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New Year’s Resolutions – why change might be so difficult

The start of a new year feels like a good time to make resolutions to change your life. Cut down on drinking, learn something new, be more efficient, be kinder, be more sociable or get fit.

Gym memberships regularly peak in January, increasing by 10%-20% but how many of those new memberships are used? According to research by Fridge Raiders, published in the Daily Mail in March 2019, 23% of Britons have gym memberships but only 12% use them often. They estimate that more than 4 billion pounds a year is wasted on unused gym memberships.

The reasons given for the 50 percent who did not attend regularly or at all, were to do with feeling self-conscious or intimidated, thinking that everyone was watching, finding repetitive activity boring and not knowing how to use the gym equipment. These could be valid reasons but Robert Kegan and Lisa Laskow Lahey think it goes deeper. They ask why do we stick with the status quo when we are unhappy or unwell and know that change will make us feel better or even make us live longer? Kegan and Lahey have been researching the resistance to change for many years. In their book Immunity to Change (2009) they discovered that strongly held values, often unconscious, prevented both collective and individual change.

The most quoted finding from their studies comes from interviews with patients with heart disease who were told they must change their habits around eating, drinking, smoking and exercise and take their medication otherwise they would die. Kegan and Lahey found that only one in seven was able to make the necessary changes. Making further enquiries they discovered that although patients recognised the imperative of their doctor’s advice there were deep seated beliefs that contradicted their desire to get well.

A composite example would be a man who said that cutting down on food and drink and taking medication for ‘old people’ would make him feel he was old and weak. This challenged his idea of himself as a competent man in the midst of a productive life. Beneath this was his fear of becoming incapacitated and dying that brought back memories of his father’s illness and death. At a deep level the fears that prevented him taking care of himself were the very things that were likely to happen to him if did not change his habits.

There are many other examples in their book. Another composite example would be a manager who wanted to be more collaborative and involve his team in decision-making.  Until he participated in the research he did not realise how much his fear of being a weak leader prevented him from being open to the ideas of others. This feeling stemmed from the unspoken culture of ‘you must be strong otherwise you won’t survive’ in the family he grew up in and was an integral belief about himself. When he could recognise this belief and its negative impact he was able to ask for support to change and eventually become a better and happier leader.

Kegan and Lahey’s research helps us understand why it might be so hard to change our habits to improve our lives. They offer an alternative to castigating ourselves for our indiscipline and lack of commitment and, I think, suggest that we begin by being kind to ourselves and curious.

 

References – 

https://www.dailymail.co.uk/news/article-6765171/Britons-spend-4-billion-year-unused-gym-memberships-new-survey-reveals.html

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

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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.

 

Please follow the links to find out more about about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

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Educational Psychotherapy (2) – developing empathy, mind-mindedness and self-discovery

In Educational Psychotherapy (1), I explain how Educational Psychotherapy first evolved and how, as an approach, it can help promote social and emotional development as well as the thinking skills required for learning.  This was illustrated through the aspects of a child’s first six months in therapy. Here, I highlight three areas of further progress over the next 12 months of work with the same child. Again, this account is disguised and anonymised.

Empathy and feeling understood

One of the most exciting benefits of Sammy’s becoming more emotionally literate was the opening it allowed for me to make connections between his experiences with family and friends and his feelings and then providing empathy for Sammy’s felt experience.  This enabled Sammy both to feel held and understood by me at an emotional level and to experience his feelings as making sense. Over time, Sammy came to welcome this and it seemed to encourage him to actively seek openings to make further connections between his experiences past and present and his thoughts, feelings and behaviours.

Mind-mindedness and social connection

Early on in the therapy, Sammy found it difficult to engage in wondering about his own mind or about others’ minds, in either imaginary or real contexts.  There were times when he seemed to think I should have already known what he was thinking. Things began to shift when trust developed and Sammy allowed himself to become more openly curious about me, what my life might be like and how I might perceive him.  He grew increasingly accepting of the idea that I had a mind separate to his and that learning about each other involved a shared process. He started to wonder about my own mental state and thoughts, perhaps partly in response to my modelling of a mentalising approach with him.  This capacity to be “mind-minded” was also reflected in Sammy’s accounts of social interactions at school when he openly wondered about various students’ motivations for particular actions and how they might have been feeling about a situation.  This included an understanding that people might have mixed feelings at times.

