The Importance of Connection, Rhythm, and Intonation in Accent Training
Accent training is a specialized form of language instruction designed to help individuals modify or refine their accent in a second language. It goes beyond working on your pronunciation and perfecting the sounds of individual words; it also involves the way we connect words, the rhythm, and the intonation that we use when speaking. Many speakers unknowingly carry over the speech patterns of their native langue when speaking English, this can sometimes change the meaning of what is being said and affect clarity. Personalized Accent training can pinpoint the specific aspects of speech a person may need to target, to ensure that they are conveying a clear message. This guide will explore how connection, rhythm, and intonation are essential to accent training and how they can help anyone who wants to sound more natural and confident when speaking English.
Who can benefit from accent training?
- Non-native speakers who want to improve their clarity and confidence when speaking a second language, particularly in professional, academic, or social settings.
- Professionals who need to communicate clearly with native speakers for work, such as in international business or customer-facing roles.
- Actors or performers who need to adopt a specific accent for a role.
- Anyone who feels their accent may be a barrier to effective communication or integration into a new language environment.
Why Focus on Connection, Rhythm, and Intonation?
Mastering connection, rhythm, and intonation is crucial for achieving natural and fluent English speech. While pronunciation is foundational, these elements ensure that speech flows smoothly and conveys intended meanings accurately. Effective accent training emphasizes these aspects to help non-native speakers overcome the influence of their native language and sound more natural in English.
Connection in Speech
Connection in speech refers to the way we blend words and sounds to create fluent communication. Without these connections, speech can sound unnatural or choppy, making non-native speakers come across as robotic. English speakers often link words that start with consonant sounds or blend vowel sounds between words, such as in phrases like «turn off» (which can sound like «turnoff») or «see it» (which can sound like «seeyit»). Enhancing how you connect sounds can improve pronunciation, rhythm, timing, and overall intelligibility. When speaking English, it is important to connect words smoothly so that entire sentences flow together. Pausing is natural and appropriate at the end of a sentence, when taking a breath, or when emphasizing a particular point.
Rhythm in Speech
Rhythm in speech plays an important role in effective communication. It involves the patterns of stressed and unstressed syllables and influences how messages are perceived. People are accustomed to hearing a certain timing during speech to fully comprehend a message. When the rhythm is off, the message can be difficult to follow or can cause confusion. “English is a stress-timed language, meaning, we don’t give equal stress to every syllable, but we spend lots of time on some syllables and we rush through other syllables” (The accent Channel). In English, when stressing a syllable, the vowel becomes longer, louder, and goes up in pitch. This can make it challenging for Spanish speakers to adapt to uneven stress patterns and can affect the natural sound of their speech.
Intonation in Speech
Intonation in speech refers to the variation in pitch that we use to convey different meanings in English. It helps distinguish between statements, questions, and commands. Intonation can also reveal emotions like sarcasm, uncertainty, or enthusiasm, and it highlights important aspects of a spoken message. When we vary in pitch, we can express a range of meanings and emotions.
Spanish speakers sometimes use repetitive intonation patterns when speaking English, this can make a person sound monotone and confusing. Without proper intonation, speech is flat and difficult to follow. Stressing different parts of a phrase can completely change its meaning, even when using the same words. Mastering intonation is crucial for clear and engaging communication.
Differences Between English and Spanish in Connection, Rhythm, and Intonation
English and Spanish differ significantly in their approach to connection, rhythm, and intonation. Spanish, being a syllable-timed language, maintains a steady rhythm by giving equal time to each syllable. In contrast, English’s stress-timed nature creates a more fluid and varied rhythm, with stressed syllables occurring at regular intervals. This difference can lead Spanish speakers to emphasize every syllable equally in English, disrupting the natural rhythm and clarity of their speech.
When it comes to connection, Spanish tends to maintain a more continuous flow between syllables, with each sound clearly articulated. English, however, often blends sounds together, making it sound smoother and more connected. Additionally, while Spanish vowels are precise and static, English vowels are longer and more dynamic, requiring greater mouth movement. Finally, when Spanish speakers speak English, they tend to use a repetitive intonation, and English requires varied intonation to convey different emotions and intentions. By focusing on these differences—strong syllables, elongated vowels, varied intonation, and fluid sound connections—Spanish speakers can significantly improve their clarity and fluency in English.
How a Speech Coach Can Help
A speech coach is essential for mastering connection, rhythm, and intonation which are critical for natural English communication. Through tailored exercises and real-time feedback, a coach can address specific challenges in blending words, managing syllable timing, and varying pitch. Coaches use practical techniques, such as listening drills and rhythmic practice, to improve speech flow and intonation. Personalized training ensures that learners understand and apply these elements effectively, leading to more natural and confident speech.
Mastering connection, rhythm, and intonation is essential for anyone looking to improve their English accent and communicate more effectively. These elements are the building blocks of natural speech, influencing how we are understood and how our messages are received. While pronunciation is important, it is the fluidity of connected words, the rhythmic flow of stressed and unstressed syllables, and the dynamic use of pitch that makeup language.
For non-native speakers, especially those coming from languages with different speech patterns like Spanish, focusing on these areas can make a significant difference in how natural and confident their English sounds. With the help of personalized accent training and a speech coach, learners can develop these skills, leading to clearer, more engaging communication. Whether for personal growth, professional development, or social interaction, refining connection, rhythm, and intonation can unlock a new level of proficiency in English, helping speakers to be not only understood but also to connect more deeply with others through language.
About the author
I am Jarrisvette Villarreal, originally from South Texas. I have been living in Spain for several years, where I have worked as an English teacher and have taught young Spanish speakers. Through my experience, I have become familiar with the common mispronunciations and typical mistakes Spanish speakers make when speaking English. In addition to teaching, I have experience as a Speech-Language Pathologist Assistant, working with children on articulation through speech therapy. I have also completed a specialized training in accent coaching through “The accent channel”, which has equipped me with the skills to provide personalized accent training. I have also worked diligently to achieve a neutral English accent; I understand the challenges and preconceived notions about having an accent. I am passionate about teaching pronunciation and excited to help others reach their communication goal.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
What is Speech and language therapy?
Speech therapy is the branch of science that focuses on the assessment, diagnosis, treatment and prevention of speech, language, communication and swallowing disorders. It is a discipline that serves people of all ages. Speech therapy is a profession that combines different areas, such as linguistics, psychology, biology and medicine.
In America, the Spanish Association of Speech Therapy, Phoniatrics and Audiology (AELFA-IF) is one of the main organisations of speech therapists in Spain. This association offers resources, ongoing training and support to professionals.
Areas of intervention in speech therapy
Speech therapists can work in a wide variety of settings, such as hospitals, private clinics, schools, nursing homes and early childhood centres, among others. Areas of intervention include:
- Speech disorders: this group of disorders encompasses difficulties in producing speech sounds, such as stuttering, dysarthria and articulatory disorders.
- Language disorders: this group of disorders encompasses difficulties in the comprehension and production of language, both written and oral. Within language disorders, we can distinguish expressive disorders, i.e. those that consist of difficulties in expressing oneself, and receptive disorders, which are characterised by difficulties in understanding the message.
- Social communication disorders: these are disorders that involve difficulties at the pragmatic level, i.e. with the use of language. They usually occur in social communication and are characterised by difficulties in communication skills. Communication skills are understood as those skills that are put into action and allow for an effective exchange between two or more people.
- Within these skills we can distinguish: the ability to communicate assertively, the ability to communicate a specific message, the understanding of non-verbal language, the ability to develop active listening, etc.
People with social communication disorders show difficulties in using these skills effectively. - Voice disorders: these are pathologies that involve vocal difficulties. This group includes problems such as aphonia (absence of voice) or dysphonia. These disorders are characterised by an impairment of the quality, tone and volume of the voice.
- Swallowing disorders: these disorders are commonly known as dysphagia and affect a person's ability to swallow. They may be caused by neurological disease, injury or surgery.
Speech therapy as evaluation
As mentioned above, speech therapy also encompasses the area of assessment. This is a multi-stage process. Speech therapists use techniques and tools to assess speech, language, communication and swallowing. Assessment can be carried out through standardised or non-standardised tests.
