This article appeared in the New Zealand Herald on Thursday the 18th of February, 2016.  Click here for the original…

Meet the Herald Life & Style’s new columnist, psychotherapist Kyle MacDonald, here to answer your queries and concerns about mental health.

Kyle MacDonald has rapidly become one of the country’s most prominent psychotherapists – a practicing professional with a strong and growing public voice he uses not only to help people deal with their lives but also to fight for a better mental health system.

As a young man, his interest was in understanding “how people tick”, an interest that led him to psychotherapy, which he has now been practicing for 15 years.

He has become a vocal commentator on issues like how social and political factors contribute to mental health and wellbeing, and the politics of how therapy is funded or, more specifically, not funded.

He blogs regularly on his website psychotherapy.org.nz, produces a podcast on social anxiety called The Confident Mind and has developed the website overcomingsocialanxiety.com as a way to spread the word about the value of therapy and to start making therapy and therapuetic ideas more accessible to the public.

He says that therapy, “May be the most underrated – and is certainly the most underfunded – health intervention in New Zealand.”

“We know it works better than medication in many instances – mild to moderate depression for instance – but for many the idea of ‘going to therapy’ still carries more stigma than simply taking a pill. Sadly, it’s also more expensive than the pills.”

In short, he says, there is clear evidence that talk therapy works, and that it can help people make substantial and meaningful changes in their lives. What’s important to him now is to make sure that people get access to that help.

“I think we need to now be talking more and educating people about what good treatment looks like, so as a country we can ask for, and lobby if necessary, for best practice treatments to be funded and available. As a country, and the depression and suicide stats tell us this, we all need to be thinking more about what good mental health looks like, and how to stay mentally and emotionally well.”

MacDonald hopes to carry on the good work that has been done by people like Mike King on his Newstalk ZB radio show The Nutters Club, to destigmatise mental health treatment.
He says that therapy is for anyone who wants to make changes in their life. There are the obvious triggers, like anxiety, depression, drinking issues, relationship struggles, but if you’re curious, he says, you’re likely to gain something from it.

“I’m not going to say everyone should try it, but it can be really helpful if you find yourself stuck or struggling emotionally with something in your life, you don’t have to be “depressed” or “ill” to see a therapist.”

He adds that it’s important for people to find the therapist that is right for them. Research has shown that the ‘therapeutic relationship’ between client and therapist is an accurate predictor of therapy’s effectiveness.

In his own practice MacDonald employs a range of tools to help clients: “I’m a firm believer in practical tools like mindfulness, exercise and so on, but also in taking time to really think through and figure out how to make the changes that need to be made.

“Some people get what they need in weeks, some in months, and some, particularly if they’ve experienced a lot of childhood trauma, may need years. People need what they need.”

“Often, people just want to know, ‘Is this normal?’ and as I often say, ‘If you do my job for long enough you realise there is no such thing as ‘normal'”.

• Every Thursday, Kyle will answer a reader question. Send your query here and check back next week for his answer.

So often these days we focus on being productive, that it’s easy to forget that we all started our learning through play. A recent article in the New York Times raised concerns about how many to case on meeting increased focus on structured learning at the cost of unstructured play, and sadly we see the same trend occurring in New Zealand is it a childhood education.

It’s a topic I’ve talked about before (see: Playtime and Mucking about) because play is how children learn, and it’s also a “language” that can be used to help children via play therapy. Mark and I talked about this on his Sunday morning show on Radio Live this week.  (Click here to listen to the interview)

From a certain point of view of course it can seem to make sense that to learn more you should start structured teaching earlier.  Surely that would help, right?

However to undervalue play, particularly in children under the age of six, is to misunderstand how human beings develop and learn.  Not only does teaching from a younger age not help, but some research suggests in fact it may be doing harm especially for children under the age of seven.

“A 2009 study by Sebastian P. Suggate, an education researcher at Alanus University in Germany, looked at about 400,000 15-year-olds in more than 50 countries and found that early school entry provided no advantage. Another study by Dr. Suggate, published in 2012, looked at a group of 83 students over several years and found that those who started at age 5 had lower reading comprehension than those who began learning later.”  (Click here for the article)

And play isn’t just about learning in the traditional sense, it’s also about learning social skills, physical dexterity, and emotional regulation. And this is how play therapy can be so useful.

““Play is often perceived as immature behavior that doesn’t achieve anything,” says David Whitebread, a psychologist at Cambridge University who has studied the topic for decades. “But it’s essential to their development. They need to learn to persevere, to control attention, to control emotions. Kids learn these things through playing.”  (Click here for the article)

The origins of play therapy go back to Anna Freud in Vienna and Melanie Klein in Berlin in the first half of the 20th century. Both women used play therapy as a means to understanding and healing what they believed to be a complex time during which children understood pain and suffering.

Klein saw the child’s play in therapy as similar to an adult’s free associations and therefore a window into even very young children’s unconscious, particularly surrounding experiences of abandonment, envy, and rage.

Since Klein’s time a host of research has shown play therapy is effective for children as young as 2-years-old up to their teens.

Simply put, play therapy works.

The idea of men (and it is usually men in the myth) on the brink of forty leaving their wife, changing careers, marrying a younger woman and starting a new family is well embedded in our popular culture: but is it real?  Is there such a thing as a mid-life crisis?  Mark Sainsbury and I talked about this on his Radio Live Sunday morning show this week.  (Click here to listen to the interview)

The midlife crisis, as a construct, was born in 1965 thanks to a psychoanalyst called Elliot Jacques and popularized by Daniel Levinson in his book “The Seasons of a Man’s Life”.  The central ideas is that each life stage requires people to overcome and meet certain challenges, and this can result in a crisis.  Critics of Levinson’s research point out that he interviewed a small sample of people (around only 40 professional men) and from this formed his central theory.  However the idea took hold in popular culture, in part at least because everyone knows someone who appears to have had a mid life crisis, and in part I believe because it is simple way to think about a complex issue.