Therapeutic journey

It was Sammy’s journey of mental-emotional-social self-discovery which came to shape the bulk of our sessions and it was an encouraging and rewarding journey to be a part of.  The significance to Sammy of this work became increasingly evident as I began to talk about the sessions coming to an end several months before the final session.  Sammy found this very hard and would avoid or deny the subject in various ways.  However, in time, we were able to talk more about what this avoidance meant and Sammy moved into a period of some weeks when, unprompted, he became highly reflective about what the sessions had meant to him, bringing in memories of particular activities and commenting on changes which he felt had taken place within himself.  He also made reference to ways in which our working relationship had changed.  He spoke with confidence and resilience and a certain assurance that his memory would remain in my mind after our sessions had come to an end – and it has!

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

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Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

The medical definition of sexual dysfunction in women is hypoactive sexual desire disorder (HSDD) that is low or no libido. Like men, women’s desire for sex is effected by all sorts of factors such as relationship issues, bereavement, physical illness and the side effects of medication, job loss or work stress, depression and anxiety, recreational drugs, hormonal changes through aging and pregnancy, child birth, miscarriage.

There are conditions such as vaginismus where penetration is too painful for women to have sex but for the moment I want to look at chemical attempts to address women’s loss of sexual desire.

Unlike Viagra which treats the mechanics of erectile dysfunction, new pharmaceutical treatments in the US that aim to improve women’s sexual problems act on the brain rather than the genitals because blood flow has nothing to do with sexual function in women. At the moment there are no licensed treatments for women’s sexual dysfunction in the UK, but two in US are available for pre-menopausal women, these are Flibanserin (Addyi) and Bremelanotide (Vyleesi). They work by enhancing the neurotransmitters in the brain that support sexual arousal, reducing inhibition and encouraging sexual excitement.

These medications demand some commitment from users. Filbanserin is taken orally every evening whether you plan to have sex or not and Bremelanotide is injected into the thigh or stomach about 45 minutes before sex, no more than once every 24 hours or 8 times in a month. There are side effects such as tiredness, nausea, headache, dizziness dry mouth and these medications should not be taken with alcohol or grapefruit juice, as this may lower blood pressure to a risky level.

HSDD treatments do not claim to make sex any better rather they claim to promote an increase in women’s desire to have sex. The research determines a positive result as a limited increase in sexual activity measured as one more sexually significant event per month.

I have looked at the anecdotal experience of US women posting online. HSDD medication is extremely expensive costing several hundreds of dollars and the jury is out on its efficacy. Many women commented on the side effects, for some there was no improvement and/or the side effects were intolerable but others were extremely grateful for the difference it had made to their sex lives.

In the UK Prelox, a herbal supplement, is marketed as improving sexual function for late reproductive and post-menopausal women. There were no adverse effects during the trials but there it was noted that any improvements maybe due to a placebo effect.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

New Year’s Resolutions – why change might be so difficult

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

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Anxiety, Fear states, Trauma

Why do we get anxious and fearful?

The anxiety /fear response is the brain’s way of trying to keep us safe and healthy. Anxiety serves as a faithful reminder of things which the brain assesses need to be avoided, based on past experience. Most of this experience is past or learned experience. This is important in understanding the role of anxiety and fear states.

Firstly anxiety and fear are natural emotions which are built into our biochemistry in order to ensure survival. The fright flight fight response takes place in the lower ‘old brain’ and is vital to promote survival. This is the area of the brain which we probably all have had some experience of in recent days and weeks with the Corona virus pandemic. This response is what we are seeing with a frightened population stockpiling food and resources and even fighting over supplies.

Secondly alongside the biochemical response of the old brain, we each have individual mental and emotional responses which are very variable

Understanding that the brain is a pattern seeking machine is really helpful here in understanding these variable responses. The brain simply reproduces a response based on past similar experience.

In order to treat anxiety we need to look at these patterns.

Different schools of therapy  have different approaches.

Behavioural  therapy looks at how thinking influences feelings and how to interrupt that pattern.

Psychodynamic therapy seeks to understand and connect past experience (which may be outside of our awareness) with the current response. A therapist can help the client to decontaminate, to understand, and process those experiences which may be outside of our awareness.

Creative psychotherapies such as Dramatherapy, Art Therapy and Music Therapy specialise in helping the client to access, process and release, out of awareness experience in very safe non directive ways. These therapies are especially indicated where there is trauma, neglect and attachment issues which are causing or contributing to anxiety and fear states.

