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Safety versus uncertainty: a relational tension

At the heart of every relationship lies a tension between safety and uncertainty. Safety allows us to let go of our worries and feel secure in ourselves and our relationships. But too much safety can make life feel flat and stuck. While uncertainty can keep us and our relationships feeling alive and open to growth, too much can be overwhelming and even destructive.

In this article we will explore the roles safety and uncertainty play in our emotional development and relational health.

The need for safety

From our earliest days, human beings have been wired to seek safety. In childhood, a consistent, caring presence helps us feel secure enough to let go of our worries and confidently look out on the world. Attachment theory calls this sense of safety a ‘secure base’ which, according to Ainsworth (a leading attachment figure), can be observed ‘when the infant uses the caregiver as a base from which to explore and as a haven of safety in times of distress’.

Without enough safety, we can feel threatened rather than creative. Instead of curiosity about what we might discover and enjoy, we can experience anxiety and withdrawal. Healthy growth becomes difficult, if not impossible, when we are constantly protecting ourselves.

Safety enables us to feel seen and known, without fear of ridicule or rejection. It supports self-reflection and gives us the courage to share our feelings, needs, and hopes with others.

Why uncertainty matters

While we naturally seek safety, uncertainty is also vital for our happiness and our close relationships. Uncertainty is present whenever we express a vulnerable feeling, welcome someone’s difference, or allow a relationship to change. It asks us to tolerate, not knowing what will happen next.

What keeps both ourselves and our relationships feeling alive is the unknown. If everything were certain, nothing would change, and no growth would be possible. When we avoid uncertainty completely, by controlling situations or keeping emotions tightly contained, we may feel safe, but we also become stuck. Relationships can lose their vitality if we fail to grow. Or as John Henry Newman said, ‘If we insist on being as sure as is conceivable, we must be content to creep along the ground, and can never soar’.

New experiences, fresh perspectives, and ever-evolving self-experiences all require stepping into the unknown. It may feel uncomfortable, but not knowing what lies ahead is what keeps us moving forward and discovering ourselves and each other anew.

Therapy provides safe uncertainty

Relational psychotherapy offers a space where safety and uncertainty can meet. Sessions are boundaried, confidential, a place where your feelings and experiences are listened to and explored. This process builds the emotional safety which has been developmentally lacking and vitally needed.

Alongside this, therapy invites uncertainty, where new and perhaps unfamiliar feelings can arise. You may say things you have never said aloud, notice patterns you haven’t seen before, or try out new ways of relating to another person. This collaborative work aims to create a space that encourages both trust and the confidence to take risk.

This dual experience of ‘safe uncertainty’ models how, in everyday life, we can cultivate relationships that are both secure and spacious, no longer fearful of change but actively encouraging it.

Building the capacity for both

Developing our ability to hold both safety and uncertainty is a gradual process. Creating emotional safety means learning to offer and seek relationships where trust can grow. Increasing tolerance for uncertainty means practising staying present when outcomes are unknown, sharing a difficult feeling, listening without rushing to reassurance, or allowing change to unfold.

Each reinforces the other: the more we feel securely supported, the more willing we become to explore. And each experience of stepping into the unknown and finding we are still okay deepens our sense of real safety.

How therapy can help

In therapy, we explore how past experiences have shaped your relationship with safety and uncertainty. Perhaps early relationships left you feeling you had to be predictable to others to stay accepted. Perhaps conflict or loss made you wary of trusting others. Understanding these patterns allows us to move on from them and for new possibilities to emerge.

Through therapy, we aim to develop a consistent sense of safety, from where you can experiment with sharing feelings and ideas you might usually hide, and discover that uncertainty, rather than being dangerous, can bring vitality and deeper connections.

Safety and uncertainty are not opposites that vie for dominance. They are complementary partners that need and work with each other. Therapy aims to build your inner security and the confidence to step into uncertainty and experience your own aliveness and growth, for you and your relationships.

