 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is the therapy show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to the next episode of the therapy show behind closed doors with Bob Cook and myself Jackie Jones and in this episode we're going to be looking at working with Lauren as a clinical condition. Yes, I won't give a parallel on football matches because I'll probably frustrate you. I'm sitting here alone talking to you so I feel there's a connection, I feel that we're on the zoom, I don't feel loneliness, a sense of loneliness at all but I want to make a separation between the terms alone and loneliness. There are two different things. You can be alone in, you can feel alone in you know where there's thousands of people you can still feel alone. Absolutely, yeah. Does it mean you feel lonely? It's another story but if we talk about loneliness we must talk about in the terms of mental health which is what really this podcast is about. So when I do assessments at the institute and I pass them on to therapists I have half an hour and one of the really important questions I ask is always in terms of do you live alone? Yeah, that's your support mechanisms. Yeah. When people feel a desperate sense of loneliness that can often lead to depression, lack of self-esteem, anxiousness and from there often acute withdrawal. Yeah. I look for a definition of loneliness by the way so I just put loneliness into Google. Okay. And it says the definition of loneliness that we use, this is the website they've gone to is called a better help, better health I think. Loneliness is a subjective, that means it's unique to ourselves, all right, comma, unwelcome feeling of lack or loss of companionship. That means the other. Yeah. And you can feel as I said it's really important this is because when people feel their loneliness which they may feel is just subjective to them I should think from that often becomes mental health problems or maiden. Yeah. So that is why you hear many in many efforts or many pleas or many especially at Christmas go and check your neighbours out. Absolutely. Live by yourself. Yeah. Because loneliness will lead or can lead to a very unwelcome state. Yeah. And I agree what you said you know at the beginning of this that you can you can feel alone in a room full of people and as soon as you said that for me it kind of there was something about a sense of belonging that we need to feel like we belong somewhere or we have a purpose or something along those lines in order to feel like we're not alone. Yeah. And you know it's loneliness is an it's a internal state. Yeah. I say do yeah I live alone but you know I have many friends I get out I can do this I do that have a very structured life and even though they live alone or they have a alone solitary life they may report to you but they don't actually feel lonely. So when I'm talking about loneliness I'm talking about the internal state of loneliness which is usually a very deep feeling of being cut off from the other. Yeah. I think about despair as well when you think about loneliness I think of you know what I mean yeah yeah and no hope and all those sort of negative things yeah. If you think of it as a clinical condition yeah yeah then that is I think an input you see it's not in the DSM for the diagnosis statistical manual as a mental health condition but I see it as a mental health condition because of what it can lead to. Yeah. Somebody feels internally lonely they often cut themselves off from society they have then have to rely on only validation from themselves they're insular their reality is very narrow the world becomes smaller and smaller in fact they could lose touch with reality. Yeah. And it's a dire sparing state to be in. Yeah. To see somebody you know suffering from extreme loneliness I would imagine he's quite rare in a therapy room because for them to reach out to a therapist is that something that you would do if you were in that you know state. It's an interesting question that is people can come to therapy because they feel they're not in touch with reality or they may come to therapy because they feel cut off from the world or they might come to therapy because they know something is wrong or they might come to therapy because they just know that without social contact of some sort they get depressed or whatever it is. Yeah. They might come to therapy when they feel depressed and down they might come to therapy when they feel anxious and as you go down the layers of the anxiousness or the depression or the lack of self-esteem it may come across an extreme sense of loneliness. So what would you do in the therapy process? What would you do in the therapy room then? You mentioned self-esteem then would you kind of work on that side of things? Well my first step I think would be to do what they call in TA script analysis in other words in other language I'd want to know their story. Yeah. Now in them telling me their story I would ask practical questions which is do you actually live with any support? Do you have any resources? So I do the I'll be setting up practical stuff listen to their story and also I wouldn't right away go down the layers and look at the developmental self but I'd be thinking about when in their history have they felt so desperately a low stroke lonely. So is this a client who comes with such extreme neglect that they are so cut off from the world that they feel utter despair and desolation that come into therapy is their last hope and from that position I know what I know what we're working with but the first step is to learn their story. Yeah. The second step would be to get the contract what they want now might take a might take a very long time to get that but the third step is to really find out the origins of the desolation and loneliness before we go anywhere else. Yeah because the practical side of things you know what I mean are quite important what you know you touched on a few though but it's like lack of social skills can you know what I mean if we can't pass time with people and connect with people that can you know lead to us being lonely you know. So it's about how far do we go in the