Mindfulness therapy is very beneficial for anxiety,  fear states and panic attacks. It works by showing the client how to learn to place awareness in the body, the feelings, sensations- to  notice the thinking and then to return to body awareness. It becomes possible to observe thoughts passing as if watching a video, and then to return to the calm still space within the body.

Over time in mindfulness therapy, a new awareness begins to develop which interrupts the fear response. The mind develops an ability to dis -identify with the thinking, the feelings and the sensations which create and support the anxiety fear response. The ability to return to the still quiet space within is a skill that can be developed with practice both within and outside of sessions.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

 

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Why psychotherapy sessions should end on time

Boundaries are critical not only to a psychotherapeutic relationship, but, as many clients learn through therapy, are essential to healthy adult-to-adult relationships.

In a good psychotherapeutic relationship, there is a solid contract between client and therapist such that clients know what to expect and when.  And part of this knowing by the client is knowing what time the session ends; most psychotherapy sessions last for a ‘therapeutic hour’ or 50 minutes.

Door-stop moments

Every clinician has encountered what are known as ‘door-stop moments’ with clients – they happen in the moments leading up to the end of a session where a client suddenly blurts out something emotive and important that can throw the therapist and lead them to extend the session by some further minutes.

Unconsciously, door-stop moments have much significance and represent a relational process between the client and therapist.  Yes, the content may be important, however, why is it being brought into the room (and relationship) in the final moments?

The client may unconsciously want to control the session by ensuring their therapist has no time to explore the content in detail; they may wish to ‘leave’ something difficult with their therapist to hold for a week; and they may be testing whether the therapist will hold the boundaries.  Or all of the above and more.

On hiding an being found

Donald Winnicott, esteemed 20th Century British analyst famously said “it is a joy to be hidden, and a disaster not to be found”.  Winnicott was making reference to the children’s game of hide and seek, which, is only enjoyable if we imagine that someone is looking for us.  If the other game participants give up and leave, we are left hiding with nobody holding us in mind – a disaster.  In this quote, Winnicott is talking about many concepts, but amongst others he is making reference to boundaries and holding others in mind.

Even though in the game of hide and seek the winner triumphs by not being found, they paradoxically only win if the other(s) are still searching for them – the game therefore is profoundly relational and based on an agreed set of rules.

Psychotherapy is also relational at its core and based on a set of rules (boundaries).  One of these is that sessions end on time.  Clients will find all sorts of ways to ‘hide’ from their psychotherapist, however, this is only ‘joyful’ if they believe that they will be found (seen and contained).

When a client presents a door-stop moment to us, it cannot be allowed to derail the boundaries of the relationship or the rules of the game.  Otherwise the client gets what they think they want (more time) but feels omnipotent and thus unsafe with their psychotherapist – in other words, the client has hidden so well the psychotherapist has forgotten about them.

It is never about the client even though it seems it is

Extending a session due to a door-stop moment is never about the client’s needs and always about the psychotherapist’s.  The client relies on their psychotherapist to ‘hold them in mind’ and thus hold their best interests in mind.  It is the latter that gets lost when a session is extended.

How can it be in the psychotherapists interests to extend a session?

Unconsciously the psychotherapist has also ‘got lost’ and is unable to remain separate from the client’s needs.  They thus extend the session to try and ‘please’, or appease the client, which fundamentally is about avoiding the client’s anger’ rage and disappointment.  And the job of a psychotherapist is precisely to survive these feelings in their client and what it makes them feel.

Don’t become a psychotherapist if you want your clients to like you

Psychotherapy is only happening when a client feels either positive or negative feelings towards their psychotherapist (and vice-versa).  If the relationship is neutral, nothing is happening.

It is easy to bask in the glow of a client’s adoration but beware, a fall will come.  And so it should.  As psychotherapists we are not there to be liked – we are there to remain constant in the face of our client’s emotions.

And being constant means ending the session on time.

 

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.

 

Further reading by Mark Vahrmeyer –

How being ordinary is increasingly extraordinary – On the role of narcissistic defences

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

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Educational Psychotherapy: (1) supporting social-emotional development and learning

Educational Psychotherapy was developed by Irene Caspari in the 1970s, an Educational Psychologist working at the Tavistock Clinic in London.  She was interested in understanding learning difficulties from a psychoanalytic and attachment perspective. In order to address both learning needs and emotional difficulties together, she pioneered a method of blending structured (educational) tasks and free expression within a 50-minute weekly therapy session.  Treatment usually lasts 1-2 years but some work continues for longer or is adapted for shorter periods or extended assessments. Trainees are typically experienced teachers or learning support staff and undergo their own therapy during training. Many continue to work in schools and adapt their learning to therapeutic teaching and attachment-aware, trauma-informed practice.  

