

Playing in therapy 

Playing together enhances connection and improves our well-being. For example, playing a rainstick or a handpan can create relaxing and soothing sounds that can be especially effective with ADHD. I have noticed that sometimes clients need a little encouragement when starting. When they listen to me playing a few chords on the piano or the guitar, clients may feel more relaxed and at ease in playing together and experimenting with sounds. Beginning to let go of anxious feelings that may arise. Playing together gets easier the more we play. It is about having fun with it and letting go of any expectations you may have for yourself. 

Writing songs

Writing can be a great way to express yourself. You are putting your thoughts and feelings on paper and finding a sound and a melody that matches the song's emotions. In music therapy, you can participate in one-to-one or group sessions. Meaning you will be in a relationship with others who will support you along the way. Songwriting supports connection and communication and helps to express thoughts and feelings creatively. 

Musical meditation

If feeling too overwhelmed, doing a simple breathing exercise to ground ourselves and let us come back to our bodies can have a significant effect. Listening to instrumental music, or music played live by the therapist, supports stress and anxiety and relaxes us into the present moment. It can be effective when working with complex and overwhelming feelings.

Drumming 

When drumming together, we can experiment with different sounds and dynamics, such as playing louder or quieter and trying out different rhythms. After playing, we can reflect on the playing and what happened in the music. Drumming helps us get more into our bodies and out of our thoughts. When overwhelmed by your thoughts and emotions, drumming can create distance between them and alleviate anxiety.

Online music therapy

Online music therapy emphasises working with the body, verbal expression, meditations, and vocal sounds since we won't be able to play simultaneously. There might not be access to instruments, but we can still work together in an embodied and musical way. Technology continues making connections and finding creative ways of expressing ourselves. 

Who can benefit from music therapy? 

Music therapy suits every age group, from infants to older adults. I specialise in working with trauma, substance misuse, depression, anxiety and neurodiversity. I use music as a tool to facilitate attachment and human connection. However, the techniques mentioned above are not necessarily used in sessions at the same time. By working together, we can explore what works for you. These are only some of the techniques that may be used. 

If you feel disconnected from yourself, struggle to make and maintain relationships, and make sense of your experiences, I look forward to hearing from you. You can contact me here or email me at arulacounselling@proton.me. 

References

AMTA (2022) American Music Therapy Association. 

Playing in Therapy

Play is a natural part of us. It lets us be creative and in flow with our whole beings. We begin to play from an early age, being curious about the world through sound, smell, taste, and touch. As we grow up, the ability to play may diminish, depending on our experiences in the world. When we are unable to play, or the ability to play is disrupted, something is holding us back. Something is telling us that we are not safe to express ourselves fully, that it is not safe to be 'ourselves'. 

The importance of play

British child psychiatrist D. W. Winnicott (1971) has said,

‘It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in playing that the individual discovers the self’.

It is about getting in touch with the younger part of us that we may have been trying to ignore and suppress for a long time. Showing compassion towards that part of us, giving them attention, showing them that it is safe to be in the world. We can begin to get curious about that part through art, which can act as a safe space to have feelings in.

Free improvisation

One of the foundations of music therapy is free improvisation. It is based on the subconscious principle, where music informs what is happening inside the person. Improvisation helps to connect us to our past experiences, integrate them with the present, and bring up memories or feelings we may not have been aware of. In therapy, we can start to better understand these experiences and work through them verbally and musically.

Principles of free improvisation:

1. Using creativity in therapy

No previous musical skill, such as knowing how to play an instrument or sing, is necessary to benefit from music therapy. What's important is to participate in the musical exchange and express yourself in a way that feels right to you. There is no right or wrong way of doing that. Through playing within the therapist-client relationship, you can start to gain clarity about your internal processes and behaviours since sometimes we cannot put our feelings into words. Some experiences are more somatic and challenging to describe. Hence, through non-verbal and free expression, you can start to make meaning of your felt senses. 

2. Authentic expression

As sometimes it is easier to hide behind words, you can start to let yourself free from these defences through free improvisation. The way you play and use instruments may give us a glimpse of what might be going on for you, connecting your body and mind. It takes time to feel and be comfortable in our bodies and learn how to express ourselves in a new way. It may be connected to our self-esteem, anxiety, fear of being seen, or fear of making mistakes. By slowly working through these feelings in a safe space, you begin to make room for yourself.

