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What is EMDR?

You might have seen EMDR being spoken about in the media a fair bit recently.  Many famous people have been speaking out about how it has helped them with psychological difficulties, most often past traumas, but what actually is it?

EMDR stands for Eye Movement Desensitisation and Reprocessing.  It was developed in 1987 by American Psychologist Francine Shapiro, initially as a treatment for trauma.  Shapiro tells how she discovered the main premise, almost by accident, as she walked in the park:  She noticed that as she thought about some distressing memories, her eyes moved back and forth and the distress she felt reduced.  From this she went on to develop EMDR, which is now widely practiced across the world.

The National Institute for Health and Care Excellence in the UK currently recommends EMDR as a treatment for Post Traumatic Stress Disorder.  There is also a significant and ever-growing evidence base for the use of EMDR to treat other psychological issues.  EMDR can be used effectively with children and adults.  Clients often notice quick changes (sometimes in even just 2 or 3 sessions) which can have long lasting effects.

There are several theories as to how EMDR actually works, although it still isn’t 100% clear.  The main premise is that the two sides of the brain are alternately stimulated whilst the person holds a difficult thought or memory in mind.  Traditionally the therapist would stimulate alternating sides of a person’s brain by moving their hand side to side, whilst the person tracks with their eyes (hence the name Eye Movement).  However, there are other techniques, such as alternating hand buzzers, hand taps, audio or light bars.  This allows things have that become ‘stuck’ to be re-processed, and therefore to be less distressing.  The eye movements (or other forms of alternating stimulation) form a significant part of the therapy.  There is also talking involved, but people do not necessarily have to share all the details of their traumatic story if they prefer not to.

EMDR is an advanced therapy and should only be delivered by highly skilled, trained therapists.  In order to become an accredited EMDR therapist there is a significant amount of training and then supervised therapy work with clients.

The website of the EMDR Association UK and Ireland has more information on EMDR, finding a therapist and some stories of people who have benefitted from EMDR therapy – www.emdrassociation.org.uk

 

Dr Emma Stevens, HCPC Registered, Clinical Psychologist, is currently undergoing the training process to become an accredited EMDR therapist and is able to offer EMDR, under specialist supervision.   She has an integrative approach drawing on Cognitive Behavioural, Systemic and Psychodynamic models, as well as Attachment Theory. Emma sees individuals primarily for short-term work. Emma is available at our Lewes Practice.

 

Further reading by Dr Emma Stevens –

Emotional Well-being

 

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The Therapeutic Relationship and the Unconscious

Therapy is often referred to in terms of it being relational, or as a relationship, albeit a particular type of relationship, one that has very specific parameters, particularly around money, time, touch, and about whose inner life is there to be explored.

Despite this, in some ways, very one-way relationship, an awful lot of what goes on is a kind of relating. The therapist will encourage the client to speak as freely as possible and through a careful listening to the client’s words and to what is evoked in themselves, through this listening, they will try and relate as closely as possible to the clients experience and will feed this understanding back via their own comments, or interpretations.

What makes this different from other listening conversations, is that the therapists understanding and feedback will be influenced by the therapists training, specifically their own therapy and their learning of theories, which provide maps of mental structures and types of human experience and distress.

The therapist as well as listening to the stories, will also listen for patterns, for words, they will try and be attuned to what is going on emotionally for the client and also pay attention to the actions of therapy, to the how the client goes about relating to the therapist. When the therapist feels something useful has been understood, they will share this.

Sometimes this may not have been consciously known by the client, and this is why it can be useful. However, it can also be unnerving, as we like to believe we are the masters of our own houses, independent and not in need of the help of another.

Freud said there have been three great blows to man’s ego, the Copernican discovery that the solar system didn’t revolve around the earth, Darwin’s discovery that we are descended from animals, and share an essentially mammalian brain structure and Freuds own discovery that we have a dynamic unconscious, that the rational beings we like to believe ourselves to be is only one part of the story.

Part of this unconscious is the repressed unconscious, the place where we store the things we don’t want to know about ourselves, however these things are known at some level and we can expound a great deal of energy trying not to know them.