What follows is an anonymised, disguised case study which illustrates how Educational Psychotherapy can begin to support social-emotional development and learning.

11-year-old Sammy was referred for therapy by his key worker on account of difficulties he was having with relationships, expressing and understanding emotions and understanding the world. An earlier Educational Psychology assessment had suggested that high levels of anxiety were impacting on Sammy’s capacity to make full use of learning.  Therapy took place over 18 months.  

Sammy soon engaged with a variety of word, number and drawing games and activities, offered within the context of a supportive relationship.  Tasks which combined cognition, physical activity and relational connection proved an effective way to build trust, stimulate thought and enliven Sammy’s felt experience in the room.  Shared story writing and the free use of paint and clay facilitated expression and imagination. Conversation also had a significant place, at the point of checking in, within and around activities and, over time, for sustained periods.

Over the first 6 months of therapy, progress became evident in the following foundational areas:

Sense of self and reciprocal interaction
Sammy came to enjoy the process of co-creation with craft activities and solving problems together, including making up physical word and number games and negotiating the rules between us.  He became more comfortable with what he didn’t know  and embraced the opportunity to find things out, explore new skills and introduce me to new areas of learning.  Sammy also started to talk more about himself and grew comfortable with the routine of checking in at the start of a session, when he would share a happy achievement or discovery or an experience of frustration, disappointment or confusion.

Tasks and learning

Persevering at a challenging task requires the use of Executive Function skills, such as being able to monitor and evaluate where the difficulty lies, use problem solving skills to work out and plan the next steps, use working memory, inhibit distracting thoughts and so on.  Young people like Sammy, who have difficulties in these areas, require considerable “scaffolding” to help them develop and practice skills and tools for thinking. To begin with, Sammy found it hard to take instruction or support from me but as trust grew he became a little more comfortable with not knowing and clearly more curious.  My sense was that a space for thinking opened up in his mind which enabled him not to panic but to consider what was required next in order to proceed. 

Thinking about and talking about feelings

The development of a language for feelings was a significant area of development.  In early sessions, Sammy would habitually say that everything was “fine” or “normal”, almost seeming oblivious to the relevance of emotional experience or reflection.  After a time, Sammy disclosed that he had been getting into rages at home and taking out his feelings on objects which had sometimes become broken.  He acknowledged that this was confusing, upsetting and problematic for him and that he wanted help with it.  Activities like squeezing paint directly onto paper or working with clay enabled Sammy to express himself viscerally and then reflect on how he connected with the images created.  We also thought about activities Sammy could do at home to self-regulate.  

In time, thinking about feelings became an area that Sammy would actively seek.  He talked about experiencing fear and how this had caused him to adopt particular behaviours as an avoidance mechanism.  It seemed that the naming of these fears was enough to create some distance and enable Sammy to make a choice about how he wanted to act.  Sammy also talked about sadness and acknowledged that he had grown used to keeping his feelings to himself.  He started to voluntarily make links between his expressive material in artwork and his own thoughts and feelings inside.  

 

In part, these conversations involved psycho-education, helping Sammy to understand more about how feelings work, that it is normal to experience a wide range of feelings and that it can help to be self-aware and to share some of what we feel with trusted others.  At times, we were able to do this through playing board games or through role-play with miniatures.  Sammy showed that he could recognise the difference between actions held in mind and actions lived and that he could think hypothetically about possible future consequences of taking a particular course of action.  

This phase of the work paved the way for more profound developments which were to follow.  Sammy was now ready to take more risks. (Read more about this in Educational Psychotherapy (2) – article will be published shortly).

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

Face to Face and Online Therapy Help Available Now

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Back to ‘BACE’ics

Work life balance is fundamental to our mental wellbeing and can easily become out of sync without us even realising it, particularly when we are feeling stressed.  This imbalance can lead to depression and anxiety.  Going back to basics and keeping an activity diary for a week or two can provide us with useful information.  Broadly speaking we are interested in 4 different areas:

1/ Bodily Self Care – this would include how we look after our physical body, i.e. exercise, nutrition, rest and sleep, self-grooming, medication, etc.