More recent detailed studies show that actually a lot of what people might consider to be a midlife crisis is actually a crisis that just happens to have occurred in middle age…

“According to a continuing national study of midlife funded by the National Institute on Aging, 26{1b812f7ed7a77644fff58caf46676f6948311bf403a3d395b7a7f87010507f87} of adults ages 25 to 75 report having had a midlife crisis. Among respondents who are 50-plus, slightly more, 35{1b812f7ed7a77644fff58caf46676f6948311bf403a3d395b7a7f87010507f87}, say they’ve had one.  But in the group that includes 30- and 40-somethings, only about half who reported having a midlife crisis said it was triggered by “inner turmoil and angst associated with getting older,” says Margie Lachman, a professor of psychology at Brandeis University and a researcher on the study. The rest of the crises, she says, were linked to problems that aren’t unique to midlife, including job loss and divorce… …Moreover, about the same proportion of study participants say they experienced crises at other points in their lives.”  (Click here for the rest of the article)

So there is at best very weak evidence for a crisis that is directly triggered by simply entering the phase of life called “middle age.”  And add to this that the life satisfaction literature tends to say that for many happiness increases at the time we turn forty, and continues to grow across the rest of the lifespan…

“…life satisfaction increases significantly from the 40s to the 50s—and again from the 50s to the 60s—as children and careers mature and salaries reach peak levels. While midlife is often a time of stress, Prof. Wethington says, those between the ages of 40 and 60 also “have the resources and experience to manage more daily stress than younger people do.” Midlifers, she adds, are “champion copers.”  (Click here for the rest of the article)

So is there such a thing as a midlife crisis?  No, but that doesn’t mean there aren’t unique and specific challenges associated with this phase of life.  It also doesn’t mean you can’t get depressed, re-evaluate your life, or otherwise struggle for a plethora of reasons in the middle phase of life.  Just that it ain’t the number on your birthday cake that is the problem.

So if you’re creeping up on your forties, rest assured, turning forty in and of itself isn’t going to cause a crisis.  In fact, make the most of it because it’s likely things will in fact only get better from here.

Do you remember learning to ride a bike?  Some of us do, and some don’t.  However I bet none of us remember learning to walk, yet we still know how to do it.  This is the difference between implicit memory, learning to do things, and explicit memory which I talked about in my last blog.  This week Mark Sainsbury and I talked about childhood memories, and the role of implicit memory especially as it relates to psychotherapy.  (Click here for the audio of the interview…)

There are some ideas in psychotherapy that on first inspection can sound a bit weird.  But increasingly the science of neurobiology is showing us that some of Freud’s key insights into the functioning of the human mind, memory and consciousness were accurate.  Without doubt the most accepted of Freud’s now famous theories was the existence of an unconscious mind, and the way in which acting from our unconscious can cause us problems.

Related to this is an idea key to many theories of psychotherapy: transference.  Transference is a way of understanding how patterns of relationship, often patterns that we learn when we’re very young, keep getting repeated and played out in our adult relationships and lives.  Psychotherapists try to be alert to these patterns when they show up in the therapeutic relationship so they can be bought into consciousness, by noticing, describing and talking about them, therefore making them subject to change.

But what does this have to do with riding a bike?

Explicit memory as discussed last time is the memory for the “when and where:” the autobiographical memories.  In contrast implicit memory is essentially unconscious, we don’t need to remember when we learned to ride a bike, or tie our shoes to be able to know how to do it.  Learning these kind of tasks and then being able to carry them out relatively automatically is also known as procedural memory.  We don’t tend to develop an autobiographical memory until about 3 1/2, yet from the moment we are born we are developing implicit and procedural memories about the world, learning how to be and how to do things.

“The ability to fix a childhood memory strongly enough to last into adulthood, psychologists now say, depends on the mastery of skills of attention, thought and language at the level of an average 3- or 4-year-old. People simply do not retain into adulthood memories of specific episodes that took place at 1 or 2, before these crucial abilities emerge, although research like that with Rachel shows that as young children they do, indeed, have such memories.” (Click here for the whole article)

 So the modern research supports the idea of what has been called “childhood amnesia”, simply because before the age of about 3 1/2 the faculties required to make autobiographical memory doesn’t yet exist.  But on the other hand implicit memory does, and implicit memory is unconscious, practice based and while you might struggle to tell someone how to ride a bike, it’s nevertheless easy to get on one and do it.

You never forget, as they say.

Under the age of three we implicitly learn a massive ammount about how to regulate our emotions, about how others respond to use when we’re upset or need soothing, what happens when we call out for help, and what it feels like to have someone close to us both physically and emotionally.  This is all implicit learning, and if it doesn’t go well it can cause us significant problems in out adult life.

You see, we might not know why we expect other people to not be interested in our emotions, or our expressions of distress, we might have no rational explanation for why we are terrified of being rejected when we express anger, but  it motivates our behavior anyway.  This is the unconscious in action.

And when these patterns keep showing up in life, we call them unconscious patterns of behaviour.  And when they show up in the therapy room, between a client and myself, I would call them transference.

Shining a light on these patterns enables us to be able to understand and change them, in much the same way as any other behavior.  But it can be next to impossible to know about these patterns, let alone change them, without being in a relationship that triggers them, and being able to talk about the patterns when they emerge.

Ultimately to learn how to ride a bike, you must actually be on a bike.

“The poets and philosophers before me discovered the unconscious; what I discovered was the scientific method by which the unconscious can be studied.”

 Freud, from The Interpretation of Dreams (1899)