The first step in an assessment is an initial interview, in which detailed information about the patient’s development is collected. It is important to know the patient’s medical history and family history. In addition, it is very important to know about possible speech and language difficulties.
After this first step, assessment takes place. This may be through standardised tests, with specific tests that compare the individual’s performance in a given area with the norms established for their age group, or through non-standardised tests, which include observation of the user in their daily life or in specific activities to assess specific aspects.
This assessment allows the identification of the strengths and weaknesses of individuals, which enables the setting of specific goals for therapeutic intervention.
With the information extracted from the assessment, the speech therapist establishes intervention objectives. These goals can be short, medium or long term and allow the user’s progress to be monitored.
- Articulation disorders: the exercises that are implemented in therapy to treat these difficulties are focused on learning the way and place of articulation of sounds, to improve the emission of sounds, as well as exercises to improve the clarity of speech.
- Language disorders: Exercises to target language disorders are aimed at improving language comprehension and production. They may also focus on improving pragmatic and social skills.
- Voice disorders: to treat vocal difficulties, users learn techniques to improve breathing and phonation. These exercises improve their vocal quality.
- Swallowing disorders: THE intervention in this group of disorders is aimed at the user learning strategies to improve swallowing safety and efficiency. Exercises to work on the tone of the facial muscles, changes in diet and learning safe swallowing techniques can be found.
Recent advances in speech therapy
Speech therapy intervention is a dynamic process, i.e. it is subject to change, as each person has specific needs. It will be up to the professional who takes the individual to make these adjustments to the initial plan. This will be done on the basis of how he/she sees the individual in the sessions.
Speech therapy is a fairly new science. Moreover, it is a field that is continually evolving, which is why research within speech therapy is so important. Some of the recent advances are:
- Neuroplasticity: this is research into how the brain can reorganise its connections and form new connections in response to therapy.
- Genetics: research within genetics allows for the exploration of the transmission of different disorders and the observation of whether genetic inheritance influences the transmission of these disorders to offspring, as well as the likelihood of their occurrence.
- Evidence-based intervention: research allows for the development of new therapeutic practices. This allows speech therapists to implement these new techniques in their intervention, with the advantage of ensuring that they are effective and efficient treatments.
As a general conclusion, speech therapy is a profession that treats disorders related to speech, language, communication and swallowing through individualised intervention. The goals of the intervention are established on the basis of an exhaustive assessment carried out by the professional. The speech therapist has a very important role in improving the quality of life of individuals in need and seeks to develop skills and tools that enable people to communicate effectively.
It is an area in which research plays an important role in incorporating new techniques into interventions, ensuring their effectiveness.
Some sites that provide up-to-date information on speech therapy are:
- American Speech-Language-Hearing Association
- National Institute on Deafness and Other Communication Disorders
- Speech-Language-Therapy.com
- Understood
Written by:
Mariló Martínez
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Analysis of the Netflix Series "Love on the Spectrum"
The Netflix series «Love on the Spectrum» offers a unique perspective on the experiences of people on the autism spectrum in the realm of both social and romantic relationships. Through various episodes, it explores how these individuals navigate the complex world of dating and relationships, highlighting both their challenges and triumphs. This analysis will focus on three main aspects: social and communicative difficulties, the importance of understanding and support, and the positive impact of media representation for the autistic community.
Social and Communicative Difficulties
One of the most prominent aspects of the series is observing how individuals on the autism spectrum face social and communicative difficulties when trying to form romantic relationships. Communication is a fundamental tool in any relationship and can be especially challenging for people with autism due to differences in interpreting social and emotional cues.
Non-Verbal Communication
People on the autism spectrum often find it difficult to interpret and use non-verbal communication, such as body language, eye contact, and facial expressions. The series shows how some participants may miss subtle cues of interest or disinterest from their partners, leading to misunderstandings and frustrations. This difficulty can make dating stressful and sometimes discouraging for the protagonists.
Literal and Direct Language
The tendency to interpret language literally is also a common characteristic within the autism spectrum. This style of communication is seen in the series when participants speak in a direct and honest manner, often without the nuances or filters that many neurotypicals use in dating. While this frankness can be refreshing, it can also create awkward moments or misunderstandings with their dates.
Social Anxiety
Social anxiety is another significant challenge depicted throughout the series. The anticipation of a date can generate considerable stress, often manifesting in repetitive behaviors or avoidance of social situations, such as fleeing from the date. The series captures moments when participants feel overwhelmed by the pressure of social interactions, highlighting the need for coping strategies and support during these times.
Importance of Understanding and Support
The series also emphasizes the importance of understanding and support from both loved ones and professionals in developing healthy relationships for people on the autism spectrum. This is crucial, as the protagonists might not venture to use the tools provided and communicate their needs and concerns without this support.
Role of the Family
Families play a crucial role in providing emotional and practical support to autistic individuals. In «Love on the Spectrum,» many participants rely on their family members for advice, motivation, and companionship. This familial support is essential in helping them face the challenges of dating and build self-confidence.
Dating Coaches
The series also features specialized dating coaches, or professionals who work with people on the autism spectrum to improve their social and communication skills. These professionals provide practical techniques and personalized strategies to help participants navigate dates with greater confidence. Their intervention may include practicing eye contact to understanding the emotional signals of the other person.
Community and Connection
Creating a community and fostering connection with others in similar situations is also a recurring theme. Support groups and specialized social networks can provide a safe and understanding environment where autistic individuals feel accepted and valued. These environments can help reduce feelings of isolation and provide opportunities to learn from others’ experiences.
Positive Impact of Media Representation
Accurate and positive representation of people on the autism spectrum in media is crucial for combating stereotypes and fostering greater social understanding and acceptance. «Love on the Spectrum» makes a significant contribution in this regard.
Visibility and Empathy
The series aims to humanize people on the autism spectrum by showing their personalities, desires, and struggles authentically. In doing so, it promotes empathy and challenges negative stereotypes. The audience can see beyond the autism label and recognize the universal experiences of seeking love and connection with another person.
Diversity of Experiences
One of the strengths of the series is its focus on diversity within the autism spectrum. Each individual has a unique experience, and the series highlights this diversity, from high-functioning autistic individuals to those needing more support. This inclusive approach helps demystify autism and show that there is no «right way» to be autistic.
Inspiration and Hope
For autistic viewers and their families, the series offers a message of hope. Seeing others facing similar challenges and finding love can be inspiring and motivating. This type of representation can help reduce hopelessness and increase self-esteem by demonstrating that meaningful relationships are possible for everyone, regardless of neurological differences.
«Love on the Spectrum» offers a profound and enriching view of the experiences of autistic individuals in the realm of romantic relationships. By addressing social and communicative difficulties, the importance of support, and media representation, the series significantly contributes to understanding and accepting autism. This analysis highlights the need for an empathetic and supportive approach to help people on the autism spectrum navigate the world of relationships and find love. Lastly, it is not only an entertaining series but also educates and promotes greater inclusion and respect for the neurological diversity present in our world today.
Written by:
Lidia Fernández
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Understanding ASD: Adult Women within the Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in communication and social interaction, as well as the presence of repetitive and restricted behaviors and interests, having a lifelong impact on the individual. Ideally, it should be identified during childhood to address any potential difficulties during the early stages of development. However, those who are not diagnosed until adulthood may experience other related mental health issues, such as anxiety disorders, due to the challenges they face in social adaptation.
How many autistic women are there in our country?
In Europe, it is estimated that around 1% of the population has an ASD diagnosis. In Spain, 0.9% of people are diagnosed, a percentage similar to other European countries, which hover around 1 to 1.2%. It is estimated that for every four men diagnosed with autism, one woman receives a correct diagnosis, encompassing the entire spectrum of this disorder. However, it is concluded that the figures for women are not entirely accurate, and we do not have the real value in the Spanish population.
A study by Bonney et al. mentions that if autism is diagnosed in childhood in both boys and girls, girls would receive a diagnosis at least one year later than boys, as 80% of girls remain undiagnosed until the age of 18 (McCrossin, 2022). This may be due to girls and women on the spectrum masking or camouflaging their difficulties to the extent that even their close circles are unable to identify them and thus seek help.