therapy room modelling things you know if they're an introvert all that sort of stuff all personality types can have an impact on us and whether we connect with people and build relationships appropriately and all these sort of stuff so there's an awful lot of stuff there isn't there. Yes we haven't even touched about the other side of the consumer that's neurodiversity. Absolutely yeah yeah where they are kind of cut off and separate and yeah. Black empathy perhaps. Yeah. Old and black and white have problems in social relationships and understanding social cues. Yeah yeah. I feel different from the world. Yeah. Now that may not be the same continuum but it's a very important continuum to look at. Absolutely. Of course of what decisions they may have made about themselves and other people from that. Yeah. So there's a whole world of neurodiversity to really know about and that's why I said we need to know their story first before we make any clinical contracts. Yeah and you know do you think society plays a part in this as well now you know compared to how it used to be in the good old days. I was having this conversation with somebody I can't remember who it was but you know in the olden days therapy used to take place over the garden wall you know we would talk to our neighbours and that I've got an old bloke that lives next door to me and he often just sits on the bench outside the front of his house and we have a chat when I'm walking past and things but it's the older generation that tends to do that a lot of the younger generations they haven't got a clue who lives next door to them or anything. But they do have a clue. Well yeah maybe they do and they avoid them. I was thinking in terms of social media. Yeah. Instagram all the TikTok all these sorts of things the most lonely people are often people who are so immersed in the world of social media. Yeah and the pandemic do you know what I mean that's not helped us with how we interact with people you know I've got clients even now that you know when we came out of lockdown really struggled to reconnect with people again after so long and you know if they were sheltering for health reasons and things like that. Yeah there's all those sorts of things however somebody is talking from extreme loneliness after you've discovered their story the end goal in many ways not the end goal sorry not the end goal at all sorry a goal on the way is around contact with you the therapist in other words yeah because in the end you need to work towards them connecting with other people first step usually is they have to connect with themselves but you can help them do that second step then is how they can connect to other people yeah just will connect with themselves to be aware of how to connect with other people yeah and again that can be a slow process yeah yeah it can and on the way as they start to learn about themselves and learn to be aware of internal and external connections you might give them some I would say homework but some ideas so for example well you know you tell me about your structure of the day and I tell you and you realise in the structure of the day they don't actually meet anyone okay so I'm just going to give you a piece of homework I'd like you to do how about you just go out of your way to look at what sort of people you'd like to meet or if there's any groups in your whatever it is but it's sort of fostering external connection yeah but before you get there you need to find out you know around the lack of the internal connection with the self but on the way you will then work towards them making connections in some way for the outside world whatever yeah I think I would do that you know and modulate and practice it in the therapy room as well I can remember a long long time ago I've been a client who found it really difficult to just pass time and I think it was one of the first times I'd ever come across my mum had a hairdressing salon when I was growing up and then she had a dress shop with me Nana and I kind of grew up in that environment so it was really easy for me to talk to people who I've never met before and to just pass the time with people I thought everybody could do it until I met this client who really struggled to just have a conversation with somebody at a bus stop for no apparent reason yeah usually people extremely lonely feel their social misfits yeah they feel they're eccentric or they feel there's something wrong with them so from that position it's so hard isn't it yeah well then yeah first of all lies actually they may feel their social misfits or they may feel their eccentric let's look at where they come from you do all that work so that so they can get to a place perhaps they may dare to believe they're not those things and then maybe how we can connect with others yeah and that you know I think I would probably look at you know doing some work around their self-worth as well do you know what I mean and what they've got to offer in a relationship with somebody and you know that it's a two-way street when we do make a connection with somebody and what do you mean by a two-way street well it's it's not about just what we can offer them it's about what they can offer us as well it's like both ways you know and that yeah I sometimes get the impression with some people that it's what the other what they can get from the other person a lot of the time and they don't really think about what they can give as well what their worth is to the other person you could not have said a true word but in terms of the treatment of loneliness before you know besides finding out their unique story you need to find out first how they've lost connection with their self because unless you go there first it's very hard to get to that yeah two-way street you're talking about so why would we do that then well first of all I'd be looking at where in your life in your earlier life have you felt this extreme loneliness and what are the feelings that come with that you know that's where I'd go first yeah yeah no I might not say it in those words but I probably would where in your life have you felt these familiar feelings and when in your