 

Thad is an experienced psychotherapist, a registered member of the British Association for Counselling and Psychotherapy (BACP) and United Kingdom Council for Psychotherapy (UKCP). He works long-term with individuals in our Lewes and Brighton and Hove practices.

 

Further reading by Thad Hickman

The cost of hiding your vulnerability: why emotional strength begins with openness

When life shifts without warning: finding your way through unwanted transitions

What is the role of creativity in psychotherapy?

No space to be heard?

Does your life story make sense?

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Should I talk about my therapy? Understanding privacy and reflection in counselling

Having previously explored the compulsive use of pornography, I wanted to continue reflecting on what it’s like to work with clients who consider their use to be excessive.

Should I talk about my therapy?

A common question that arises is, ‘should I talk about my therapy’? Clients sometimes ask whether they should speak to their partners, family, or friends about what they’re sharing in therapy. This question usually surfaces early in the process, when a client starts to notice the difference between what’s explored in the session and their relational world outside.

This question doesn’t feel purely practical. It opens reflection on how we relate to ourselves, to others, and to the therapeutic process itself.

What brings you to therapy?

When a client begins to consider sharing aspects of their therapy outside the session, it’s often helpful to reflect on what brought them into therapy in the first place.

In the context of compulsive behaviours such as the use of pornography, it’s important to ask what role the behaviour plays in their personal relationships. Feelings of guilt, shame, or fear of being ‘found out’ are common. There’s often an awareness of the rupture this behaviour has caused in close relationships.

Therapy, in these moments, can initially feel punitive, as if one is attending only because they were ‘caught’. However, over time, therapy ideally becomes a space where change feels possible and the rupture in relationships feels repairable.

What should I say?

When someone enters therapy in response to their behaviour being discovered, there may be a sense that they ‘should’ disclose what goes on in the sessions. This urge can stem from guilt, from a desire to make amends, or from pressure,  internal or external, to demonstrate accountability.

While this impulse is understandable, therapy is more than just an act of reparation. It should be seen as a place for reflection, not a reporting tool.

Therapy allows for sharing

Reflecting on and articulating one’s emotions can be difficult, especially when those emotions haven’t previously been explored. Therapy provides a space to begin this process in a contained, safe environment.

Over time, this reflective work often leads to deeper conversations outside of therapy. What was once unspeakable becomes more manageable. Therapy can act as a reference point,  something that fosters further understanding and connection in one’s relationships.

Therapy as progress and change

At first, talking about therapy outside the session may feel like a burden or even a duty. But as therapy progresses, clients often begin to see their compulsive behaviour in a new light, as something that is now a choice.

Sharing from this perspective doesn’t come from guilt; it becomes an expression of change. It reflects not only personal growth, but a deeper capacity for intimacy and emotional connection.

There’s a sense of reward in this work, not just for the client, but for their relationships as well.

Therapy is private, not secretive

When thinking about what can or should be shared outside of sessions, it’s important to consider: do you want everything that is said in therapy to be shared?

Therapy is private, but that doesn’t mean it has to be secretive. Clients have the agency to decide what they want to share, and with whom. There is no obligation, but there is choice.

Coming into therapy can feel daunting, but it offers the potential for real, lasting change. In the context of compulsive behaviours, like pornography use, therapy helps make sense of what those behaviours may have represented. It offers time and space to reflect, without punishment or judgement.

Clients are not required to share everything outside of sessions. But over time, what they choose to share can become part of a changing relationship with their previous compulsive behaviour.

 

To enquire about psychotherapy sessions with David , please contact him here, or to view our full clinical team, please click here.

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove.

 

Further reading by David Work –

Beyond the label: rethinking assessment and diagnosis in psychotherapy

Wearable tech: when is there too much data?

In support of vulnerability

Trauma and the use of pornography

Reflections on bereavement

 

 

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In therapy the past repeats until it can be let go of

A foundational principle of depth therapy is that until mourned, the past is never truly past. It lives on in the present in our relationships shaping how we see others, how we see ourselves and in how others see us. In the consulting room, this process plays out much the same way as it does in our regular lives but here it can be thought about and worked with. We call it transference.