According to 2018 data on the Spanish population, it is estimated that there are currently between 140,000 and 264,000 autistic girls and women in Spain, a significant minority too large to be ignored.
What signs of ASD can we identify in girls?
The characteristics found in girls with ASD include:
- Presence of intense emotions
- Greater sensory alterations
- Resistance to change
- Altered prosody (hyperlexia, unusual or misaligned speech)
- Directed, non-cooperative, and exclusive play
- Lack of coordination between facial expressions and emotions
- Coexistence with social anxiety, mutism, and separation anxiety
On the other hand, the diagnosis of autism in adult women can be made, and the signs differ from those in girls.
What are the signs that identify ASD in adult women?
- Difficulty maintaining social relationships and avoiding group interactions.
- Need for control and aversion to being ordered around, but difficulties in organizing themselves.
- Extreme exhaustion after exposure to social events and high-demand activities.
- Hypersensitivity to sounds, textures, and smells, or hyposensitivity to pain.
- Extreme honesty.
- Hyperfocus on their topics of interest and very low interest in other topics.
- May suffer from central sensitization syndrome (chronic fatigue, fibromyalgia, etc.).
- Strong sense of justice.
- Great difficulties in organizing themselves (work, family, home, personal care, etc.).
- May have completed higher education but do not find corresponding job opportunities.
- Jobs in low-skilled positions, job insecurity, and poverty. Family dependence.
- Families may reject the option of living as a couple and motherhood due to overprotection.
- High risk of experiencing gender-based violence, making education and prevention a priority.
- It is common to find couples where both individuals are autistic.
Women with ASD often receive incorrect diagnoses or no diagnosis of ASD despite seeking mental health services more frequently than men (Gesi, C., 2021). The diagnosis of a mental disorder may be the first and only one received by women with autism who use camouflage strategies, as diagnostic tools are based on the male profile and how ASD is described therein.
When time passes without an ASD diagnosis, we find a group of women who end up with psychiatric diagnoses and treatments that do not address the main symptoms of their problem but rather the manifestations of a prolonged imbalance. A study conducted in 2017 by the Women’s Board of the Association of Autism Professionals (AETAPI) indicated that 40% of the women surveyed had previous diagnoses of depression, more than 30% had anxiety, and approximately 20% had social phobia. They possibly manifested these symptoms, but they undoubtedly stemmed from their life difficulties and social rejection.
In many cases, not only do women with autism present the symptoms of this broad disorder, but it is often accompanied by symptoms of another disorder that may have developed until the diagnosis is obtained.
The most prevalent comorbidities in women with ASD are:
- Obsessive-compulsive disorder
- Anxiety disorder and affective disorders
- Eating disorders
- Attention deficit hyperactivity disorder (ADHD)
- Addictions
- Burnout
- Somatic pathologies (gastrointestinal disorders, epilepsy, or sleep disorders)
- Gender dysphoria
How do professionals diagnose an adult woman with ASD?
Diagnosing Autism Spectrum Disorder (ASD) in adult women can be a complex process due to gender differences in symptom presentation and the tendency of women to use camouflage strategies. To achieve this diagnosis, mental health professionals conduct a thorough evaluation to provide answers to the uncertainty and explanation that our adult patients need. To do this, we use the following tools:
1. Detailed Clinical Interview
The first step in diagnosis is conducting a thorough clinical interview covering personal and family history, childhood development, educational and work experiences, as well as interpersonal relationships. It is essential that the mental health professional is trained to ask specific questions that can reveal behaviors and experiences typical of ASD in women.
2. Assessment of Current Symptoms
A detailed evaluation of current symptoms is crucial. This includes observing communication and social interaction, as well as identifying patterns of repetitive and restricted behavior. Women with ASD may present symptoms more subtly, such as having intense interests that are socially acceptable or using coping mechanisms that mask their difficulties.
3. Use of Specific Diagnostic Tools
Standard diagnostic tools, such as ADOS-2 (Autism Diagnostic Observation Schedule) and ADI-R (Autism Diagnostic Interview-Revised), should be used alongside questionnaires and scales that have proven useful in detecting ASD in women. It is important that these tools are applied by professionals who understand gender differences in the manifestation of autism.
4. Evaluation of Comorbidities
Adult women with ASD often present comorbidities such as anxiety, depression, eating disorders, and obsessive-compulsive disorders. A comprehensive evaluation should include an analysis of these conditions, as they can influence the presentation of ASD and the interpretation of symptoms.
5. Observations in Different Contexts
To obtain an accurate picture of the woman’s functioning, it is useful to observe her behavior in different contexts, such as at home, at work, or in social situations. This can help identify behavioral patterns that are not always evident in a clinical setting.
6. Testimonies from Family and Friends
Testimonies from family, friends, and coworkers can provide valuable information about the woman’s behaviors and social skills at different stages of her life. These reports can complement the clinical evaluation and provide a broader perspective on her challenges and strengths.
7. Self-Report and Self-Perception
It is important to consider the woman’s own perception of her experiences and challenges. Self-reports can reveal how she feels about her social interactions, her interests, and her ability to manage daily life. This subjective component is crucial to understanding how she perceives and handles her condition.
8. Ongoing Training for Health Professionals
Mental health professionals must receive ongoing training on gender differences in ASD and stay updated with the latest research and diagnostic practices. Sensitivity to the ways women may mask their symptoms is essential to avoid incorrect or late diagnoses.
In conclusion, diagnosing ASD in adult women requires a multifaceted and gender-sensitive approach. By combining detailed clinical interviews, symptom evaluations, specific diagnostic tools, and considerations of comorbidities, as well as evaluating observations in various contexts and third-party testimonies, professionals can offer more accurate diagnoses and ultimately provide more effective support.
What happens after the diagnosis?
After the diagnosis, although it can initially be a shock, this relief is usually limited to the woman or girl’s immediate environment. For most adult women, discovering that the difference they have felt since childhood is not imaginary or a severe personal deficit, and that previous mental disorders treated over the years are actually manifestations of another problem, generally brings a great sense of relief.
But after this feeling of relief, girls and women may be subjected to what can be called the «ghosting effect»: «How can you be autistic if you are smart…», «If you have children…», «If you work…», or «If it doesn’t seem like you have autism…».
This effect continues with masking, fear of being different, and plunges women who thought the diagnosis would alleviate their burden into confusion and loss of self-esteem. It is already very challenging for adult women to get an accurate diagnosis, and if we add the normative society’s doubts about whether they belong to the spectrum or their special needs, which for them are basic needs to lead a functional life with the necessary supports.
Needs and Support for Adult Women with Autism
Adult women with Autism Spectrum Disorder (ASD) often face unique challenges that require specialized support to improve their quality of life. Below are some of the main needs and types of support that can benefit them:
- Accurate Diagnosis and Evaluation: Many women with ASD do not receive a diagnosis until adulthood because diagnostic criteria and evaluation tools have historically focused on men. A late diagnosis can lead to years of misunderstandings and inadequate treatments. Therefore, it is essential to have mental health professionals trained to recognize signs of autism in women and provide accurate, gender-sensitive evaluations.
- Psychological and Emotional Support: Women with ASD often experience high levels of anxiety, depression, and other mental health issues. Cognitive-behavioral therapies and other forms of psychological counseling can be very beneficial. It is crucial that therapists understand the specific experiences of women with ASD to provide effective support.
- Development of Social Skills: Difficulties in social interaction are a central feature of ASD. Social skills training programs can help women develop strategies to manage everyday interactions and personal relationships. These programs should be tailored to individual needs and consider the ways in which women may mask or camouflage their symptoms.
- Workplace Support: Women with ASD may face particular challenges in the work environment, such as difficulties with communication, organization, and stress management. Workplace accommodations, such as a more structured environment, flexible time, and a mentor or coach, can facilitate a more inclusive and understanding work environment.
- Assistance for Daily Living: Some women with ASD may need additional support to manage daily tasks, such as household management, activity planning, and financial management. Support services for daily living can provide the necessary assistance to increase independence and quality of life.