2/ Achievement – this would include work, study, housework, any tasks / activities that gives us a sense of having achieved something.

3/ Connecting with others – this can be family, friends, work colleagues – in person, over the telephone or social media.  It can simply be being in an environment where there are others as long as we feel connected. It can also include connecting with animals.  Our pets can be very therapeutic.

4/ Enjoyment – hobbies, interests, fun activities, relaxing activities – anything that gives us a sense of pleasure

Each day categorise how you are spending your time into each of the areas.  Sometimes one activity may fulfil more than one category, e.g. walking the dog can be exercise so would meet bodily self care, it could also be an achievement if you really didn’t feel like going, it could be connecting with others as you may have met other dog walkers, and you may have enjoyed it.

By monitoring our activity according to these categories we can gather information and gain a sense of where there are gaps, where we might need to make some changes in our lives.

In my work as a CBT therapist I see all too easily how we can forget to enjoy ourselves.  We can get so caught up with work and what we think we should be doing we can lose sight of enjoyment and connecting with others.  Or we may have crammed so much into our day that we have no time to stop and just be.  Activity monitoring can be a useful tool for anyone who wants to take stock and see whether they are tending to their mental wellbeing.  To help us do this we can use a form called BACE (https://www.get.gg/docs/BACEdiary-weekly.pdf)  which is a daily activity monitoring form.  You will notice that the word BACE is an acronym for the four areas.

Once we have gathered information and highlighted the areas that need to be addressed we can use the same form as a daily planner to set ourselves small goals to address the gaps.

Sometimes the simplest strategies are the most helpful.

 

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults.  Rebecca is available at our Brighton and Hove Practice.

 

Further reading by Rebecca Mead –

Interpersonal Therapy (IPT) explained

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CORONAVIRUS – How Psychotherapy can help you navigate your way through the crisis

I am writing this blog four days after the UK government imposed an effective ‘lockdown’ in response to the spread of the Covid-19 virus.  Inevitably this crisis will have a considerable impact on all of us be it emotionally, financially, physically, spiritually and psychologically. Depending on our character, disposition and ways of thinking we will experience the impact in specific and particular ways. We may be very aware of feeling lonely, anxious, frightened, overwhelmed, sick, vulnerable, frustrated, bored, angry and our unconscious fears almost certainly will be highlighted by this unprecedented situation.

From what my clients have been telling me over the last couple of weeks it seems to me that the most difficult aspect of this situation for people is the uncertainty.  We don’t how long the threat of the virus will stop us from leading our ‘normal’ lives.  We don’t know what life will be like at the end, how it will end and what the longer lasting effects will be on us, our families, our communities and the world at large.

As human beings we struggle with uncertainties and ‘not knowing’. We may not always be aware of it but the lack of certainty the ‘not knowing’ makes us feel afraid, ill at ease, out of control and so in order to protect ourselves from these uncomfortable feelings we unconsciously replace them with the illusion that we are in control and therefore we know exactly what will happen. Being certain, knowing what will happen narrows the mind, reduces the questions and makes life feel easier.  We usually forget to focus on the present moment and instead we make plans for the future, focussing on what we are going to do, where we’ll go, what we’ll buy, who we’ll see etc, confirming our illusion that we know what will happen and that we are in control.

Focussing on the future works until we are faced with a crisis or we are under threat then we focus completely on the present moment, it takes up all our thinking.  The present moment right now is frightening and for many people this is overwhelming.  Many people are struggling to bear the awfulness of it and the feelings of uncertainty they are having to cope with.

The reality is we cannot change what is happening, we cannot control outside forces we can only change the way we think about them and therefore how we feel in response to them.  In essence this is the work of psychotherapy.

Having a therapist to talk to at this time can help you bear the uncertainties of life and what feels overwhelming.  As therapists we are trained to work with the ‘not knowing’ and are therefore uniquely placed to help you face uncertainty and anxiety – it is our medium and what we work with all the time in our consulting rooms. Having a space where you can verbalise your anxieties and reframe your life so it becomes more bearable is invaluable right now.

 

Please follow the links to find out more about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

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Making the Most of your Online Therapy Sessions

During the recent challenges brought about by Covid-19, we all had to make significant changes to our lives and adapt quickly to a new reality. This is also true for therapists and clients who shifted quickly from the safety and familiarity of their consulting rooms to video or telephone meetings. I would like to acknowledge the impact of these changes on both clients and therapists on a separate blog. But first, to help remove some of the anxiety of involved in this transition I want to outline how you can make the most of your online therapy sessions.