3. Expressing yourself in a non-verbal way

Humans are preverbal. We all have rhythm and sound before we have words. Therefore, expressing yourself musically can connect you to your early life experiences when you didn't know any better. We can now start to make sense of that and show ourselves compassion. Expressing emotions, thoughts and feelings in words can sometimes be difficult. Through improvisation, we have an opportunity to give them space. This provides another layer of expression and helps us better understand our emotions and work through them.

Working with a client through play

In client work, improvisation can be used anywhere in the session, depending on the client's needs. The intense feelings that are difficult to express in words can be expressed through music. In working with a client of mine, I offered to choose an instrument that described their feelings in the moment. They chose a small harp and started to play delicate and fragmented sounds on the instrument. After listening for a little while, I started playing the guitar with some soft chords. The sounds melted into each other, creating a safer environment for the client to express what they felt. Afterwards, we reflected on the music where they were able to translate their experience into words. We were able to unpack what was happening in the room and make sense of it. As a result, they felt more at ease and relaxed which wouldn’t have happened by only using words.

Connecting with your inner child through play

We are all surrounded and connected to play. It gives us information about how we interact with other people, play with the world, and express ourselves. It is important to show self-compassion towards us when this doesn't come naturally to us. Connecting with your inner child may be difficult at first but where can we begin? Here are some questions you may ask yourself:

• What does play mean to you?

• Do you allow yourself to play?

• Do you feel stuck or unable to play at times?

• Do you feel self-conscious whilst playing?

• What are the blocks, if any, that are holding you back from expressing yourself fully?

Doing that in a safe space and in a relationship with the other supports having shame around it. We can start to interact and connect to ourselves in a way that we may have forgotten or never experienced before. This way of working with play can fluctuate between verbal and musical expression. However, improvisation is not a substitute for the verbal expression but rather an indirect medium of expression where difficult material can be explored and an interpersonal relationship can be strengthened. 

Get in touch with me

I offer online and in-person counselling in Berlin. If you would like to participate in therapy with me, please contact me here or email me at arulacounselling@proton.me to arrange a consultation call. The first call is to get to know each other, explore the possibilities of music therapy and assess your suitability for treatment. After that, if you would like to continue with therapy, a consent form will be filled in, and a start time will be agreed upon. I look forward to hearing from you.

References

Eno, B. (2022). Apple Music podcast with Zane Lowe.

Rogers, P. (1992). Issues in working with sexually abused clients in music therapy. Journal of British Music Therapy, 6(2), 5-15.

Winnicott, D. W. (1971) Playing and Reality. London: Routledge. 

How Trauma Affects Our Bodies

How does trauma show up in our bodies and how can we start to heal ourselves, create change and get better? Can our bodies really tell what is going on? How can we start paying attention to it?

What is trauma? 

Trauma is not something that happened to us, it is what happened in us after we experienced it. A complex childhood environment, neglect, moving countries frequently as a child, abuse, broken relationships, and bullying can all leave us with long-lasting effects. Trauma can show up through physical pain, feeling disconnected, not finding joy in what used to lift you up or having intrusive memories that disrupt your daily life. 

Understanding the impact of trauma 

Traumatic experiences can leave us feeling overwhelmed, dissociated from ourselves and others, feeling sad, anxious, numb, agitated, or confused. Trauma shows up different in all of us, depending on our environment and circumstances, depending on social structures, race, gender and sexuality. Hence, there is no straight-cut answer to who gets traumatised and who does not and wounds can run deeper than we think.

Can trauma be stored in our bodies? 

Trauma can show up as an intolerable felt sense such as psychosomatic pain from emotional and mental stress. It may be a tightness in your chest, neck, or back without any seaming reason. In therapy, we can start to work with these sensations and get curious about why that may be. What are our bodies trying to communicate to us? Hence, relieving the nervous system from hyper-arousal such as feeling anxious or overwhelmed or hypo-arousal, like dissociation, numbness, feeling unmotivated or stuck is vital for our emotional regulation and well-being.

