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A Primary Task

This is second of eight short blogs exploring the elements of therapeutic change as proposed by Dr Sebastian Kramer.  Click here to read the first one – ‘A Desire to Change‘.

2.  A primary task, a goal . . .

When a client enters therapy they give us permission, to help them with an initial task or goal.  This goal may change throughout the therapy so it can be discussed and the ‘therapeutic sat nav’ can be reset. 

It is important that both of therapist and client understand and agree with what is being worked towards. 

We call it a ‘therapeutic contract’. It helps to keep our talking on subject and the last thing a therapist wants is for a client to walk out of the room thinking that the session had not been useful, that the conversation may have drifted around too many subjects or they had not been asked the questions they were hoping to be asked.  

In systemic psychotherapy it is not unusual for us to ask for feedback from our clients a little way into the session to help us understand if the session feels on track and useful so we can change direction to recalibrate the conversation.

When I was training I thought it was the therapist’s job to solve all of the client’s problems and dilemmas – this was an overwhelming and crippling thought.

I now understand that therapy can exist in chapters, in segments and in episodes.  You can move in and out of therapy with different goals.   

Therapy is an on-going dialogue with the therapist’s job being facilitate, encourage, cajole, challenge, question, celebrate and witness the reflection, insights and successes that our clients experience.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

A Desire to Change (part 1)

Covid 19 – Talking with children in uncertain times

Family Therapy for Beginners

 

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Cultural Identity and Integration – Feeling at Home in your own skin

I feel lucky to live and work in a place where I am in contact with people of diverse cultural backgrounds. Many seek me out as a therapist to talk about their personal struggles with cultural identity and belonging. Difference is something which is deeply felt in one’s skin and bones and living in a different culture to one’s own can feel like being a fish out of water – permanently. Everyone goes through their own unique set of issues depending on circumstances linked to upbringing, race, gender, immigration status, class, age, sexuality, and disability.

Sense of Belonging

Cultural and psychological integration go hand in hand, given culture is an intrinsic part of one’s identity which is linked to a sense of belonging, safety, and mirroring. All of these are associated to early childhood experiences; for instance, hearing our parents or carers speak in a certain language or with a particular accent, and sensory experiences – smell, taste, sound, and touch. Most of us can recognise the familiarity which transports us ‘home’ through hearing a piece of music, eating certain foods, or hearing our language. Other familiar experiences can include literature and art, nature and wildlife, and weather.

The True Meaning of ‘Cultural Integration’

Migration, whether through choice or not, can result in the loss of everything that has once felt familiar. These losses need to be felt and mourned so we can better accept and embrace the new culture we are living in. I have come across individuals from other cultures who had on the surface integrated very well in the UK, but on the other hand carried a deep melancholia about their cultural past, preventing them from ever fully ‘arriving’ here. Leaving one’s country and culture for another means reinventing oneself to a certain degree. Whilst this may sound appealing to some, the other side of it is that it can feel that you must constantly explain yourself. The lack of familiar cultural references, working harder to understand and be understood, and the constant feeling of being different are aspects of a migrant’s daily experience which remains invisible to others. We understand cultural integration more superficially as whether one can speak the language fluently, settle and adapt to a new environment. This is only the beginning.

The Role of Psychotherapy

We can think of Psychotherapy as integration of the different parts of the self which conflict with one another. This usually involves mourning losses, accepting reality, and learning to live with (or even embrace) paradox and uncertainty.  This is not about leaving your culture behind – quite the opposite. The more we process and integrate experiences, the more we learn to accept who we truly are. As you can imagine, this will not happen in just a few sessions. Preferably seek a culturally aware psychotherapist who has been through this process themselves or is at least far enough along the journey to take you through it.

 

Sam Jahara is a UKCP Registered Psychotherapist with a special interest in working with issues linked to cultural identity and a sense of belonging. She works with individuals and couples in Hove and Lewes.

 

Blogs by Sam Jahara

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Leaving the Family

Psychotherapy and the climate crisis

 

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Why behavioural approaches do not work for all children

One of the most frequently asked questions put to me in clinic, is why some children do not respond to traditional reward/punishment based behavioural strategies. The answer is simple – because, contrary to popular opinion, these strategies do not work for all children in all situations.