  1. Spend some time setting up

Although most of us are familiar with video technology in our personal and professional lives, meeting online for therapy requires some preparation. Not just in terms of tech but also allowing a psychological transition into the therapy space, especially if you are shifting from a different activity in your home.

Give some thought to the room you wish to use, making sure that it is private and quiet, and that you will be sitting comfortably for the duration of the session. Make sure your devices are fully charged or plugged in and well positioned, so that you can see and hear your therapist well. Preferably wear headphones for a better sound quality and experience. Have a phone available in case one of you encounter issues with your tech and need to continue your session over the phone.

Finally, make sure the lighting in the room is positioned so you can also be seen well. Seeing and hearing you well will enable your therapist to ‘tune in’ much better to you, reading nuances in your facial expressions and tone of voice.

  1. Avoid all distractions

Make sure your notifications are switched off and all distractions are put away, such as work and study materials. Most therapy rooms are deliberately thoughtfully furnished in order to offer a calming, comfortable and uncluttered environment.  Ideally try to replicate this in your home where possible. If you live with others, schedule your session at a time when no one will hear or interrupt you.

  1. Communication queues

Psychotherapy and counselling usually take place face to face because it important for both the client and therapist to be able to communicate well with one another. This communication is largely non-verbal and often ‘felt’ rather than spoken. Video can be an additional of barrier to communication, despite advances in technology and video quality. Therefore, it is important that both client and therapist flag up missed queues or gaps in connection as it can be the case with delays or frozen images. Voice any frustrations you are experiencing in relation to this and work with your therapist to try and improve them where possible.

  1. Transitioning into and out of your appointment

As in number 1., give yourself space before and after your session. The travel journey to and from a meeting can help with processing, reflecting and thinking. In the absence of this, allow yourself some quiet time before and after your therapy session. Dealing with difficult emotions and discussing sensitive topics can leave us feeling vulnerable for a little while. If you are using your therapy to work on relationship difficulties with someone you live with, engaging with them straight after your appointment might not be a good idea. Go for a walk, take a bath, or just ask for some quiet time on your own. Equally, moving from a therapy session straight into dealing with work emails might not be such a good plan.

  1. Remember the positives

With Covid-19, we have moved our face to face meetings online because of circumstance rather than out of choice. However, people have been offering online therapy for quite a few years now. Although my preference remains meeting people in person, I am beginning to appreciate some of the advantages of online working. For instance, it is nice to be able to use headsets and adjust the volume if I can’t hear someone well. Because I no longer need to travel to and from work, I now have more time to do things I used to have no time for. It has also given me much more flexibility to see clients at times I previously couldn’t. There are advantages and disadvantages of working at home and working online. It will take us sometime to get used to our new reality. If we can’t change our new predicament, we may as well make the most of it!

 

Sam Jahara is a Psychotherapist and Supervisor in private practice working with individuals and couples. She is also the co-founder of Brighton and Hove Psychotherapy, a multi-approach clinic, offering Psychotherapy, Psychology and Counselling to all client groups, both face-to-face and online.

 

Further reading by Sam Jahara

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

Leaving the Family

Psychotherapy and the climate crisis

Psychotherapy can change your life – but you may not want it to

Face to Face and Online Therapy Help Available Now

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

Many self-employed psychotherapists, psychologists and counsellors have immediately felt the economic impact of the crisis brought by Covid-19. As our clients began to either lose their jobs or face increasing economic uncertainty, many had to either put their sessions on hold or stop coming altogether. Many of us have either dropped our fees or continued seeing people with the uncertainty of getting paid. Unfortunately, some people have lost their support system when they need it the most.

Private Psychotherapy has always been enjoyed by many in the UK and around the world, as most national health services cannot offer the same level of professional service due to cost.

Psychotherapy practices have always offered a vital service to the community, whether through charities, low-cost services or full paying clinics. Psychotherapy is a place where people’s deepest mental anguishes have a place to exist, to unfold and to be healed.

The health and consequent economic crisis brought by Covid-19 is already affecting people’s mental health in several ways, some of which have not yet come to light. This is being felt and will continue to be felt for a while to come at all levels of society.

An Existential Crisis

Covid-19 has highlighted our main vulnerabilities as human beings. It has hit many people at a very fundamental existential level as many have lost their jobs and their livelihoods overnight. In addition to this, as more people become infected and die of Coronavirus, we have become much more aware of our mortality and that of those we love.

