Brighton and Hove Psychotherapy

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A Dramatherapist at work in the sand tray

 

Dramatherapy is one of a group of therapies which are called Creative Arts Therapies, along with Music therapy and Art therapy. Today I am going to explore one aspect of Dramatherapy.

We usually come to therapy to talk.  Dramatherapy, has the capacity to go beyond the talking because it is creative.

Dramatherapy becomes useful in the therapy space when it is used as a way of illustrating  the talking which takes place between the client and therapist. This illustration provides another way (a container) for the client to find meaning in their experiences and in their sense of self.

How is this?

Mostly when we seek therapy we expect to be talking. As a dramatherapist I am always alert to opportunities within the talking,  opportunities to explore  those things for which there are no words-maybe those things that happened to us before we spoke,  or those painful experiences, things that we want to actively or unconsciously deny, or perhaps a dream, or an illness.  In other words those things that are not part of our everyday cognitive knowing.

And this is where creativity comes in. When we are creative we are tapping into the right side of our brain which is very different from the left side.  Simply speaking the right brain does not have the same rules of logical thought and sequential time. It receives and processes information and experience very differently. For us to be able to connect and communicate with the rich wisdom of the right brain we need to use a medium which represents (re-presents) our experience to us in a different way.

Sand tray is such a medium which can re-present a situation or experience. The placing of objects in the sandtray is intuitive, there is no right or wrong, only personal and individual interpretation.

In my work with a particular client who suffered from chronic anxiety, we explored her early pre-verbal experience as a way of understanding the roots of the anxiety.  She made sandtrays of her early years showing scenes of confinement, of heaviness, weight and pressure. Over the weeks she interpreted her created scenes to me, her witness. Through this witnessed process she was able to articulate her pain for the first time. As her feelings emerged and as she became more emotionally open her anxiety lessened.

In my experience this precious work continues outside of the therapy room, bringing a richness of new experience and self -understanding.  Through this work I see clients growing in self-confidence which I think is born from coming to know the self more fully and  profoundly.

If you are interested to know more about dramatherapy and how it may be of help to you, do contact me.

 

Magdalena Whitehouse is an experienced HCPC Registered Drama Therapist, working with individuals, couples and groups.

 

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Is growing up in a different culture always a good thing?

The world today seems smaller than ever before.  We think nothing of travelling to once exotic destinations for our annual holiday and more and more of us are choosing to live in countries other than that of our birth.

Alongside these effects of globalisation is that of children who are now growing up in cultures other than that of their parents and yet remaining to varying degrees apart from the culture of the country they live in.  These children are known as Third Culture Kids.

What defines a Third Culture Kid?

The term Third Culture Kids (TCKs) was first defined in the 1950’s to give a classification and understanding to American children growing up outside of the United States.  Technically it refers to a child who is likely to have parents (or a parent) who are working in a foreign country (or countries) for a period of time and the child therefore spends a significant part of their development; they therefore neither really belong to their original nor host culture and are therefore defined as being of a ‘third culture’.

Effects of globalisation

More and more children are growing up as TCKs as people think less and less of living and working in other cultures and countries.  The benefits of being a TKD are obvious if not always ubiquitous: TCKs learn to mix with other cultures; they frequently speak multiple languages; they are more likely to undertake a degree and can easily feel at home anywhere.

So, are there only positives?

Put simply, no.  If a child grows up as a TCK and has a ‘secure base’ – is securely attached to their caregivers – then the experience can often be largely positive though still comes with a price such as a loss of belonging, limited contact with wider family, confused loyalties etc.

However, if a child has a less than ‘good enough’ home environment then the experience of being a TCK can exacerbate their lack of boundaries and can make neglect and/or abuse more likely as there is no wider family network or community to care for the child.

It takes a village to raise a child

In my clinical work I have come across individuals who have survived extremely neglectful or virtually non-existent parenting, who have nonetheless managed to locate enough consistency in adults around them in order to be OK.  In other words, there is great truth and wisdom to the old adage that it takes a village to raise a child and often, the village is the container and parent for the child where their biological parents have failed them.

Third culture kids and loss

Loss is a key aspect of growing up as a TCK.  There is often the initial loss of ‘home; to overcome – house, town, culture, extended family, friends, identity – which can be a significant shock in itself.

However, the losses continue to define TCKs as it is extremely likely that if they are growing up as part of an expatriate community, friends, teachers and familiar faces will come and go fairly frequently as contracts end and jobs take the adults elsewhere in the globe.  This can be a particular challenge when it comes to the frequent and ongoing loss of friends which is often the hardest part of a TCKs experience.

On a psychological level the losses combined with a lack of cultural embeddedness and identity can lead to difficulty in settling down, committing and fitting in.  This can then translate to anxiety, depression and a sense of free-floating dread.