Transference defined?

Transference is the unconscious repetition of early relationships in the present. The patient unwittingly re-enacts old relational patterns with the therapist which gives the skilled therapist an insight and understanding of how the patient learnt to navigate their relationships as an infant and from there onwards. Put simply, these relational patterns were once necessary in order for the infant to get their needs met (to varying degrees) but over time they have harden into fixed ways of relating that restrict emotional freedom.

Freud saw this phenomenon as both the greatest obstacle to therapy and its most powerful tool describing transference as “the prototype of all love.” Transference shows how the mind repeats what is familiar, even when it causes suffering. The therapeutic relationship becomes the arena in which these repetitions can be recognised, thought about, and over time different relational patterns experimented with whereby the patient comes to see the therapist as someone who is different to those in their past.

Why do we repeat relational patterns?

The repetition of the past in the present is not accidental. We repeat what we cannot yet remember or think about with the unconsciously hope that we may eventually get a different outcome. The patient unconsciously assigns to the therapist the role of the critical parent, the unavailable caregiver, or the idealised rescuer, depending on where their relational trauma lies. And these roles cannot be mentalized until they are lived through in the therapeutic dyad.

In this way, the therapeutic relationship becomes both a mirror from the past and an opportunity for change. It reflects the patient’s inner world while providing a new relational context in which that world can evolve.

Working with the transference

A common misunderstanding is that the therapist’s role is to correct the patient’s distortions of reality, however this is unlikely to lead to any relational change as simple insight rarely does. Relational depth psychotherapy instead takes the view of observing what unfolds in the relationship, as a vital indictor of what has unfolded in the patient’s early primary relationship. But, instead of reacting to how they, the psychotherapist, feel in response to the transference, they instead use what is known as their counter-transference to work but the patient’s projections and to name the pain and grief locked within those relational patterns.

Freud called this process working through. It involves returning to these patterns again and again in the therapeutic relationship until their meaning becomes clear to the patient.

The aim is not insight for its own sake, but the gradual loosening of the grip that the past exerts on the present through mourning.

The therapist as separate to the patient

Over time, the work is such that the patient begins to experience the therapist not as a figure from their past, but as a real person with a separate mind. This marks a crucial developmental step which didn’t happen when the patient was growing up and has kept them relationally stuck. It is the developmental step of recognising that others exist independently of one’s own needs and projections.

Analytical psychotherapists call this capacity the two-person world. In this world, the therapist is neither idealised nor devalued but experienced as a whole separate person. The patient’s growing ability to recognise separateness opens the possibility of genuine relatedness in all their relationships.

The emotional demands of change

Transference is not an intellectual concept but an emotional event that is worked with leads to developmental change and psychological maturity. The feelings it stirs can be intense, confusing, and often painful and throughout he therapist’s task is to stay present, holding onto their thinking mind and to use these emotional currents to help the patient understand what happened to them.

For the patient, the process invariably involves mourning. Old hopes of finally being loved or rescued must give way to the reality that the past cannot be undone as its only by grieving what was not possible that a person becomes free to live differently in the present – the past can be let go of.

Why transference matters

Transference provides a living picture of the patient’s inner world and defines how they do relationships. It brings into the open what might otherwise has remained hidden in repetition throughout the patient’s life. Without transference, depth therapy is imply not possible and the therapeutic encounter remains insightful at best.

The goal therefore is not to eliminate transference but to firstly understand it and then help the patient work through it. This is not easy work for the therapist as they must not only be asking themselves ‘who do I represent in the transference?’ But must also survive the patient’s idealisation and hate. Resolution means recognising these patterns for what they are: echoes of earlier life and not the reality of the therapeutic relationship.