Living in a globalised world, the spread of the virus had happened so rapidly that we have not had the time to process and digest the changes which we have been required to make as a result of the restrictions imposed to keep the virus from spreading. Never could we have imagined that something which started in China a few months ago could spread and reach our doorstep so rapidly and dramatically. This further highlighted our lack of immunity to world events.

Impacts of Lockdown

With people being asked to stay at home to protect the NHS, schools and businesses closing and people being asked to work from home (if they still have work), suddenly the home has become office, school, gym, social hub and place of relaxation. Whilst some families are feeling more crowded as a result of these changes, some people living on their own have become more lonely, isolated and vulnerable.

Some families trying to make life work under lockdown are finding that their relationships are being put under more strain, whilst children of unhappy and even abusive families are being made to stay at home more.

Of course, there are also positive stories emerging as a result of families spending more time together and solidarity between people. In times such as this, we are seeing the best and the worst of human nature.

Why is Psychotherapy vital during these times?

To put it simply, in times of crisis psychotherapy helps us to hold onto our thinking. When our survival is threatened, our ‘reptilian brain’ takes over and we can act impulsively (panic buying for instance) often resulting in harm to self or others. Thinking makes us slow down and consider options. In times of crisis, we sometimes need to think quickly and make decisions. However, buying time to think enables us to put things into perspective and to make wise rather than impulsive decisions.

Because this is both a health and economic crisis, it is hitting many of us at our very core. The British attitude to “keep calm and carry on” works to a degree. Of course, we need to keep calm, but we also need a place to acknowledge and talk about our fears, losses, despair, sadness, anger, etc if we are going to survive this crisis in good mental health.

 

Sam Jahara is a Psychotherapist and Supervisor in private practice working with individuals and couples. She is also the co-founder of Brighton and Hove Psychotherapy, a multi-approach clinic, offering Psychotherapy, Psychology and Counselling to all client groups, both face-to-face and online.

 

Further reading by Sam Jahara

Leaving the Family

Psychotherapy and the climate crisis

Psychotherapy can change your life – but you may not want it to

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Spirituality and Mental Health

Spirituality is an often-used term these days, and around 20% of the population in the UK define themselves as spiritual, but not in the religious sense. So what does it mean to be spiritual?

There are many definitions of spirituality but generally we could say that it involves having a sense of something bigger than ourselves – a transcendental view of life where we start to realise that there is more to life that we see around us. This can include a sense that there is a God or creator, an intelligence in the universe, or maybe a deeper wisdom that we all carry. However we conceptualise it, spirituality often leads to a greater sense of purpose and meaning as we start to step back from the everyday world and see a bigger picture playing out before us. Spirituality also includes a sense of connectedness, which might be with others, ourselves or with something more transcendental. This feeling of connectedness can bring us a great deal of peace as we start to realise that perhaps we are not alone in the world. 

Spirituality is different from religion, but is linked to it. Religion is about adhering to a set of doctrines that define each particular faith. Religion will often have a spiritual component – a worldview that has an idea of something greater than us (God, for example) and may also involve a spiritual connection as part of the religious practice. However, you do not need to be religious to be spiritual, and indeed being religious doesn’t need to be spiritual!

So how important is spirituality to our mental health and wellbeing? There has been a lot of research over the past decade that considers this question. The findings show that engaging in spiritual practices have a positive impact on our mental health. Lower levels of depression can be found in those who are actively involved in spiritual communities. Levels of stress and anxiety can be lowered by engaging in spiritual practices, and spirituality can be instrumental in the recovery from trauma. Also, there can be a greater sense of purpose and meaning from having a spiritual perspective, which can have a positive impact on our wellbeing. 

Having a committed spiritual practice – whether it is mediation, prayer, or whatever feels right for you – reading spiritual philosophy and engaging with a spiritual or religious community can be hugely beneficial in improving and maintaining positive mental health. Even if you don’t consider yourself to be spiritual, it is worth spending a few moments thinking about life and the wonders that we see around us. It is easy to see that there is more to life than our own limited worldview and when we step back and consider this, our problems and daily issues can be put into perspective as we gain a more holistic view of life.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

 

Further reading by Dr Simon Cassar –

Living with borderline personality disorder

Online Therapy

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

Face to Face and Online Therapy Help Available Now

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Online Therapy

We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?

There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.

There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?

Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.

Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.

A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.