A rolling stone gathers no moss

Third Culture Kids can grow up to become Global Nomads relishing the confidence that being able to settle anywhere brings to them.  However, this is also often not the case and TCKs can oscillate between a dread of not belonging versus a fear of putting roots down and building an ordinary life with substance.

As with most experiences, whether something is positive, or negative is so very often contingent on how secure a child feels in the relationship with their parents.  With a secure base, we feel safe enough to venture further from home, even when that means exploring other cultures.

Mark Vahrmeyer is a UKCP registered psychotherapist and a self-defined Third Culture Kid who, by the age of 12, had attended 10 schools across five countries.  He speaks four languages and is attuned to working with Third Culture Kids, Global Nomads and Existential Migrants, as well as anyone struggling with cross-cultural experiences. Mark sees clients in Hove and Lewes.

 

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What is ‘Blocked Care’ as it applies to parenting?

The phenomenon of parental ‘blocked care’ is a term coined by eminent Clinical Psychologists Dan Hughes and Jonathon Baylin and Psychiatrist Dan Siegal. It represents a central feature of the Dyadic Developmental Psychotherapy (DDP) approach to treating children and young people with a history of developmental trauma and attachment disruption.

Advancements in the areas of attachment, trauma and neurobiological development, teach us that children’s brains are shaped on a neurological level by their earliest caregiving experiences. Indeed, we now know that an infant’s brain is primed, even in utero, to adapt to the type of care that it anticipates receiving from its primary caregivers in order to maximise its chances of survival. What is perhaps less known however, is that parents’ brains are also neurologically influenced by their experience of caring for their child. When things are going well, five main areas or ‘care systems’ in the parental brain are optimally functioning. These are:

  1. The Approach System: The system that enables us to fall in love with our children, to crave to be with them and to become completely absorbed in them. Not surprisingly, this system is associated with the release of oxytocin (the ‘love hormone’).
  2. The Reward System: The system that enables mutual delight and attunement when a parent interacts with their child. This system is associated with the release of dopamine (the ‘addictive hormone’).
  3. The Child Reading System: The system that enables parents to positively interpret our child’s behaviours and motivations and to remain interested in their unique qualities.
  4. The Meaning-Making System: The system that enables parents to think positively and meaningfully about their relationship with their child.
  5. The Executive System: The system that enables us to physically care for our children.

For some parent-child dyads however, things do not go so well. Some parents may face unmanageable levels of stress whilst caring for their infants, which may be exacerbated by their own poorly developed care and emotional-regulation systems. Others may be offering reparative foster parenting to children who, owing to previous experiences of abusive or neglectful parenting, now fear, mistrust and reject the care they are being offered, which can be extremely painful for their new carers to bear.

The real risk when things go wrong however, is that parents may enter (chronic or acute) periods of ‘blocked care’. When this happens, the first four systems listed above start to shut down. The parent no longer experiences joy or fulfilment of being with their child. They do not get the rushes of oxytocin and dopamine that other parents get, and they do not seek to be with their child. They also become much more likely to interpret their child’s behaviours and motivations with a negative bias (e.g. “he is manipulating me” or “she is a spiteful child”) as well as their relationship with the child (e.g. “I am a rubbish parent”).

A stressed-out parent is in survival mode. They are no longer able to remain open and engaged to the child’s emotional and developmental needs. Rather, they are liable to become extremely rigid, defensive and behaviorally-focused in their approach to parenting. Sadly, however, without support, the final care system, the executive system, may also start to shut down. This is the point when we start to see abusive or neglectful parenting emerge.

The growing evidence-base for blocked care, therefore, highlights the crucial need for psycho-education, as well as early and non-judgmental support to parents and carers who are most vulnerable to entering it.

References:

Hughes, D. & Baylin, J. (2012). Brain-Based Parenting: The Neuroscience of caregiving for healthy attachment. Norton

Hughes, D. & Baylin, J. (2016). The Neurobiology of Attachment-Focused Therapy: Enhancing Connection & Trust in the Treatment of Children & Adolescents. Norton

Siegal, D. & Hartzell, M. (2003). Parenting from the Inside Out. Tarcher/Penguin

 

Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes practice.

 

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How important are our Groups?

“Each individual – itself an artificial though plausible abstraction – is basically and centrally determined, inevitably, by the world in which he lives, by the community, the group, of which he forms a part.”  Foulkes, S.H. (1948, p 10, Introduction to Group Analytic Psychotherapy, Karnac)

The above quote is from Sigmund Foulkes who was the founder of Group Analysis, a widely disseminated group psychotherapy approach used in this country and internationally.  It might seem an extreme position to suggest that the individual is not real, but an ‘abstraction’. So, what does this mean?