Getting to know and understand these parts of ourselves although often frightening to begin with, can actually be a huge relief as we come to know and accept these parts of ourselves, parts of ourselves that may seem like monsters under the bed and cast scary shadows but are usually essentially human characteristics.

 

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 –

A Nation Divided

Adolescence: the trials and tribulations

Does the male mid-life crisis exist?

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How do I choose a psychotherapist?

Deciding that you want or need psychological help can be a difficult position to arrive at.  Choosing the right practitioner to work with can feel like a daunting task with so many different fields of talk therapy, types of therapy and professional bodies overseeing the field.  This blog is a guide to helping you find your way to the right psychotherapist for you.

Counselling, psychotherapy or psychology?

Counselling, psychotherapy and psychology all broadly fall under the category of ‘talking therapy’.  They have much in common, yet are also very different.  I have previously written a piece on the difference between counselling and psychotherapy; the former being largely for shorter-term work and the latter being appropriate for deeper and long-term work on the personality.  We also have an in-depth page on psychology here so I shall not go into more detail about that here.

Depth of work

In choosing a psychotherapist, it can be helpful to have a sense of what it is you are seeking to gain from therapy.  Generally, psychotherapy is longer term than counselling and rather than working with one specific issue, is instead a relationship through which the client can work through relational patterns (with themselves and others), formed in childhood that they wish to change. Depth relational psychotherapy takes time – months to years – to understand and process relational, or attachment, losses. It is a commitment to a process of therapy and to oneself with sessions being as a minimum weekly, at the same time and on the same day each week.

Professional Body

There are a few professional bodies who offer voluntary registration to counsellors and psychotherapists – the BACP and UKCP. Whilst the BACP includes the ‘P’ for ‘psychotherapist in its acronym, the minimum training requirements of the BACP for someone to call themselves a psychotherapist are quite low. The UKCP, on the other hand requires all registered psychotherapists to undertake a minimum of four years of post-graduate training at an accredited training institution alongside a mental health placement and four years of personal therapy, before permitting applicants to join.  At Brighton and Hove Psychotherapy, all of our psychotherapists have trained at least to this standard and many far beyond.

Training

Psychotherapy training is long, challenging and requires the candidate to be in their own personal therapy throughout the training period.  Most training institutions are located in London, or further afield, and so a great deal of commitment is required to reach the necessary training standards. One of the main aspects that sets UKCP registered psychotherapists apart from counsellors is that they have been trained to ‘formulate’, which is another work for diagnose, or understand, more complex trauma and mental health issues.

First Appointment

If you have never previously been in therapy, then the prospect of the first appointment can be daunting. It is the job of your psychotherapist to set clear boundaries and create an environment that ‘feels safe, but not too safe’.  What does this mean?  Psychotherapy is about learning to tolerate difficult feelings and your psychotherapist is there to facilitate this process through their relationship with you.  They are not there to be liked, or to be your friend, as this would not be beneficial to you or to your process. If all goes well at the initial consultation then you and your psychotherapist may ‘contract’, or agree, to work together.  This means that they have assessed what work is required to facilitate change for you and you have decided that you are going to enter into an intimate relationship unlike one you have perhaps ever had before.

Length of Contract

How long is a piece of string?  Most psychotherapy can last for months or years, however little can be inferred from the duration.  For example, someone attending a year of therapy is not necessarily ‘healthier’ or ‘saner’ than someone who attends weekly for many years.  It is entirely dependent on the work required, how the client wishes to ‘use’ therapy and the relationship formed. Freud famously believed that therapy only begins when the client is no longer in a crisis.

Final Thoughts

Finding a good psychotherapist begins on paper but ends with a feeling, or a set of feelings.  As it is in the relationship that the unravelling of the past takes place, it is critical that as a client, you feel you can build a therapeutic relationship with your psychotherapist. The capacity to do this will hinge on their degree of training, clinical experience and therapeutic boundaries, as well as on it being a relationship that feels ‘safe enough’ – not too safe to not be challenging – within which the therapeutic process can unfold.  

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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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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