Here are a few points you might want to consider if you want to access therapy online:

  • You will need to have a good, stable internet connection for the duration of your session.
  • It is best to have a few connection options available – such as wifi and data, and a couple of different options of apps – such as Skype and Zoom, to allow for tech difficulties.
  • You need to be comfortable working online and familiar with the tech you are using. It’s a good idea to turn off any notifications for the duration of your session as these are very distracting when you are trying to work with your therapist.
  • You need to ensure that the location you are in is private and confidential.
  • You should check the credentials and qualifications of your therapist before you engage in any online therapy. There is a growing number of people setting up online as ‘therapists’ with little or no training. Make sure your therapist is registered with a professional body such as UKCP.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

Face to Face and Online Therapy Help Available Now

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Popping a bluey – young men and Viagra

Following on from my earlier blog about the physiological effects of Viagra, in this blog I am going to discuss some of the psychological and social issues that make young men pop a blue pill.

There is common notion that young men are constantly getting erections and always up for having sex. Various sources indicate the reality is different. Peggy Orensteins’s recent book ‘Boys and Sex’ cites a General Social Survey study showing young men between 18 and 29 are having less sex. This is indicated by the increase in the number of men who declare themselves abstinent, which rose from 10% in 2008 to 28% in 2019.

Orensteins’s conversations with young men reveal the extent of their performance anxiety. They fear that girls would be more knowledgeable and experienced and in contrast they will be unsatisfactory sexual partners. They are anxious that any inadequacy, such as not being able to undo a bra strap or coming too quickly will be broadcast to their peer group on social media and result in humiliation. They are also concerned that girls will take it personally if they can’t get an erection. Young men seem to feel that they are responsible for the success of a sexual encounter.

At the same time online pornography has set up unrealistic expectations about opportunity, performance and satisfaction. The Reward Foundation is an educational charity that focuses on the internet, love, sex and relationships; they have found a correlation between erectile dysfunction in young men and an increase in access to internet porn. Whether or not young men actually believe that the sexual relationships and encounters they view on screen are ‘real’, these representations have an impact. As a young presenter on VICE online magazine said, “In my head I’m thinking that girls will be expecting me to fuck them like a porn star.”

First dates or sexual encounters can be extremely anxious events. Dating apps like Tinder and Grinder make it easy to move on to a new sexual partner if the sex does not meet expectations the first time. This may increase pressure on men to have a prolonged erection or several erections and Viagra can be an ‘insurance policy’ or a ‘booster shot’ to ensure a good performance the first time they have sex with a new partner. If the relationship continues they may continue to take Viagra to maintain their performance and hide the fact that they took it in the first place.

So what’s the problem with young men using Viagra to perform better? If young men believe that the standardised notion of good sex is a good performance as Orenstein’s study suggested, we can see that taking Viagra would be a way to avoid some of the stress about being a good performer. Unfortunately this can create a psychological dependency making it more and more difficult to stop taking Viagra and harder to open up the subject with a partner. Like any kind of emotional withholding keeping Viagra a secret is likely to be a negative factor in a sexual relationship.

Good sex can be whatever is good for each couple and is far more nuanced and complex than a good performance. In a relationship of mutual consent sex can bring physical and emotional intimacy but sex does not always go smoothly, misunderstandings and disappointments happen. Exploring sexual dissatisfaction and difficulties makes people feel extremely vulnerable. By using Viagra to focus on performance, young men are avoiding the opportunity to speak honestly about what they expect and want from sex as well as finding out what pleases their partners. Trusting each other and exploring differences and desires together can build a stronger relationship as well as a more satisfying sex life.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

Face to Face and Online Therapy Help Available Now

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COVID-19 (CORONAVIRUS) Important Notice

We would like to reassure all our clients that Brighton and Hove Psychotherapy, including The Barn, in Lewes,  is operating as normal despite the current situation. 

We are coordinating our response to the virus to ensure we can continue to deliver sessions to our clients, look after the welfare of our associates and maintain the continuity of our practices.

Psychotherapy sessions do not involve physical contact and a boundaried physical working distance of more than a metre between clinician and client is maintained in sessions as general good practice.

Should clients or clinicians need to self-isolate, regular sessions will continue using video call or telephone as an alternative means of working, until face-to-face sessions can be resumed.

We are monitoring the situation closely, guided by appropriate health organisation advice (PHE) and relevant government guidelines.

Face to Face and Online Therapy Help Available Now

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