- Support Networks and Community: Connecting with other women who have ASD can be an invaluable source of emotional and practical support. Support groups, both in person and online, offer a safe space to share experiences and coping strategies.
- Education and Awareness: It is crucial to promote education and awareness about ASD in the general community to reduce stigma and increase understanding. Educational campaigns can help demystify autism and foster a more inclusive and empathetic environment.
Adult women with ASD can significantly benefit from a comprehensive and personalized support approach that addresses their unique needs. By providing accurate diagnoses, psychological support, social skills development, workplace accommodations, and community support networks, we can help these women lead fuller and more satisfying lives.
In conclusion, as a mental health professional, it saddens me that women face so many difficulties in accessing an answer to the feeling they have often carried since early stages of their lives. I also believe that it is the responsibility of professionals to continue updating ourselves on these issues to provide the best quality care to our patients and to be aware that in today’s society, there are many prejudices that cause many women on the spectrum to camouflage themselves and not obtain the help they need until adulthood, leading to other problems beyond Autism Spectrum Disorder. I faithfully hope that we will continue to advance in this area, and autism specialists will continue to provide the essential, basic supports for all individuals on the spectrum, enabling them to achieve the highest possible quality of life despite their difficulties.
References:
– Mujeres y autismo. La identidad Camuflada. 2022
– Mujeres autistas: Dentro del espectro. Ed. CEPAMA. 2020
– Hervás, Amaia. (2022). Género femenino y autismo: infra detección y mis diagnósticos. Medicina (Buenos Aires), 82(Supl. 1), 37-42. Recuperado en 25 de junio de 2024, de http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802022000200037&lng=es&tlng=es.
Written by Lidia Fernández.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Psychological Analysis of the book "Invisible" by Eloy Moreno
«Invisible» by Eloy Moreno is a novel that addresses the complex and devastating phenomenon of school bullying from an intimate and psychological perspective. Through the story of a teenager who feels invisible due to the bullying he is experiencing in his life, Moreno offers a deep exploration of the emotional and mental effects of bullying. This psychological analysis examines various aspects of the novel, including the impact of school bullying, the protagonist’s defense mechanisms, the role of empathy, the formation of self-concept, the recovery process, and the long-term consequences.
Impact of School Bullying School
Bullying is a phenomenon that can have devastating consequences on an individual’s psychological development. In «Invisible,» the protagonist experiences constant bullying that leads him to feel invisible. This feeling of invisibility is not just a literary metaphor but a reflection of the profound dehumanization and isolation that a bullying victim suffers. Continued victimization can lead to low self-esteem, anxiety, and depression.
Isolation and invisibility
The isolation and invisibility that the protagonist feels are representations of how bullying can make victims feel worthless and that their existence doesn’t matter. This sense of irrelevance can be especially destructive during adolescence, a crucial stage for the formation of personal identity.
Defense Mechanisms and Coping
To manage the emotional pain of bullying, the protagonist develops several defense mechanisms. Invisibility becomes a coping mechanism, a way to escape the oppressive reality he experiences during this process. Psychologically, this can be interpreted as dissociation, a separation between his identity and reality to protect himself from emotional trauma.
In addition to invisibility, the protagonist exhibits other defense mechanisms such as avoidance and repression. He avoids situations that could lead to more bullying and represses his emotions to avoid showing vulnerability. These mechanisms, while understandable as responses to a hostile environment, can impede healthy emotional development and perpetuate the feeling of isolation.
The Role of Empathy
One of the central themes in «Invisible» is the importance of empathy in resolving bullying. Throughout the novel, some characters begin to recognize the protagonist’s suffering, highlighting the transformative power of empathy. This recognition and resulting compassion are crucial steps in combating bullying. Observers of any type of bullying are also complicit in allowing the situation to continue for the victim.
From a psychological perspective, empathy involves understanding and sharing another person’s feelings. For bullying victims, being seen and understood by others can be incredibly validating and help rebuild damaged self-esteem. Empathy not only helps victims but can also deter bullies by making them aware of the impact of their actions.
Impact on Self-Concept
Self-concept refers to the image a person has of themselves, which is deeply influenced by social interactions. In «Invisible,» constant bullying distorts the protagonist’s self-concept. Internalizing the negative and humiliating messages he receives leads him to question his own worth and abilities.
The protagonist’s internal struggle with his identity and self-esteem reflects how bullying can erode a person’s self-perception. This psychological damage can manifest as severe self-criticism, self-loathing, and a negative outlook on the future. The novel shows that recovering a damaged self-concept is a long and complex process that requires support and self-reflection.
The Power of Voice and Visibility
The protagonist’s journey towards reclaiming his voice and visibility is a crucial theme in the novel. Initially, his invisibility symbolizes his despair and desire to escape the constant unpleasant situation he is experiencing. However, as the story progresses, he begins to find the courage to be seen and heard by others.
From a psychological perspective, finding one’s voice is essential for self-affirmation and recovery. Moreno’s narrative underscores that being heard and understood is fundamental to overcoming the trauma of bullying. Building support networks and the ability to express emotions and experiences are vital steps towards recovery.
Long-Term Consequences of School Bullying
Moreno not only focuses on the immediate impact of bullying but also on its long-term consequences. The trauma of bullying can have lasting effects that affect victims in adulthood. These may include anxiety disorders, depression, difficulties in interpersonal relationships, and trust issues.
The novel suggests that the trauma of bullying does not simply disappear over time. Overcoming bullying requires continuous self-reflection and therapy. It also highlights the importance of early intervention and ongoing support to prevent long-term consequences from becoming more severe.
Psychological Interventions
To address school bullying and its effects, it is essential to implement appropriate psychological interventions. These may include cognitive-behavioral therapy to help victims rebuild their self-concept and develop healthy coping strategies. Family therapy can also be useful to strengthen support at home and improve communication.
In the school context, promoting an environment of inclusion and respect is crucial. Emotional education programs and empathy training can help reduce bullying and foster a culture of support and understanding. This novel emphasizes that fighting bullying requires a community and multidisciplinary approach, where all members of the school community are committed to creating a safe and welcoming environment.
In conclusion, «Invisible» by Eloy Moreno is a powerful work that offers a rich and nuanced representation of the psychological effects of school bullying. Through the story of the anonymous, yet victimized, protagonist, Moreno explores how bullying can dehumanize and isolate victims, distort their self-concept, and cause lasting trauma. The novel also underscores the importance of empathy, finding one’s voice, and community support in recovery and overcoming bullying.
From a psychological perspective, it is not only a moving narrative but also a call to action to effectively and adequately address bullying by professionals and society. Understanding the psychological effects of bullying and implementing appropriate interventions are essential to helping victims heal and thrive.
Written by:
Lidia Fernández
Sinews MTI
Psychology, Psychiatry and Speech Therapy
What is Academic Support and What Does a Support Therapist Do?
The educational field today faces significant challenges. After the COVID-19 pandemic, various studies have shown negative consequences on the cognitive development and academic learning of children worldwide. This has been reflected in the complexity and diversity of learning needs, requiring new approaches for each student. In this context, the role of the educational support therapist becomes crucial to ensure proper learning development and overcome any difficulties that may arise. We generally understand their professional work, but we are often unclear about the scope of their professional competence. So, what exactly is an academic support therapist?
The Importance of the Academic Support Therapist
Academic support therapists or psychologists are professionals specialized in the educational environment of children and adolescents, focusing on analyzing special needs and learning difficulties to design strategies aimed at acquiring skills and abilities. With this objective, the academic support therapist studies the difficulties encountered, determines, and provides a series of tools, which are individually adapted to help and foster the development of their learning.
The work of the educational support therapist begins with «Understanding,» which means identifying and understanding the underlying causes of the difficulties students face. This initial understanding is fundamental, as it allows for the precise design of procedures and strategies to effectively address these difficulties. To achieve a holistic understanding of the students, brief reports and evaluations are used, providing a broader view of the student’s educational needs.