Working with trauma 

When we work with trauma on a pre-verbal level, we can start to unlock our painful experiences. Getting curious about our felt senses through breathing, movement and non-verbal expression. Gabor Maté has said that artistic expression itself is not a form of working through trauma. However, working through trauma in a relationship with the other such as in a therapeutic relationship is invaluable in creating change. Someone who can hold space for your thoughts and emotions, be it artistic expression or through words, has a different kind of value. Someone who is there to receive and reflect back on what might be going on for you. For people who have grown up in stressful households since early childhood, the absence of stress can create a sense of unease, boredom and meaninglessness. People may become addicted to their stress hormones, adrenaline and cortisol (Maté, 2003). Therefore, creating new neural pathways and ways of thinking, re-directing you from your old beliefs has immense value. How can we start to create awareness of our bodies and create change?

1. Checking in with yourself:

Use this five-point check-in when you are feeling overwhelmed, anxious, or disconnected: 

1. Mind - notice your thoughts and mental focus

2. Breath - are you restricting or holding your breath?

3. Body - notice your body's sensations

4. Emotions - what about feelings and associations?

5. Energy - do you feel fatigued or energised?

Emotional regulation plays a big part in how we connect to ourselves. For some clients, breathing can be a great anchor. For some, singing or vocal sounds are the most comfortable in grounding themselves. You can use this check-in throughout the day to notice where your mind and body are—checking in with yourself and your feelings. 

2. Finding your community

Having a support network around you who can support you and understand your experiences is good for our well-being and a part of taking the step towards healing. Winnicott has said that there is no such things as a baby, but that we are all related to one another, dependant on one another and we all deserve to have that care and supporting environment.

When living in a city different from where you grew up, the language may be different, the culture may be unfamiliar and you are in an unfamiliar environment. In this case, having a solid support network around you is important. Finding community and the people that support you through your difficult experiences, who can be there for you and understand your experiences.

3. Noticing your environment:

• Do you feel safe in your surroundings?

• Do you feel supported by others?

• Do you have people around you who you can turn to in times of difficulty?

• How do you feel when you're around them?

• Do they lift you up?

It's okay if you answered 'no' to these questions. The purpose is to just notice where you are and how you feel in your environment. There is no judgment. From this place, we can start to make slow changes. Maybe it is about coming to therapy and finding a safe place there. Perhaps it is about going to nature and finding your safe place there for a start or deciding to make changes about the relationships with people who make you feel good. Meditation and visualisation exercises can also create these places in our minds. 

4. Working with the body 

Working with the body grounds from our thoughts that may be overwhelming and triggering. Observing your breath and how the body moves and feels through movement, art-making, or music creates awareness. Through these mediums, we can slowly return to our bodies, building connections and starting to feel and see ourselves as a whole. Being more present, mindful, grounded in making decisions, and connecting with others. We don't always have to know what happened to us, but our bodies know. It stays with us. This means that we can change its course. We can take action and responsibility towards healing. We can start to learn about ourselves and show compassion towards ourselves.

Trauma is complex, challenging and a long-term process. And it is even more difficult to be alone in it. But working together with a therapist treating trauma can support healing and understanding yourself. You shouldn’t have to go through it alone. I look forward to connecting with you to discuss your needs and whether I could be of support to you. I am an English-speaking therapist in Berlin, offering online and in-person counselling for adults. You can contact me here or email me at arulacounselling@proton.me.

Disclaimer: If you live in an abusive household, you can find your closest counselling centre in Berlin here. If you are thinking of hurting yourself or others, please call 112, where professional mental health workers can help you. 

References

Maté, G. (2003) When the Body Says No: The Cost of Hidden Stress. Penguin Random House.

Siegel, D. (1999) The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. Guilford Publications.

Winnicott, D. W. (1960) The theory of the parent-infant relationship. The International journal of psycho-analysis, 41, 585–595.

ADHD - Finding Peace in the Midst of Chaos

October is ADHD (Attention Deficit Hyperactivity Disorder) Awareness Month. Therefore, we will discuss the symptoms of ADHD and focus more on ADHD in adults. How does ADHD influence us, what about getting assessed, and how can therapy support an adult diagnosed with ADHD? If you’re looking for ADHD support for adults in Berlin, here is how counselling can help.

What is ADHD? 