This is because the ability to make a mental link between a behaviour and a punishment, and to then be to be subsequently less motivated to use that behaviour again, actually involves quite sophisticated cognitive processes. It also requires specific parts of the brain to be functioning well. Difficulties with this may apply to children with learning disabilities or neurological conditions. It may also apply to children who are anxious, fearful or traumatised. This is because anxious or fearful children are often operating from a very primitive part of their brain that physically impedes their ability to access more developed parts of their brains. This in turn makes it harder for them to make cause and effect links, to generalise, to suppress their impulses, to make rational decisions, to maintain empathy for others and, in some cases, even to trust in the motivations of others. Punishing these children without supporting them to understand what is happening for them, therefore, is actually more likely to increase their fearful behaviours and further undermine their trust in those around them. For some children, it can also exacerbate feelings of shame.

A second concern with an overly heavy reliance on behaviourist principles when applied to children, is the theoretical and research origins upon which these principles are based. Behaviourism was largely developed in the 1950s and 1960s in laboratories with small mammals such as dogs, cats and rats – animals with significantly less developed brains than our own. Whilst these experiments can teach us a lot about how to shape behaviour in its purist sense therefore (i.e. classical and operant conditioning), they offer nothing in terms of how we build children’s self-esteem, build their intrinsic motivation, or even how to protect their attachment relationships. For instance, classically conditioning young babies to sleep by ignoring their attachment-seeking behaviours, can have detrimental effects on a child’s subsequent relational security and internal regulation skills. Similarly, a heavy reliance on operantly conditioning ‘good behaviour’ in young children with external motivators (e.g. star charts) has been shown to undermine a child’s natural desire to problem solve, be creative and to keep building on their successes when these external motivators are later removed.

Whilst some behavioural principles within a parenting repertoire can undoubtedly be helpful, therefore, when used to excess, and particularly when used in the absence of a broader context of sensitive, loving and developmentally appropriate care, they can quickly become damaging. This is because human children have brains that require so much more from the parent-carer relationship than simple behavioural conditioning.

Part of my role as a Clinical Psychologist, therefore, is to help parents, carers and professionals, to find new and more effective ways of supporting children to reach their full potential.

 

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.

 

Blogs by Dr Laura Tinkl

Tips for talking to young children about their behaviour

Parenting Styles

‘Ghosts in the Nursery’ – The Power of Family Scripts

When praise becomes harmful to children

The role of ‘attunement’ in relationships with babies and young children

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Analytic Therapy for Addictions

In this blog I want to briefly explore the analytic approach to addictions.  Freud stated that his aim in Psychoanalysis was to help the patient transform ‘hysterical misery into common unhappiness’. In Buddhism, a central concept is that of Dukkha, commonly translated as ‘suffering’, ‘unhappiness’, ‘pain’, or ‘stress‘. It refers to the fundamental painfulness of mundane life.

Henry David Thoreau (1854) declared that most men lead a life of quiet desperation.

As depressing as these concepts seem, the intention is actually to relieve suffering, that it is the excess of suffering that we visit upon ourselves by an excess of demand, the demand to be excessively happy, to criticize and shame ourselves for not being ‘good enough’, the sadistic internal voices that berate us for the shortcomings of what is often an unachievable internal ideal that creates an unbearable pressure.

Modern life is designed to sell us things. One the most successful early pioneers of advertising, Edward Bernays was a nephew of Freuds and advertising has very successfully realized that we are driven to buys things that we imagine will make us feel better about ourselves, that within the object brought is an identity of ourselves as, better, more desirable, happier etc, in short to offer us promises of less painful or even pain free lives.

Zizek notes that the unconscious ideology of today is the demand to ‘enjoy’.

In terms of addictions, especially the addictions, now facilitated by the internet, and even more so by the internet in the pocket, the phone; gambling, pornography and shopping, these promises are ever ready. Its is also worth noting that addictions can be hidden in seemingly healthy pursuits; healthy eating, work, exercising, that can also be used as an avoidance of emotional pain through compulsive stimulation.

There are broadly speaking two approaches to therapy and to treating addictions and their underlying causes, the conscious strategies and good advice model and the more exploratory underlying approaches. Both have their place and it may be necessary to utilize both to really address issues.

The first model; involves CBT and specialist structured interventions; – managing access to the source of addictions, keeping diaries, replacing destructive habits with healthier ones and these will be more advice led. Sometimes it may necessary to utilize these approaches to try and get something under control. However, what these models may not do is to really dig down and get underneath the causes of the problems. The addictions are often the symptoms of underlying traumas and difficulties, sometimes these are not conscious and this is where the analytic or exploratory approach focuses its beam. The problem with not doing this, is that in true wac-a-mole style, the underlying causes tend to resurface and one addiction will merely be replaced with another.