This comprehensive approach is key to their professional execution, as it allows the support therapist to develop individual interventions that address not only the surface symptoms but also the root causes. From this point, strategy planning begins, adapting to the student’s academic curriculum. These strategies are primarily implemented in learning areas that pose difficulties and where the student lacks sufficient resources for proper coping. In this regard, the support therapist provides specific tools tailored to the identified needs.
Psychopedagogical Support: Beyond Cognitive Aspects
Psychopedagogical support has its roots in cognitive psychology, initially focusing on learning difficulties, especially those related to executive function regulation. However, after the COVID-19 pandemic, support needs have been significantly exacerbated.
Functions like planning, inhibition, and working memory have suffered cognitive deterioration after the confinement period. Additionally, new adaptation difficulties to education have emerged: anxiety became a significant trigger within the adolescent and even child educational landscape. This symptomatology impacted these functions, particularly working memory, due to anxiety caused by confinement, directly affecting reading and writing performance as they are key to processing.
Therefore, we must consider that today, psychopedagogical support is not limited exclusively to cognitive functions. It is essential to understand the relationship between emotional and cognitive factors that affect a child’s development. These factors constantly interact in the execution of their skills, directly reflecting on their performance. A clear example is the common situation of facing a difficult exam and experiencing what is popularly known as a «blank mind.» These paralysis symptoms, loss of control, and insecurity are nothing more than anxiety states caused by emotional symptoms, demonstrating how emotional management can facilitate or complicate the execution of our skills and the application of our knowledge.
Current Challenges in the Educational Field
The educational context reflects what develops outside of it. After the confinement period, the COVID-19 pandemic has imposed significant challenges on the educational system:
1. Impact on the Socio-Demographic Framework:
The adaptation effort of education during the confinement period relied heavily on technological resources, which were limited for part of the school population. This lack of access has hindered the schooling period, reflecting predominantly negative effects on learning and development processes, especially in contexts with fewer economic and cultural resources. This period has further highlighted social inequity, exclusion, and educational barriers that many children and young people face, underscoring the importance of education from a more inclusive and equitable perspective.
2. Role of Teachers:
It is crucial for teachers to reflect on how they can contribute to reducing learning barriers, both cognitive and affective-motivational. The pandemic has highlighted the importance of supporting teachers and strengthening the pedagogical use of technological tools. However, there is the challenge of improving the effectiveness of training, as many teachers find it difficult to use new tools. It is necessary to promote training programs that facilitate the use of flexible strategies for a variety of students and teaching contexts. Masland’s (2021) proposal on resilient pedagogy, which meets psychological well-being needs such as autonomy, competence, and affiliation, can be an effective model to increase motivation and engagement.
3. Challenges for Parents:
Parents also face challenges, such as reviewing and modifying practices that negatively affect their children’s learning experiences. The current most prevalent issue is the excessive use of video games, cell phones, and television, which can exacerbate learning and development difficulties. Conversely, practices that promote reading, sports, and the arts should be encouraged, as they facilitate other types of learning and improve self-esteem and self-concept by developing competence strategies. Additionally, reward mechanisms are highly motivated by prizes, neglecting the practice of intrinsic motivation. The practice and discovery of this motivation foster more resilient development and improve frustration management.
4. Preparation of Educational Institutions:
Educational institutions must prepare for the return to classrooms with flexible mechanisms to design recovery and learning acceleration courses, as well as emotional support programs for students and teachers. It is essential to implement policies that allow reasonable adjustments so that students can equitably access resources and opportunities, evaluating possible losses in learning and development. These adjustments should seek to level students in cognitive, emotional, and social aspects.
Future Lines of Action for Support Therapists
Given the current challenges in the educational field, it is essential for professionals to analyze new lines of action and reflect on the measures and practices implemented. The pandemic caused a readjustment of previously established routines, incorporating new methodologies and resources. It is crucial to critically evaluate how students are adapting to these changes. Some of these lines of action include:
- Evaluating the Use of Technology: Investigating whether teachers' efforts to use and adapt to technology have facilitated effective knowledge construction processes and whether this benefits all students. It is important to adapt technology as a tool and not as the primary basis on which educational quality rests.
- Sustainability of Adapted Practices: Examining to what extent changes and adjustments in teaching practices are maintained after returning to in-person learning. Developing a routine adapted to new student needs will be crucial for development.
- Learning and Psychoeducation in the Family: Investigating the informal learning that has taken place in families during the pandemic and post-pandemic, identifying which of these are beneficial or harmful to cognitive, social, and emotional development. Professionals must guide and provide orientation in dynamics to promote improvement in different parenting styles and offer psychoeducation on new needs within the educational framework.
- Experiences and Meanings of the Pandemic: Exploring students' experiences and the meaning of the pandemic and how it has affected them within the educational system to establish new support programs that improve their impact on learning.
The pandemic has transformed the educational landscape, presenting challenges that require innovative and adaptive responses. Academic support therapists play a crucial role in this new context, helping students overcome cognitive and emotional barriers exacerbated by the health crisis. By reflecting on these new needs and adjusting our practices, we can work towards a more equitable, inclusive, and effective education for all students. The role of the therapist goes beyond cognitive reinforcement; they are the support link that will help steer in the same direction.
Written by:
Paula Taguas Labrador
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Autism Spectrum Disorder and Pathological Demand Avoidance
What is “demand avoidance” and when is it pathological?
We all experience “demand avoidance” at times, i.e. we resist doing something which is either requested of us or expected of us. This article sets out to raise awareness of and explore a specific “condition” or profile which has been identified in the field of Psychology but about which there is still some controversy and lack of understanding. The focus here is on children. Recommended strategies to support PDA sufferers, both at home and in education, are also outlined.
Demand Avoidance in People with ASD
People with Autism Spectrum Disorder (ASD) sometimes avoid situations which cause them anxiety or give them sensory overload as well as activities which are not in their usual routine. They also sometimes resist transitioning from one activity to another or avoid activities which seem pointless to them. They may refuse, have an emotional crisis or try and “escape”.
How does Pathological Demand Avoidance differ from the above?
Individuals with PDA might avoid the above situations for the same reasons. However, PDA has some unique aspects:
- Many everyday demands are avoided simply because they are demands. It is the expectation (from someone else or yourself) which leads to a feeling of lack of control, and this feeling triggers anxiety increases and even panic.
- There can be an ‘irrational quality’ to the avoidance – for instance, a seemingly dramatic reaction to a tiny request, or the feeling of hunger inexplicably stopping someone from being able to eat.
- The avoidance can vary, depending on an individual’s capacity for demands at the time, their level of anxiety, their overall health/well-being or the environment (people, places and things).
What kind of everyday demands are we talking about?
- A direct demand (an instruction like “brush your teeth!” or “put your coat on!” or “do your homework!”).
- An internal demand (e.g. willing yourself to do something or bodily needs, e.g. the need to eat when you are hungry).
- An indirect or implied demand (including any expectation, for example a question that requires an answer, food that you are expected to eat, or a bill that needs to be paid.
Conversely, a demand that triggers stress or anxiety in individuals with PDA is not necessarily something unpleasant: it could be, for instance, opening your presents on your birthday.
When was the PDA profile first identified?
The term was originally coined by Elizabeth Newson in the 1980s but it took until 2003 for it to appear in formal scientific research (Newson et al., Arch Dis Child 88:595–600, 2003). Originally, PDA was a term used to describe a group of children who did not fit into the stereotypical presentation of autism recognised at that time but who shared certain characteristics with each other, the key one being a persistent and marked resistance to demands. According to Newson, autistic children display rigidity through rules, routine and predictability; in PDA their rigidity is in their need to avoid demands and control situations, which can often lead to the child appearing extremely impulsive in their emotions and behaviour, as they react to what they perceive to be demands.
Whilst autistic children often show little or no sociability, children with PDA display surface sociability. However, they often fail to recognise boundaries and struggle to understand the social norms of relationships. Children with PDA, like autistic children, often experience early language delay but often catch up later. They might have normal facial expressions and make eye contact; however their speech content can seem odd and, importantly, communication can be significantly affected by demand avoidance. The predominant characteristic of children with PDA is their continued resistance and avoidance of the ordinary demands of life. Whilst autistic children can be reluctant to comply, this is often in a non-social way; they lack the empathy to make excuses or develop strategies for avoidance. In contrast, children with PDA develop multiple strategies of avoidance, which they are able to adapt to the adult involved and can appear socially manipulative. (Newson, 2000).