life did you make the decision that there was something wrong with you so again I'm working development again all the time I know there are other ways to work but in terms of this podcast you've got a therapist I me here who will always work that way because I believe that the past affects the present absolutely so we can get the healing in the past how can the present be different yeah well how can it be different because we're always we're always going to repeat our past yeah I yeah I 100% agree I don't think I work that way as much as what you do I think I go there every now and then but not intentionally if that makes sense no you can work another way you can work behaviorally you can really you know you could set these people new behaviors to you could change them how they're thinking about themselves you know you could do all those sorts of things you could put different resources in for them etc etc so there are different ways but for me unless we go back to where all this began and I don't get this wrong for people with listening in I think a lot of the other things become plasters yeah I do agree with that yeah and I don't want to discount anybody listening or works in a different way at all simply my professional training in the way that I think and the thought years are working that way yeah I think I'd like to think that I do a bit of both I do a bit of the deeper stuff but then you know I also do some practical educative yeah but if you do the developmental stuff you can then put in the other stuff you're talking about if you do it the other way round and do the behavioral cognitive stuff first I think you're going down a different road yeah yeah I agree but I think sometimes it depends on the client and where they are it's like I'm thinking particularly I've been working with a a young person and it's very very difficult with them so we do do a lot of practical things in the session how old is she's I don't want to give out too much away but yeah are you talking about are you talking about an adolescent yes right now if we talk about adolescence I think there's different ways of working with adolescents so I really can understand what you're talking about yeah yeah and she you know they are a bit of an introvert so I don't want them to feel like they're under the spotlight a lot of the time so we do do a lot of practical there's a whole different way of working with children and adolescents to the way that I'm talking about which is working with adults yeah yeah there's two different way different processes here and at the same time uh when you're working with adults and where I work with the adults you will work with their younger selves fanzax analysis is a marvelous model in thinking about how to work with the younger self and the child league estate and fanzax analysis is very much so in developmental ways yeah yeah and I think that's why I like it you know because there are so many different you know me and my diagrams and you know all those sorts of things I do find it I I do like it there's always something that you can look at on on working with clients whether that's script analysis or the okay corral or whatever it is there's there's always a way somewhere yeah definitely I said the first thing really after meeting somebody who has a profile of loneliness in the clinical room is to get to know their story yeah and usually for somebody who reports extreme loneliness you might be the only person they've seen that week so coming with that it's really important to think the next bit which is around overwhelming them but if you go gung-ho into extreme I don't know validation or whatever it is they can feel so overwhelmed they'll never come back yeah most people extremely lonely you're often the first you know the person they see and often they will report it was it took all my strength to get through the week you know when I came back from a therapy session because I'm not used to that level of contact yeah yeah and it can be overwhelming well it will be yeah haven't added yeah and that's important to remember I think yeah yeah loneliness is a is a clinical condition and especially what it can lead to which is depression can lead to depression self-loathing self-hatred feeling worthless feeling of social you know out of touch with society all the things we're talking about so it's very important and sometimes you know in a therapy work with clients you'll go down the layers and come to the lonely self which has been covered up through very strong adaptations defense systems but underneath it all they feel something's really wrong with them and an outcast and then you hear about the loneliness and the word you use desolation yeah yeah as you were saying that then I was thinking you know we I don't want to say every mental health issue or not but you know loneliness must play a part in in a lot of it because we do disconnect from from people you know when we are anxious or depressed or you know ill or anything like that you know if we social anxiety whatever it is we do disconnect so that there's going to be loneliness peppered in a lot of mental health conditions yeah and it's really important for the therapist to realise that putting them in a group or overwhelm and the validation is completely the wrong way to work you need to find out you need to hear their story and find out how come they have become that way and help them understand the disconnection and find out what the context was in their lives when they decided to disconnect in such an extreme way yeah oh i'm not really lonely i've got plenty of friends somewhere oh how many friends you've got well um well i haven't seen them for a while so so then the therapist said well when did you last see them well maybe three or four months ago but you see the minimization they're moving away from the other one might feel off an intrusion yeah there's something as well about you know often i'll speak to clients sometimes and it's like is there a benchmark for for being sociable and how many friends and how many acquaintances is the average persons because you know when i talk to clients i think they're quite shocked at the amount of friends