ADHD is one of the most common neurodevelopmental disorders in children and adolescents, with symptoms present in 3-10% of school children. ADHD is three times more common in boys than girls and is usually passed on into adulthood. However, diagnosing ADHD in adults is more difficult since they have learned to mask their symptoms. 

ADHD symptoms

ADHD is characterised by poor impulse control, difficulties concentrating, restlessness, fidgeting, tics, and hyperactivity. Dr Gabor Matè has stated that ADHD is not a disease, but a byproduct of not getting our attachment needs met in childhood. Genetic risk, metabolic diseases, immune disorders, infections, physical trauma, toxic environment and neglect may contribute to ADHD. It may be associated with other mental health conditions such as depression, anxiety, dyslexia, learning difficulties, developmental disorders, and speech and language disorders. 

Early childhood environment

For young children, there is a need for attention and emotional regulation, the importance of attuning to the child, being present with them and offering physical and emotional security. Children are more vulnerable to environmental stressors, sensitivity to the environment, and not being soothed when distressed. A stressful childhood environment with no consistency or predictability creates a lack of trust, possibly leading to zoning out or a 'freeze' response as a coping mechanism, making the pain more bearable. 

Moreover, schools or other systems we operate in may be trying to fit children with ADHD into society's norms, ignoring their needs that are different from the 'norm'. However difficult it may be for the teacher or other professional to attend to everyone's needs, it always comes a long way. Including parents or caregivers in treatment plans is equally important, offering the child the appropriate support for healthy development. 

ADHD in adults

Untreated ADHD can impair work performance, damage self-esteem and interfere with relationships. It can also reduce the chances of success and satisfaction in life, leading to substance misuse and distracting yourself with other activities rather than sitting with the pain. Studies show that the brain retains neuroplasticity throughout life. The brain continues to develop new pathways and synaptic connections to environmental stimuli. Meaning without the change in the environment, the brain cannot create new circuits of the mind relating to self and the world. Having ADHD doesn't mean there is a flaw in one's personality. There may be distress, loneliness and confusion that the adults may be unable to express. Separation of the mind and body, where the mind keeps wandering in another direction. Sometimes, the person can be highly interested in certain motivating activities. 

What can therapy offer for adults with ADHD?

Therapy offers a safe space to explore any difficult feelings or triggers. It allows you to explore your patterns and behaviours and make sense of your inner experience. It is important to note that a therapist is not qualified to assess you for ADHD but can guide and support you in your process. 

How can music therapy help with ADHD?

Oliver Sacks, neurologist and author of Musicophilia, has said: "Nothing activates the brain as extensively as music". Music helps to relieve tensions and express yourself through play. Sometimes, there is no need for words. Music has its own pulse, rhythm, breathing and movement. As music evokes different emotions, you start to gain clarity about the processes within yourself in a safe environment and by reflecting on your experiences with a therapist. 

This type of therapy involves cognitive, emotional and social processes. The treatment uses musical interventions to support concentration, self-expression and social skills where the relationship between client and therapist is at the centre of therapy. However, creative activities such as free improvisation, listening to music, songwriting, movement and art can be used alongside words. Through these activities, the therapist guides the client towards specific therapeutic goals. 

1. Providing structure

Providing a framework through regular weekly sessions creates predictability and safety that you may lack in your daily life. It forms a boundary from where you can start to explore your emotional and behavioural patterns with the therapist. The client's self-confidence and sense of achievement can be supported and enhanced through goal-oriented activities. 

2. Safety and self-expression

Feeling safe is vital for growth and healing. From this environment, you can start to understand yourself better. Moreover, self-expression is one of the core values in music therapy. Music is a way to express yourself and convey and understand your emotions. Sometimes, expressing yourself through non-verbal means is safer and more accessible than words, finding new ways of relating and having fun with it. Expressing yourself in a way that feels comfortable and right for you. 

3. Supporting focus

Playing music or other forms of self-expression supports attention skills, where we pay attention to the body and mind. Listening to music activates the whole brain compared to speaking. Purposefully playing a musical instrument, writing songs, singing or listening to music can help you concentrate better and help make new neural pathways in your brain. 