Outside the UK, there is little awareness of PDA. However, in the UK, the term has been given some attention in TV and social media and this has led to an increase in pressure to consider PDA as a diagnosable disorder. Currently, while PDA is mentioned in latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) it is treated as a specific profile under the umbrella diagnosis of autism spectrum disorders (ASD). However, this does not mean that clinicians cannot use PDA as a descriptive diagnosis alongside a clinical diagnosis of ASD.
How common is PDA?
We don’t know. Because demand avoidance is currently understood as one characteristic in a person’s neurodevelopmental profile and is neither a diagnosable stand-alone condition nor is there a standardised assessment for the characteristic, there are no data to reliably indicate how common it may be. Research to date has been limited and often unreliable.
“Can’t” versus “won’t”: the difference between PDA and Oppositional Defiant Disorder
It is without doubt very stressful for parents to experience their child avoiding simple tasks or refusing to follow rules or basic routines. However, it is essential that we distinguish between PDA (Pathological Demand Avoidance) and ODD (Oppositional Defiant Disorder). Whereas PDA is an anxiety-driven need to be in control and avoid demands or expectations, ODD is characterised by angry and irritable mood, an argumentative and defiant attitude and vindictiveness.
Accurately identifying whether a child has PDA or ODD is key for implementing the right support strategies and can help others outside the immediate family to better understand the child’s needs. Some key characteristics of PDA which can help us with this distinction are:
- Difficulty tolerating uncertainty or unpredictability;
- Language delay and trouble with social interaction, which is common among autistic children;
- Mood swings and emotional dysregulation;
- Impulsivity and risk-taking behaviors;
- Obsessions and compulsions related to control or avoidance.
Tactics PDA children might use include distraction, making excuses, or shifting blame to avoid tasks and maintain a sense of control over their surroundings. Understanding these coping mechanisms is crucial for designing effective strategies to support them in managing their anxiety-driven behaviours.
How might a PDA child behave in a school environment?
It is possible that approaches used by teaching or special needs staff for autistic children can be ineffective for a PDA child and might even make things more difficult. In a school setting:
- They may have poor self-esteem, although this might not be obvious from their behaviour.
- Like many young people with ASD, they may behave very differently at home and school due to masking
- They may find regulating their emotions very challenging.
- A PDA learner may not seem interested in ‘doing well’ and may respond negatively to praise, for example by destroying work.
- They may say that the work is boring, or that they already know it.
- They may use charm, imaginative talk or attempt to shock to avoid demands.
- They are likely to want to build friendships with peers, but may find maintaining friendships difficult due to a need for control.
In terms of school attendance:
- They may have experienced school exclusions, even from an early age.
- A PDA child or young person may be absent from school altogether. 70% of PDA learners are either not in school or regularly struggle to attend. Many PDA children are home educated.
- Not every PDA child will have attendance difficulties – some may have slipped under the radar completely.
Support strategies for Parents at home
Unfortunately, there is limited research on support strategies. However, it is evident that people with PDA are best supported with strategies and approaches personalised to their specific strengths and needs.
The following advice is compiled from an American organisation called Trails Carolina (Trails Carolina – Leading Wilderness Therapy For Teens and Adolescents) and the Autism Society, U.K.:
- reduce and/or remove demands whenever possible;
- a collaborative approach is likely to work best, where the child is treated as an equal, rather than adults acting as an authority;
- use indirect communication styles (rather than making demands directly)
- avoid potential stressors such as eye contact, touch and confrontational postures/physical stances;
- if the child is distressed, give them space, remove spectators or move the child to a quiet space if possible;
- a coordinated approach to support is essential, involving the child, their family, school and health or social care professionals;
- In addition, it has been suggested that people with PDA may benefit from:
- identifying and understanding their demand avoidance and its triggers;
- sensory regulation and creating a sensory environment that works for them;
- therapy, counselling, mindfulness and meditation.
Support Strategies for School or Education
- Focus initially on building relationships and trust with a key adult before learning is attempted.
- Focus on the end goal rather than the means of getting there.
- Collaborate with the learner, adopting a child-centred approach focusing on their needs and strengths, and negotiating with them.
- Allow PDA learners to follow their interests and passions, and ensure learning topics are useful, meaningful and relevant to their lives.
- Provide choices and options over what work is completed, when, where, how and with whom.
- Try to recognise any signs of escalation of stress or anxiety and address them before the student reaches crisis point. Distress is usually caused by emotional, social or sensory overload; be aware of the child or young person’s potential triggers.
- Avoid direct requests; use a tone of voice and phrasing so that requests are made indirectly and allow for flexibility.
- Keep expectations to a minimum so that you can focus on the ones that are really important. This may mean having to be flexible about, for example, uniform, timetabling, homework expectations and the way results and progress are recorded.
- Provide a quiet area such as a calm corner for learners to use when they feel overwhelmed.
Some of these approaches may require significant adjustments on the part of the school, but they could be essential in ensuring that a PDA child continues to attend school.
The ongoing debate about PDA
Finally, it is necessary to highlight that, within the autism community (which includes autistic people and their families, autism researchers, health care professionals and education professionals) there is a great deal of disagreement about the validity and usefulness of the concept of PDA. However, one point on which there is broad agreement is that more and better research into Pathological Demand Avoidance is required.
Resources on PDA for Teachers and Parents
- Twinkl has partnered with the PDA Society to provide some helpful guidance documents (PDA PANDA Approach: Disguise and Manage Demands | Twinkl)
- The Autism Society (Demand avoidance (autism.org.uk). This page includes some real-life experiences in the form of quotes.
Abouth the author
Julia Jakubovics is from the UK. She has lived in Spain for over 20 years. She has a degree in Psychology and recently completed a Masters course in Interventions for Learning Difficulties in Children at ISEP (Instituto Superior de Estudios Psicológicos). She is currently working as a Shadow Teacher and Study Coach for Sinews, providing one-to-one and in-class support for children with special education needs.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
What is narrative therapy and how can it help me?
Narrative therapy is a form of therapy that is based on the idea that people are the storytellers of their own lives and that by changing the way they tell their stories, they can also change the way they perceive themselves and the world around them. In this article, we will explore in depth what narrative therapy is, how it works, and how it can help us.
What is Narrative Therapy?
Narrative therapy is a form of therapy that focuses on the narration of personal stories and the exploration of how those stories affect a person’s life and experiences. It was developed by Australian therapist Michael White and New Zealand therapist David Epston in the 1980s. Narrative therapy is based on the idea that people construct their identities through the stories they tell about themselves and that these stories can be modified to promote change and personal growth.
Key Principles of Narrative Therapy
Narrative therapy is based on several key principles that guide the therapeutic process:
- Externalization of the Problem: One of the central principles of narrative therapy is externalizing the issue. This involves separating the problem from the person, allowing the person to see the problem as something external to themselves and, therefore, easier to address and change.
- Co-construction of Alternative Stories: Instead of accepting a single narrative about their lives, clients are encouraged to explore and co-create new alternative stories that may help them reinterpret their experiences in a more positive and empowering way.
- Respect for the Client's Experience: Narrative therapy believes in respecting the client's experience and the importance of allowing people to tell their own stories in their own terms. This involves active listening, validating the client's experiences, and working collaboratively with them to find solutions that are meaningful to them.
Why is Narrative Therapy Healing?
Narrative therapy is considered healing for several fundamental reasons that are rooted in its approach and therapeutic practices. Here are some key reasons why narrative therapy is perceived as a healing form of therapy:
1. Identity Reconstruction:
Narrative therapy allows people to reconstruct their identity by challenging dominant narratives that may be contributing to their emotional distress. By changing the way personal stories are told, clients can develop a more compassionate and empowering understanding of themselves, contributing to a renewed sense of self-esteem and self-acceptance.