that i say i have because i think they think that you should have more i've got a lot of acquaintances but friends you know true friends that i know i could pick up the phone and the there for me i could probably count on one hand i felt i listened to a very sad story i was listening to um people who came off love island they've been on love island that reality tv program yeah i was looking at well what you know why people went on don't they gained out of it because 10 percent of the relationships don't last that they're making love island and all the things from that and one of the people was saying that because they haven't got 10 000 likes or something more than that when they came out of love island they saw themselves as a failure and it made me think about how many people base their sense of connection on the likes they gave it to their facebook or instagram pages yeah absolutely yeah yeah and like he's just you know one of the things that kind of goes through my mind i must google what is the average amount of friends we should have for to be a healthy all well-rendy person and i bet it's not as many as what people think it is but the you know the most important friend is yourself yes that's where you stem from really and that's what i'm saying people who suffer from this clinical condition at loners they've cut off from themselves they've not even got a narrative in their head which is particularly friendly because they've lost that part of themselves yeah and it's a big thing for people to be alone with themselves you know a lot of the time clients will say to me i'm okay until i stop and then you know the thoughts and the overthinking so they're just busy and doing things all the time to just sit and be with your own thoughts is quite difficult for a lot of people absolutely right and we haven't even touched on the somatic considerations of loneliness in other words a lack of eating yeah yeah headaches extreme weight loss many of the consequences of loneliness are played out in the body as well because the body becomes impoverished yeah that's really sad i hope doctors are taught about some of these things because when somebody goes to see them with extreme weight loss or they come go to see them with headaches or whatever we're talking just talking about here i think the doctor needs to think about social contact if you live by yourself or what's and hopefully the the doctor will start to ask these basic questions because the somatic considerations of loneliness is played out in the physical sense as well as the emotional sense yeah yeah when you were saying that then i was thinking about a lot of elderly people it's quite apparent when you're saying that did you know what i mean that a lot of that somatic you know could be down to loneliness when yeah often is yeah often is and i don't think we pay attention to it no and i think society unfortunately isn't just either particularly they don't yeah we we've moved away from uh the time when we had extended families and all the things you talked about you know like popping down the garden and speaking to the people next door all being extended families and all these sorts of things i know you can feel alone and alone and alone again in extended family situations but we've moved away in the western world to a more nuclear family situation where those types of extended families and everything that goes with that has got lost yeah i think doctors and you know they've started doing something called social prescriptions now aren't they where you know they have somebody that can prescribe social things to them like going for a walk with nature or you know joining a gym and all these sorts of things instead of it being you know medicine subscript prescriptions they're looking at more you know mindfulness and all those sorts of things or things and also if the person has lost connection with themselves um these sorts of prescriptions can unfortunately be overwhelming yeah i've enjoyed this podcast but it's been a i think it's a we haven't even got on to existential loneliness but i haven't got time about that but the person feels that's so to their core a sense of being wrong in society or a miscast or a sanctuary called what we talk about will lead often to mental health so it's a very serious podcast i think this yeah i mean i know a lot of people talk about a serious but i think loneliness leads or can lead to many of the mental health issues that we're talking about today and i think it needs people like society to think more about people who live alone perhaps have contact with people who you just see like the person you mentioned which i thought was a kind of you when he talked about the person is i don't know if it's next door to you the sits on the bench on the front of his house and then when you go by you have a conversation yeah absolutely it might only it might be the only conversation yeah all of that day until you arrive the next day and they continue the conversation yeah but it used to when i was growing up it used to be a regular thing where you'd see people sitting outside the front of their houses or whatever you know somebody i don't know cleaning the windows and you'd stop and have a chat with them and things we don't tend to do that as much now yeah so you know i think it's an important podcast and absolutely i think it's definitely one worth doing okay doki what's the next podcast then the next one i've got is running therapy groups oh we're going to talk about how how how we run them how do we decide uh when to to run individual therapy groups yeah that's the great subject of course i was a group therapist for most of my life so that'll be an interesting i'm looking for i know i say i'm look forward to each and every one of them bob but i am because i've never done group therapy i've been in group therapy personally myself but i've never run a therapy group so i will be taking notes on this great so look forward to uh speaking next week then okie doke i shall speak to you very soon you will take care bye bye you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and leave us a review we'll be back next week with another episode