4. Supporting social skills

Music and the arts offer opportunities to support communication and find new ways of interacting. Creative activities help to communicate in a more accessible way where no words are needed since we don't all communicate in the same way. Making yourself heard, validated and accepted in a therapy space helps you implement these skills outside the therapeutic relationship. In therapy, looking at and understanding your parental relationships and family history helps to make sense of your experience and create awareness. 

Getting assessed for ADHD as an adult in Berlin 

ADHD assessment is done by a psychiatrist or professional with the appropriate qualifications. Getting a diagnosis can be a source of relief and helps to validate your experience. Although some people prefer not getting an assessment for ADHD because of stigma or personal reasons. However, a diagnosis will help you get the appropriate care you need and enable you to adapt your school or work environments according to your needs. 

Conclusion

Not everyone's brain works in the same way. Offering compassion, listening and being valued for who you are goes a long way. In addition to learning about your emotional and behavioural needs and patterns in therapy, we may also explore parental relationships and family history. It can be terrifying to sit with your mind but doing that in a safe and trusting space can make all the difference. 

Contact me here if you think you or your loved one would benefit from counselling or music therapy.

Please note: If you are in a severe crisis, thinking of hurting yourself or others, then call 112, and professional mental health workers will be able to help you. Arula Counselling is not designed to offer help in immediate mental health crises.

Building Resilience

How can you build resilience in your life to cope with the difficulties that life throws at you? You may want to run away in these moments to hide from conflict or anything else that requires your attention. During the current climate crisis, the war and rising cost of living make finding peace in and around all of us even more complex. How do you stay grounded during these times to protect yourself from hardships and move through life? 

What is resilience?

Resilience is surviving and thriving from stressful experiences while building defensive skills to manage future difficulties. It is about successfully adapting to complex or challenging life experiences and finding ways to rely on your resources. However, building resilience requires a skill set you can work on and grow over time. Let's look at what these might look like. 

Dissociation from difficult feelings

When you confidently face difficult emotions instead of shutting them down, you can integrate your thoughts and feelings and make sense of them. Nonetheless, because it is difficult and uncomfortable to sit with painful feelings, you may try to get further away from them. This leads to dissociation from your emotions. You may start to numb yourself with alcohol, food, other substances, or social media, creating a distance between your mind and body. Additionally, this builds a loop of endless distractions rather than having to focus on your inner feelings. It may also be by avoiding conflict and expressing how you really feel. This can be extremely difficult, but when getting comfortable with being uncomfortable, that's where growth lies. 

How to build resilience?

When leaning into the feeling of discomfort, you may notice that there is emotional and intellectual movement. Slowing down, focusing on your breath, seeing what comes up and being curious. Below are some of the ways you can start to build resilience during difficult times. 

1. Self-awareness

Self-awareness is about being aware of your thoughts, emotions and feelings. It is about noticing the way you behave or react to something. To begin seeing your reactions, think about why you might've reacted the way you did? Were you actually feeling hurt, rejected or abandoned? You can then think about what you really need. It may be that something needs to change in your life that is not making you feel fulfilled. Maybe you need some more time to focus on yourself and your needs. We all need to look after ourselves first before helping others. You may turn to your community and be open and vulnerable about your needs, even though this may be the hardest thing to do. 

Ask yourself: 

• How is my relationship with myself?

• Do I show kindness and respect towards myself?

• Am I able to regulate my emotions?

• Am I able to speak about my needs?

When you open yourself up to the possibility of showing your deeper feelings, people can start to understand you better and offer help and guidance where needed. 

2. Nurturing relationships

How are your current relationships with others? Do you feel supported and connected to them? In relationships, we feel more empowered and worthy when developing more prosperous and meaningful relationships. To care for others and be cared for. Nurturing relationships takes time and commitment. When you engage in secure relationships, it enhances your intellectual development, sense of worth, sense of competence, empowerment, and sense of connection. However, sometimes making and keeping relationships is complex, and you may not know why that is. Together with me, we can start to unpack your relationship patterns by creating a trusting and safe therapeutic relationship. These learnings can then be transferred from sessions to your relationships outside therapy. A sense of trust will always be at the centre of relationships. 