2. Empowerment Promotion:
Narrative therapy promotes empowerment by focusing on the individual’s strengths and resources. Through the co-construction of new alternative stories, clients discover that they have the ability to influence the direction of their own lives and to face challenges with resilience and creativity.
3. Redefinition of Past Experiences:
By rewriting past stories from a more positive and empowering perspective, narrative therapy helps people find new meanings and lessons in their past experiences. This can lead to greater acceptance and inner peace regarding past events that may have previously caused distress or emotional pain.
4. Encouragement of Self-Reflection:
Narrative therapy encourages self-reflection by inviting individuals to examine their own stories and narratives in a more conscious and reflective manner. This process of self-exploration can lead to greater self-awareness and self-understanding, facilitating personal growth and positive change.
5. Building Meaningful Relationships:
The therapeutic relationship in narrative therapy is based on respect, empathy, and collaboration. This genuine connection between therapist and client provides a safe and supportive space where individuals can explore their personal stories and work together to find meaningful and lasting solutions.
Applications of Narrative Therapy
Narrative therapy has been successfully used for a wide range of issues and populations, including:
- Depression and Anxiety: Helps clients reconstruct negative narratives about themselves and find new ways to relate to their emotions.
- Trauma: Allows trauma survivors to rewrite their stories of survival and resilience.
- Family Conflicts: Facilitates communication and conflict resolution within families by helping members understand and redefine their relationships.
- Identity Issues: Helps individuals explore and assert their unique identity in the face of social and cultural pressures.
Examples of Narrative Therapy Exercises
Here are some examples of tools employed in narrative therapy:
- Self-Compassion Letters: This exercise involves the client writing a letter to themselves from a compassionate and understanding perspective. In the letter, the client can gently express their feelings, acknowledge their strengths, and remind themselves that they are worthy of love and acceptance, even in times of difficulty.
- Strengths Family Tree: The therapist guides the client in creating a family tree that represents the strengths and resources that have been passed down through generations. The client can reflect on the strengths of their ancestors and consider how these positive qualities have influenced their own lives.
- External Observer: The client takes on the role of an external and objective observer to examine their own experiences from an emotional distance. This can help the client gain a new perspective on their problems and separate their personal identity from the events and circumstances that have occurred in their lives.
- Life Book Creation: The client creates a life book that includes significant moments, achievements, and experiences that have shaped their identity. By reflecting on these events and narratives, the client can identify common patterns and discover new ways to interpret their personal story.
- Gratitude Journaling: The client keeps a gratitude journal where they record things they are grateful for each day. This exercise fosters a more positive and appreciative approach to life and helps the client recognize the good things that exist amidst challenges and difficulties.
In conclusion, narrative therapy is a powerful tool that can help people reconstruct their life stories and find new ways to relate to their experiences. By changing the way they tell their stories, people can change the way they perceive themselves and the world around them. Whether facing depression, overcoming trauma, or navigating family conflicts, narrative therapy offers a client-centered approach that promotes meaningful and lasting personal change and growth,
Abouth the author
Verónica Sarria is a health psychologist at Sinews. She is specialized in eating disorders and obesity, working with adolescents and adults. She also treats other problems such as anxiety, depression, grief, self-esteem and interpersonal relationship problems, among others. Her orientation is cognitive behavioral but she integrates tools and techniques from other currents according to the needs of each patient, thanks to her training in mindfulness, mindful eating, attachment theory and systemic (family) therapy.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Improving Your Eating Habits: A Guide by an English-Speaking Nutritionist in Madrid
Food has undergone significant changes in recent decades due to a variety of factors, including changes in eating habits, technological advances, food availability and lifestyle changes. Added to this is the change in food consumption patterns. With the fast pace of life, many people are relying more on foods prepared outside the home, such as takeaways, fast food and restaurants. These foods are often convenient, but they also tend to be high in calories, saturated fat, added sugars and sodium, and low in essential nutrients such as vitamins, minerals and fibre. In addition, they can contribute to weight gain and related health problems. This way of eating is very in common in certain countries. However, in Spain, it is more common to eat home-cooked meals. As an English Speaking nutritionist my task is to adapt your foods to similar ones to make them as healthy as possible.
There are also several common mistakes people make when eating. Here are some of the most common ones:
Most common eating mistakes
- Eating too many processed foods: Processed foods are often highly palatable, tasty, but high in calories, saturated fat, sugars and sodium, and low in essential nutrients such as vitamins, minerals and fibre. Eating too many processed foods can contribute to obesity, heart disease, type 2 diabetes and other health problems.
- Consuming sugary drinks instead of water: Sugary drinks such as soft drinks, fruit juices and energy drinks can be a major source of empty calories and added sugars. Opting for water instead of these drinks can help reduce calorie intake and improve hydration.
- Eating fast and distracted: Eating quickly and without paying attention to hunger and satiety cues can lead to overeating. It is important to take time to savour food and be aware of when you are full.
- Not paying attention to portions: Many people are not aware of proper food portions and tend to overeat. This can lead to unwanted weight gain and make it difficult to control portion sizes in the future.
- Not including a variety of foods in the diet: It is important to consume a variety of foods to get all the nutrients needed for good health. By limiting yourself to a few foods or food groups, you run the risk of not getting all the essential nutrients. For a complete diet we should eat at least 20 different foods a week.
- Skipping meals or extremely restrictive diets: The belief in wanting to be in line with current beauty standards leads many people to believe that skipping meals or following extremely restrictive diets is the quickest way to lose weight. However, this can lead to nutritional imbalances and long-term health problems.
- Relying too heavily on supplements: Supplements can be helpful in certain situations, but they should not be used as substitutes for a balanced diet. It is important to get the majority of nutrients from food rather than relying exclusively on supplements.
Fortunately, in recent years there has been an increased awareness of the importance of a healthy, balanced diet to prevent chronic diseases such as obesity, type 2 diabetes and heart disease. This has led to increased interest in nutrition and greater availability of information on healthy eating habits.
How to improve our diet
There are several ways to improve the quality of our diets and eat healthier. Among them are:
- Incorporate more fruits and vegetables: these foods are rich in vitamins, minerals, fibre and antioxidants, and are fundamental to a healthy diet. Try to include a variety of different coloured fruits and vegetables in your daily meals and snacks.
- Choose whole grains: Opt for whole grains instead of refined grains to increase your intake of fibre and nutrients. Choose whole grain products such as brown rice, whole wheat bread, whole wheat pasta and oatmeal instead of their refined versions.
- Eat lean protein: Lean protein sources such as chicken, turkey, fish, tofu, legumes and low-fat dairy products are excellent choices for healthy eating. Try to limit consumption of processed and red meats, which can increase the risk of chronic diseases.
- Limit consumption of processed foods and added sugars: Reducing your intake of processed foods, such as packaged snacks, fast food and baked goods, can help you reduce the amount of added sugars, saturated fat and sodium in your diet.
- Cook at home more often: Preparing meals at home allows you to have more control over the ingredients you use and cooking techniques. Try to cook with fresh, healthy ingredients and limit the use of unhealthy oils, fats and seasonings.
Making better food choices is fundamental to maintaining a healthy and balanced diet. As a nutritionist, and specifically, as an English Speaking nutritionist I try to help people adapt their meals to their lifestyles while respecting cultural aspects as well as food preferences. Many times in my practice I find that people have barriers to, for example, finding certain ingredients that are very important in their culture, or that meal times are very different.
It is not always easy, but in my practice, I always try to help plan meals in advance so that we can make more conscious and healthier choices. Spending time each week planning menus and making a shopping list with the necessary ingredients makes our lunches and dinners more beneficial for us.
Once the menus have been drawn up, which should prioritise fresh and unprocessed foods, we should also read food labels. When buying processed foods, it is important to read labels for nutritional content. Pay attention to the amount of calories, saturated fat, added sugars and sodium contained in the products. Usually fresh and unprocessed foods (fruits, vegetables, whole grains, lean meats, fish and low-fat dairy products are excellent choices for healthy eating).
It’s not just a matter of meal planning but also portion control. Pay attention to portion sizes and practice moderation when serving yourself. Use smaller plates, share plates in restaurants or save leftovers to avoid overeating. Just as it is not good to eat 3 plates of pasta, it is not good to eat 3 oranges in one sitting.