Lance Dodes (2019) an analyst specializing in addictions highlights three pertinent areas of exploration:-

  1. Feelings of helplessness or powerlessness, produced by specific situations whose meanings interact with prior traumas. In this situation the additive act or even just the decision to undertake an addictive act can help the person regain a sense of control. The exploration of the issues leading to these feelings can unpick the unconscious feelings leading to the urges and ‘allow anticipation of future addictive urges, with the possibility of mastering the behaviour.’
  2. These feelings of powerlessness are often related to past traumas and difficult experiences often in relation to the clients attachment history, which has led to internal feelings of powerlessness and corresponding feelings of rage against these feelings.
  3. These feelings are displaced into addictions, through therapy these feelings that were once felt to be overwhelming and unbearable can over time and within a strong therapeutic relationship begin to be able to be felt to be understood and able to be experienced, often through the experience of the therapist being able to face and contain the feelings with and alongside the sufferer.

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

Loss

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconsious

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Group Psychotherapy in a post ‘Pandemic World’

I wonder how you have coped with the forced isolation imposed on all of us during the corona virus.  Has the weekly hand clapping made you feel more part of your local community providing some small contact with others during the week? Or have you been part of a family meeting on Zoom or with friends?

Now, that we are beginning to return to more familiar routines you may be wondering if joining a psychotherapy group might help with the re-adjustment to the ‘new norm.’

Our relationships with family, friends and fellow workers can be a source of inspiration and support; however, often it is these relationships that baffles us.  Joining a group can offer a space for you to share experiences and gain an understanding of yourself.

 

Why should you join a group?  Ask yourself, what are the difficulties I need to address?  These usually fall into one of two groups:

Emotions and feelings – which disrupt life including general performance of daily living skills. You may be taking medication to treat the affects of a disorder.  Common symptoms include anxiety and depression, obsessive-compulsive disorders, eating disorders and social anxiety.

Relational Challenges – we are dependent on our relationships with others to live a happy and secure life.  However, these often challenge us in ways we do not understand. The signs and symptoms above are often caused or cause problems in relationships both personal and at work.

 

What happens next?  When you contact Brighton & Hove Psychotherapy, your enquiry will be passed onto me.  I will then contact you via your chosen method of contact to discuss your concerns.  We will then set up an appointment to meet.

The initial Session – at this first meeting, you and the psychotherapist will have a discussion in order to get to know you. If you both feel joining a group would be helpful another session will be set up.  A questionnaire will be sent to you to complete.

Follow-up – at the next session, we will use the questionnaire to follow-up your history, which will have formed the bulk of the first session. What are you hoping for by joining the group? Depending on your needs for preparation prior before starting the group will be agreed.  I will ask your permission to share your name with the group in order to check out whether there are any boundary issues i.e. you do not know personally anyone in the group already.

Usually there will be at least one more session before you join the group.

The first Session – joining the group for the first time is always a challenge, you already know the psychotherapist and the names of the group members.

There is no set agenda, the group runs using free association.  The boundaries of the group are – (1) always start and finish on time, (2) it will meet in the same venue, (3) it is a confidential space which each person agrees to before joining the group and (4) the members of the group do not have contact outside of the group. It provides a predictable space and time every week for a minimum of 40 to 42 weeks a year.

 

FAQ’s

Can I be in a group and continue with my individual psychotherapy?

No, the group is the primary therapy for the whole time the person is in the group.  A process called splitting can occur if group members are attending psychotherapy outside of the group.

How does Group Psychotherapy work?

The group provides a space to explore relationships in action.  As we all come from families or experiences of care in our young life, these influences stay with us and shape how we are later on as adults.  The small group offers a space to reconnect with that experience and re-work, often-traumatic events, in a safe and secure environment.  In addition to making connections to the past, we can explore current relationships in our families, couples, social and work life. Change of this sort takes time therefore you will need to make a commitment of time for processing and integration.

How confidential is the group?

The group is a confidential space where members of the group are asked not to have contact outside of the group or to share what happens in the group outside of the group space.

How many people are in the group?

A small group has a maximum of 8 members, 9 with the conductor.

Why is the Group Psychotherapist called a Conductor?

This relates to the role of the psychotherapist in the group.  As the group matures the group members become familiar with each other; they know each other’s stories and begin to see the patterns each one may be playing out in their lives.  The role of the psychotherapist will be to bring together the voices much the same way as the conductor in an orchestra brings in various instruments during a performance.

 

Dorothea Beech is a Group Analyst with many years experience working in the UK and overseas.  She worked as A Group Analyst in South Africa as a Lecturer at Cape Town UCT and at Kwa Zulu Natal University in Durban, lecturing on a Masters Program in Group Work.  Her MA in Applied research was on Eating disorders. Her interests are in cultural diversity and trans-generational influences on the individual.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

Termination and endings in Psychotherapy

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

What is a Psychotherapy Group?

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