3. Relationship with your external environment

Do you feel comfortable, safe and at ease in your surroundings? If not, what makes you feel uncomfortable? How do you express yourself if you live in a city different from where you grew up? What led you to live in another town? Having a solid support network with people who value you for who you are can significantly impact how you see yourself and move through life. Living in a city with lots of noise and busyness, we may start to feel disconnected, burnt out and drained. Notice your environment. If it doesn't make you feel good, what can you do to make yourself more at ease? Going to nature and taking long walks? Perhaps you need to change your living situation to make you feel better? Take it one step at a time, and don't rush the process.

4. Trust

Sometimes, it is frustrating to sit with our feelings and emotions. Trusting that this will create the change or transformation you are trying hard to see or reach. A movement starts happening when leaning into it, allowing yourself to feel your feelings and sit with the discomfort without thinking of the outcome. Letting go of control, change begins to occur in your body and mind. 

Questions to ask yourself: 

• Am I getting enough sleep?

• Am I going outside?

• Do I eat healthy meals?

• Do I numb myself with food or alcohol?

• How much time do I spend on social media?

• Am I kind to myself?

• If I have people close to me, do I try to connect with them?

• Do I ask for what I need?

Resilience in therapy

In therapy, growing resilience might mean coming to the sessions when you feel your lowest. Still showing up when you don't want to and feel like there is no point in coming to therapy. You take accountability for yourself when you show up weekly, creating strength. Learning from your patterns and behaviours and creating awareness. This allows you to make changes, be aware of your thoughts and emotions and not fall into the same ways that might feel familiar.

Therapy facilitates emotional catharsis and empowerment. It connects to others and strengthens concepts of the inner self, addressing trauma and creating hope for the future. Bringing these complicated feelings to the space allows us to work through them, developing resilience. It will enable us to manage these emotions in the longer run, where we adapt more quickly. It gives us trust that these feelings will pass and that we can move forward in life. However, resilience requires work and commitment and doesn't happen overnight. 

Building resilience together

Having mental health strength doesn't mean that you have to be alone in it. It is okay to ask for help and to talk to someone you trust. Everyone is different and requires different care, and reconnection with yourself takes time. Allow yourself to heal and give it time. This can be through noticing our feelings and physical symptoms in our bodies. Leaning into these feelings through play, awareness, connection and taking care of yourself first. There is always a way out, even if you don't feel it right now.

I am an English-speaking therapist in Berlin, offering online and in-person counselling. You can reach me here or email me at arulacounselling@proton.me. I look forward to connecting with you.

References

Fava, G. A., and Tomba, E. (2009). Increasing psychological well-being and resilience by psychotherapeutic methods. Journal of Personality, 77(6), 1903-1934.

Fonagy, P. and Campbell, C. (2017) Mentalising, attachment and epistemic trust: how psychotherapy can promote resilience. Research Department of Clinical, Educational and Health Psychology, University College London, London. 

Scrine, E. (2021) The Limits of Resilience and the Need for Resistance: Articulating the Role of Music Therapy With Young People Within a Shifting Trauma Paradigm. Frontiers in Psychology, 12.

Using Music to Relieve Stress and Anxiety

What is anxiety? 

Anxiety is a feeling of unease such as worry, fear, stress, restlessness, tension or overthinking. These are all healthy responses to stressful situations where your body releases cortisol (a stress hormone) to respond to them. When we feel threatened, cortisol is valuable in protecting us, creating a fight-flight-freeze reaction. Fight or flight prepare our bodies to fight against the threat or to escape the situation. Your breathing gets quicker; your heartbeat fastens; muscles tense — your body is ready to react quickly. In freeze response, we feel like there is no opportunity for us to escape, which numbs our feelings physically, emotionally and mentally.

Common types of anxiety disorders

People with anxiety disorders experience repeated episodes of these sudden feelings, which may lead to anxiety, disrupting daily tasks. There are many anxiety disorders, the most common ones being generalised anxiety disorder and social anxiety. Let's look at these below.

1. Generalised anxiety disorder 

   In generalised anxiety disorder, there is constant worry or fear that the person cannot control. You could have sleep difficulties, the tension in your muscles, restlessness, problems focusing, fatigue, or irritability. 

2. Social anxiety

   In social anxiety, you may feel anxious when having to be at the centre of attention, perform or socialise with others. Because of the intense feelings you feel around people, you may start to isolate yourself from these stressful situations to relieve your triggers. However, some performance and social anxiety are standard, which doesn't necessarily mean you have social anxiety. 