Finally, drink water instead of sugary drinks. What you eat is just as important as what you drink. Water is the best choice for hydration and contains no calories or added sugars. Opt for water instead of sugary drinks such as soft drinks, fruit juices and energy drinks.
It is important to be aware of these mistakes and try to avoid them in order to maintain a healthy and balanced diet. By following these tips and gradually making changes to your eating habits, you will be able to make better food choices and enjoy the long-term health benefits. Remember that the key is to adopt a balanced and sustainable approach to eating. As I say in consultation, there has to be time for everything. To eat well and also to indulge from time to time. It’s OK to eat something less healthy from time to time, but be aware that you can’t overindulge.
About the author:
Adriana Martín is an English Speaking clinical nutritionist at Sinews. She treats adults, adolescents and children seeking to improve their health through nutrition. She specialises in public health and also treats ED, SIBO, chronic diseases and other pathologies, as well as muscle mass gain or weight loss. Her approach is not to prescribe closed menus, but to make people understand the importance of nutrition at every stage of life through different tools.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
The Shonagai philosophy: The power of acceptance in the face of difficulties
We live in the era of «chaos» forgetting our wallet, being stuck in traffic or our battery discharged can make us go into an emotional outburst. These situations beyond our control are part of the stress we face in our day-to-day lives. The ability to remain calm in the face of what we can and cannot control is fundamental to preserving a healthy mental and emotional well-being. Faced with this, in Japan the concept «shou ga nai» was born, which in our western version would be «what are we going to do». It is very easy to say, but how can we integrate the concept «shou ga nai» in our lifestyle?
Get to know the concept of "shou ga nai"
From the Japanese philosophy comes the expression «shou ga nai» part of a philosophy where many of those who practice it, recognize it as «the secret of happiness». The Shoganai philosophy has its origins in Buddhism, therefore, it reflects a style of coping from the acceptance of circumstances that we cannot control.
This ability to maintain serenity in the face of difficulties does not deny our emotions, indeed, it does not focus on the conformism of our reality but preserves our efforts to change that which we can transform. This direction of our energy is a great protective factor when considering the disease of the 21st century: stress.
This refreshing new perspective brings us a new coping strategy that takes us away from cognitive rumination, automatic thoughts or paralysis by analysis, to bring us greater peace in our daily life situations and in which we can find a point of support, to look at our concerns with a broad outlook.
The integration of shonagai into the western world
The Shoganai philosophy is based on the pillars of mindfulness, where the importance of living in the present is recognized, moving away from «what I could have done» in the past or «what I will do» in the future. This concept has been tried to be transferred within the Western world as (it is what it is) in English or the popularly known (C’est la vie) in French. In other languages such as Icelandic we find (Petta reddast).
Beyond the globalization of the concept, the real key to this philosophy lies in its integration into our daily lives. In the Western world, it may seem fatalistic or pessimistic to «throw in the towel» in the face of difficulties. The key has been practiced by the Japanese, who focus their efforts on respect and acceptance of good and bad cycles as part of the way.
This philosophy makes us see beyond the concept, a lifestyle completely removed from western standards of «productivity» and how little we are allowed to «stop». We can find different translations of «shou ga nai» but sadly it is very far from our integration in the face of difficulties. A good starting point to establish a new cognitive reframing in the face of difficulties focuses on the differentiation between: «Conforming» as a reactive attitude while «Accepting» is a mature and proactive attitude, which translates into emotional stability, a sense of inner control and self-knowledge.
How to practice the Shoganai philosophy? Here are 4 simple steps for its integration
Take an instance of things
Before starting to analyze a situation, it is key to take a step back and try to find a moment where our emotions are more settled. When we all receive bad news, we are flooded with negative and even catastrophic thoughts, we tend to put ourselves in the worst, going into a state of alert as a strategy of preparation for danger. A vital tool that can help us in practice is the puppy metaphor:
«We have a puppy and we see how it does not stop sitting on our sofa, chewing the cushions and even begins to leave us some gift around the house … through this metaphor, we will see how we will see how we sprout frustration and anger to have our house impeccable, however, we must be patient and focus our efforts on educating the puppy, since a scolding would not help us at all.»
Identify which are and are not in your control
Once the metaphor has been put into practice, we will begin to analyze those things that have disturbed our routine and have led to a state of chaos in our order. Before their appearance, we will take enough perspective to establish a critical judgment. We will differentiate between: Can I change it? Yes, we take action. Can’t I change it? «In this case, we should accept it and save our energy.
Practice gratitude
Gratitude is a crucial part of integrating this philosophy, so that when our efforts are focused on the things that inspire gratitude, we encourage the development of a positive attitude. In the term this attitude refers to the cultivation of our resilience as a tool for adaptability in the face of difficulties. In addition to this, an attitude of serenity in a «calm mind» makes us find new solutions in situations we had not previously contemplated.
The more practice, the greater the mastery
This type of strategies, like mindfulness, do not try to be established with a goal of hours of practice. The key lies in its frequency, i.e., if you have 5 stressful situations during the day and you practice these simple steps in the 5, you will be training the mastery of the flow of thoughts, seeing how they become less and less present and that you have much greater awareness and control over your emotions in front of these. This continuity of short time and high frequency is what really works our ability.
Know the 5 Benefits for your mental health through the practice of the "Shoganai" philosophy
- Reduce your cortisol hormone: As the hormone responsible for stress, cortisol is produced by our body in "emergency" situations in order to cope with those situations that are out of our routine. Cortisol is as necessary as any other hormone, since it is indispensable for those situations in which we are in real danger. However, its prolonged maintenance can be detrimental to our health, promoting emotional irritability, lack of sense of humor or provoking emotional outbursts of anger or sadness. Beyond this, our quality of sleep or our immune system is weakened by this continuity. In view of this, the practice of the Shoganai philosophy can reduce our reactivity to stress and thus establish a correct regulation of the hormone.
- Increase your ability of resilience: Resilience is one of the most important skills when facing the challenges of our life, and is that, bring serenity is also focus your inner energy to listen to you, understand you and especially recompose yourself from those setbacks that assail us without warning. The absence of this ability can cause fear or loss of control to paralyze us, leading us to a state of obsession or rumination of our own thoughts. It is clear that resilience will not make our problems disappear, however, it gives us the ability to see beyond them, to continue and to appreciate the good despite the difficulties.
- Improve the stability of your emotions: The Shoganai philosophy leads us to a greater state of consciousness by focusing on the acceptance of the present, that is, to focus our strength on what we really have, in order to be able to modify our reality. This makes emotions that lead us to frustration move away, establishing a greater mental balance and learning to manage those that appear to us with relativity to the facts.
- Promotes Self-knowledge: The practice of Shoganai leads us to a state of resignation which brings us to an encounter with our emotions, this encounter from the acceptance gives us a deeper understanding of ourselves and the recognition of where our limits of will are, being more aware of those things that predispose us in that state of alertness. This self-knowledge is a key ability to know how to work in these stressful situations.
- Improve your attention span with creativity: Controlling your focus of attention directly improves the quality of your attention. The Shoganai philosophy, not only helps us to establish this control, but, with the acquisition of this, we find new solutions through creativity. This valuable quality, as experts say, is blocked in those situations where there is an overactivation of certain brain areas. When we approach problems from worry or pressure, our brain goes into a "state of alert" trying to solve situations quickly and automatically and therefore limiting our ability to find creative solutions.
The importance of lifestyle for wellness
Having learned about the many benefits of this innovative philosophy, it is essential to recognize its practical application in order to integrate it as a pillar of our lifestyle. The concept of «shou ga nai» may begin as a simple expression, but it has the power to transform itself into a new way of perceiving life and every circumstance around us. Its adoption is not a passive process, but requires active commitment, willingness and awareness. However, the efforts invested in its practice bring us the peace and mental balance essential to face daily challenges with serenity. Now, I ask you: Are you willing to immerse yourself in the practice of the Shoganai philosophy?
Written by:
Paula Taguas Labrador
Sinews MTI
Psychology, Psychiatry and Speech Therapy