Partly, it means we are all part of a complex network of human relationships. Our identities are formed in and through these relationships. Even when we are alone, we are relating to others in our minds.

More radically, it means that our context (i.e. culture, society, networks, relationships) creates us. This process involves our earliest experiences of our social world which we internalise unconsciously from birth through our key relationships and groups. This continues throughout our lives as we are always relating in and to our networks, existing as they are, outside and inside us.

So, the groups that you will have lived in, and continue to live in, will be inseparable to who you are.

On a broad level your ‘group’ will include your community, your country, your ethnic and cultural group – past and present. But on a more personal level your groups include: your original family (including wider family and past generations); current family relationships; friendships – child and adult, past and present; past and current romantic and sexual relationships; other relationships and networks in schools, colleges, communities, neighbourhoods, clubs, societies; work place; support or therapy groups. The list could go on.

Everyone you relate to in your groups are connected to and shaped by their own networks and bring those into that relationship. Thinking about ourselves as a nodal* point in these complex networks it’s possible to see just how connected we all are and that the idea that we can possibly be understood as an individual alone is, as Foulkes also said, like thinking about ‘a fish out of water’ (ibid p 14)

Often the difficulties that bring someone into psychotherapy originate with a breakdown or disturbance within their relationship/s in their early group or groups. Group analysis is so effective because it understands the central role of groups in who we are and who we can become. When someone joins a therapy group they become part of a new network which they will also help shape and be shaped by.  Group therapy reconnects people with their world of relationships and helps restore a fundamental sense of themselves and their groups.

Group Analytic Psychotherapy Groups are offered at Brighton & Hove practice. Currently we have two once weekly groups on a Monday and Thursday evening.

*denoting a point in a network or diagram at which lines or pathways intersect or branch.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

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What causes insomnia?

Insomnia is defined as being a habitual, or regular, inability to sleep.

Whilst it can be linked to medical conditions, the most common causes of insomnia are lifestyle related as well as anxiety, depression and stress related.

With regards to anxiety, depression and stress, insomnia is not only caused by these conditions, but it further exacerbates them too creating a vicious circle.

What can I do to help with my insomnia?

Improve your sleep hygiene

Sleep hygiene is a term used to describe a holistic approach to sleeping encompassing who you are as an individual and your sleep environment. Improving sleep hygiene involves thinking about where you sleep, how you sleep and what may work best for you.  Sometimes this will involve a degree of experimentation, for example, do you sleep better with the window open or closed? 

Stick to a routine of sleeping and waking

Research has shown that we are biologically predisposed to sleep and wake at the same time each day, ideally in synch with the setting and rising of the sun.  Whilst the latter is a far cry from modern life, coming up with a routine and sticking to it can be extremely beneficial to both your sleep patterns as well as your physical health.

Avoid stimulants

We all know that caffeine and alcohol will impact on the quantity and quality of our sleep.  However, watching a disturbing drama right before going to bed – or the news – can have an enormous impact on the ability for us to get to sleep.  It is much better to consume the news in the morning when we have the mental capacity and waking hours to digest it.

Why do anxiety and depression make insomnia worse?

Anxiety and depression are two seemingly different mental health problems that frequently find themselves side-by-side in the same sentence.  This is because they are essentially two-sides of the same coin.

Anxiety is an uncomfortable (at times, unbearable) feeling that gives us the sense that all is not well with the world.  It is an ordinary element of being a human being and many scholars believe that we are ‘cursed’ with anxiety due to our (largely unconscious) awareness that we are going to die.

Anxiety causes restlessness and many people deal with anxiety by channeling it into activity – something that fails when it comes to going to bed.  Anxiety is often described as ‘free-floating’ and will seek to attach itself to something.  We can then convince ourselves that the ‘thing’ our anxiety has attached to is the real problem, however, this is rarely the case.

Depression is a state of inertia but an uncomfortable one.  Anxiety (and stress) can have the function of protecting us from depression, however, eventually anxiety will give way to the hopelessness of depression.  One may think that sleep would come easily in a state of depression but this is often not the case as hopelessness can feel unbearable.

Can counselling or psychotherapy help with insomnia?

If a client presented with insomnia than I would want to understand what may be causing the insomnia and to work with the client to gain a deeper understanding of what their feelings may be telling them – particularly any anxiety or depression.

Whilst anxiety is a normal element of being a human being, it should not be debilitating and an ideal is to engage in a meaningful life whereby the anxiety is channelled in a healthy way. 

Alongside this is a deepening of the relationship with ourselves in order to learn to better tolerate difficult feelings without becoming overwhelmed by them.

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

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