Common symptoms of anxiety

Anxiety symptoms can range from:

• having restless thoughts

• difficulties falling asleep

• thoughts of worry

• overthinking

• tension in muscles

• shallow breathing

• sweating

• sense of unease

How can music help to relieve stress and anxiety? 

Studies have shown that music can lower our cortisol levels, reducing stress and anxiety. Music connects us to ourselves, being aware of our emotions, and processing our feelings. When we start accepting our anxiety, leaning into it and letting go of control, we may begin to notice how the feeling is something to be curious about. Music addresses our cognitive, emotional and social needs. Below, I have listed some musical techniques to use when feeling overwhelmed and stressed. These can be used in your own time and adjusted to your needs. 

Active music-making 

In active music-making, we use instruments or our voices to create sounds and music in real-time. This involves active participation from your side and may be more exposing. Below, I have listed three active music-making techniques to relieve stress and anxiety.

• Vocal breathing

  We breathe at all times, but it is the quality of the breath that counts. Notice your breathing pattern – is it slow or fast? Is it surface level, or do you breathe deeply from your diaphragm? Once you are aware of your breath, begin to take deeper breaths, closing your eyes if this feels comfortable, placing one hand on your belly and one on your heart. Inhale from the nose, exhale through your mouth, relax your shoulders, placing both feet on the ground. As you exhale, let a sound out with your voice. It might feel uncomfortable initially but trust the process and be open to whatever happens. You are safe.

• Songwriting  

  Think about something that you are struggling with at the moment. Is it a question that you are curious about? Are you delaying a task that you'd rather not complete? Maybe you're feeling confused and need some clarity. Write down anything that comes to mind. You then have a topic that you can use for your songwriting. Start picking out some words that capture your attention, creating a map of these and grouping lyrics together. You may add music to these. Writing down words that reflect your current state can help to create awareness of your emotions and process your feelings. 

• Playing an instrument 

  If you have an instrument at hand or anything else that makes a sound, you can start experimenting with them. These can be quiet on a guitar, or maybe you want to express your anger on the drums. Get familiar with what comes out. There is no need to think about it, but just leaning into the task and letting go of your thoughts can be a great way to release any stale emotions. Voice can be another one to experiment with and is accessible to most of us. 

Music listening 

Music listening is a passive form of using music to relieve stress and anxiety. This can be either listening to your favourite song or putting on a relaxing playlist that helps you ground yourself. Let's look at some of these techniques.

• Putting on a song that reflects your current mood

  How do you feel right now? Is there a song that you associate with your current mood? Does it have any lyrics? If so, what is the message of the song? This may be your favourite song you are listening to on repeat, or you might shuffle your playlist and see what comes up. Whatever it is, trust the process and notice the lyrics or the melody. Do they reflect your current state of mind? Is it the complete opposite? Is there perhaps a feeling that you've been avoiding? Listening to a song that reflects your mood can be a great way to gain awareness of your emotions.

• A curated playlist to keep your mind calm and grounded

  I have added here a list of songs that I have used in my sessions to help my clients calm their minds and stay grounded in the present moment. You can either sit down on your chair or lie down. Try to find a comfortable position that suits you. Close your eyes and put on the playlist. You can focus on one particular feeling, or let your mind wander. Don’t worry if you get distracted by your thoughts. Just notice it, let go of them and come back to the music, to your breath.

• Creating a playlist

  You can begin creating your own playlist that resonates with your identity and feelings. You can start by listening to songs that come up and see whether you feel a connection to them. Spotify also suggests songs that sound similar to the songs in your playlist. You may find certain themes coming up. Trust the process and note these songs down. Give them a listen in a comfortable space. Notice if these songs have lyrics or are they instrumental? Are they fast or slow? These playlists are unique to us and can help us find a connection to ourselves.

Do what makes you feel good

Start by picking one technique that feels most comfortable. Perhaps you find that breathing exercises work best for you? Maybe writing is your thing? You can try out some of them and then decide. What is important is that you are curious about your emotions and feelings and what comes up. 

I am an English-speaking online counsellor in Berlin. You can contact me here or via email at arulacounselling@proton.me. I look forward to connecting with you. 

Benefits of Online Therapy

We have been living in such uncertainty and unknown for the past two years. Aside from the coronavirus-related anxieties around physical health, it has equally affected our mental health. We may be experiencing higher levels of isolation, loneliness, stress, depression, and anxiety.

What are the benefits that online therapy has to offer?

Some of us may be going through agoraphobia (fear of leaving the house) or may be fearful of being in contact with another. However, this should not limit our access to mental health support, where starting with online therapy may be a great option. Research has shown that online treatment can be as effective as in-person therapy. Let's look at some benefits online therapy has to offer, what happens in online music therapy and what the benefits of in-person therapy can be.

Accessibility

One of the main benefits of online therapy is that you can access sessions from anywhere with a good internet connection. Either from the comfort of your home or a space where you feel safe. You don't have to travel long distances to get to the therapist's office anymore. Equally, if you live in a remote area, have physical limitations or disabilities, which makes it harder for you to travel, online sessions may be a more suitable option. 

Flexibility

Online therapy offers flexibility to fit your schedule. If you cannot attend therapy and need to cancel a session in time, the therapist may be able to provide you with an alternative time that fits your timetable. There is also flexibility in accessing the right specialist who will be able to help you with your specific needs. Whether you want to access a therapist who speaks your mother tongue, or someone who can relate to your experiences of living abroad, finding the right therapist is no longer a limit. 

Structure

Online therapy offers a weekly structure to take time for yourself and attend to your needs. With your therapist, you can explore what might be going on for you and make sense of your experience. You may be able to attend sessions more regularly when feeling down since you don't have to leave your house, and therapy may still be an option to offer you mental health support during these difficult times. It may be vital to come to therapy exactly then to be able to work through the most challenging emotions and feelings.

Creating distance

Compared to in-person sessions, working with a therapist online may help to open up more quickly. It may reduce the intensity of the sessions since the therapist is not sitting across from you, which can make you feel more at ease when talking about your experiences. The comfort of your home may already be the catalyst to creating the safe space you need - another benefit of online therapy.

Presence

Because online therapy applies the same principles as traditional face-to-face therapy, it may be more suitable for your pace of life. The therapist's presence can facilitate the flexibility of thought, thinking through details, and identifying patterns. Additionally, the relationship supports the ability to make connections and feel connected to your feelings in the session, thereby creating change. Research confirms that online therapy services can have the same mental health benefits.

Benefits of online music therapy

In music therapy, online therapy services may look slightly different from in-person sessions. Because of the latency in video calls, we won't be able to play together and share the same musical space. Still, we may be using listening to music for relaxation, guided imagery, or art-making. We may take turns in playing music if instruments are available to you and if that's what you want to explore. However, this is not a requirement and will not define whether you benefit from therapy or not. 

Benefits of in-person therapy

Virtual therapy may not be suitable for everyone. Going out to a therapy practice may be essential when you live in a home where you don't feel safe or where it is difficult to find a quiet space. Bringing that up with your therapist or family doctor is essential to provide the best care for you. In-person therapy is still recommended if you have suicidal thoughts, psychosis, severe addiction, or complex symptoms of a mental health condition. Having a weekly routine of going to therapy may offer a secure structure and get you out of the house, which may be a step towards your recovery.

Conclusion

If you are struggling with completing daily tasks, feeling anxious or low in mood, then working together with a therapist can help you talk and express your needs and figure out what you might need to help relieve your pain. We are all different and require a unique kind of care. If this resonates with you, I look forward to connecting with you. I offer online and in-person therapy in Berlin. You can contact me here or email me at arulacounselling@proton.me. 

Please note: If you are in a severe crisis, thinking of hurting yourself or others, then call 112, and professional mental health workers will be able to help you. Arula Counselling is not designed to offer help in immediate mental health crises.

Podcast: Therapy Talk with It's Complicated

On a dark November evening, Kadri and founder of It’s Complicated and a psychologist Johanne Schwensen recorded a podcast on Music Therapy. They talked about the possibilities of music therapy, who can benefit from it and Kadri’s journey to becoming a music therapist. Have a listen above.

You can find Kadri’s It’s Complicated profile here and her Bandcamp here.

Music written and produced by her.