Relational freedom

When the transference has been worked through, the patient no longer needs the therapist to embody old roles and this becomes a felt experience in the encounter. The patient can tolerate the therapist as separate to them and neither perfect nor dreadful. The therapist can be disappointing to them in an ordinary way. This is what psychoanalysis calls relational freedom. The patient becomes able to love, to hate, to desire, and to depend, all while knowing that both self and other remain distinct.

Psychotherapy is not an intellectual exercise. It is a living relationship that requires both participants to learn to feel and to think together. The transference provides the raw material for transformation IF the therapist is skilled enough to hold it and work with it.

 

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

 

Further reading by Mark Vahrmeyer –

AI psychosis: why depth therapy cannot be automated

All depth psychotherapy is trauma therapy – and the rest is marketing

Why there is no such thing as a patient

How AI tools between sessions are undermining the therapeutic relationship

Masochism and the impossibility of desire

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Holding difference: identity and the space between self and other

The formation of identity is never a solitary endeavour. From our earliest moments, we develop a sense of who we are through relationship—first with primary caregivers, then with siblings, peers, and the broader cultural world. Yet this process of coming to selfhood while remaining in relationship with others presents profound psychological challenges, particularly when differences of culture, family structure, or early attachment experiences complicate the developmental landscape.

The twin paradox of separation and connection

Psychoanalytic theory recognizes that healthy identity formation requires negotiating the tension between connection and separation. We need others to mirror and recognise us, yet we must also differentiate ourselves to develop authentic selfhood. This paradox becomes particularly complex in relationships characterised by intense early bonding, such as twin relationships, where the boundaries between self and other are initially blurred.

Dorothy Burlingham’s pioneering work on twins revealed how these individuals must develop attachments to both mother and twin simultaneously, creating unique communication patterns and what she termed ‘twin transference’— the transfer of feelings and experiences between siblings. This research illuminated how early relational templates profoundly shape our capacity for later intimate relationships, particularly our ability to tolerate both closeness and separateness.

The challenge extends beyond twin relationships to any early environment where merger and differentiation are complicated. When primary relationships involve inconsistent caregiving, cultural displacement, or family structures that don’t provide clear models for healthy separation, individuals may struggle throughout life with what Juliet Mitchell calls the ‘law of the mother’ —learning to manage the simultaneous drives toward fusion and annihilation that characterize intense relationships.

Cultural homelessness and multiple selves

For those who grow up between cultures, what Ruth Hill Useem termed ‘third culture kid’, identity formation involves additional layers of complexity. David Henderson’s concept of ‘cultural homelessness’ described not merely geographic displacement, but the psychological experience of living between cultural systems without complete belonging in any. This creates what he calls ‘multiple egos’ as different aspects of self that develop in relation to different cultural contexts.

Salman Akhtar’s work on immigration and identity outlined how cultural transitions force a ‘third individuation’, which indicates a reworking of identity across drives and affects, concepts of space and time, social affiliations, and intrapsychic organisation. This process involves mourning the loss of singular cultural identity while integrating diverse cultural elements into a coherent sense of self.

Rather than viewing this as pathology, we might understand multicultural identity formation as requiring particular psychological skills: comfort with ambiguity, flexibility in code-switching between contexts, and resilience in the face of belonging nowhere completely while participating everywhere partially. These capacities can become sources of strength, fostering empathy for others’ experiences of difference and facility in navigating complex social environments.

The intersubjective third

Jessica Benjamin’s concept of the ‘third’ offers a framework for understanding how identity develops – not through isolation, but through intersubjective recognition. Rather than seeing development as a process of separation from others, Benjamin emphasises the creation of a shared psychological space where both self and other can exist as separate subjects while remaining in meaningful relationships.

This ‘co-created third’ emerges from genuine encounter between individuals who can recognise each other’s separate subjectivity while creating something together that transcends either person’s individual contribution. It requires what she calls ‘mutuality’: the capacity to see others as separate centres of experience rather than extensions of our own needs or projections of our own fears.

The implications extend far beyond individual development to broader social questions about how we navigate differences in increasingly diverse societies. When differences of ethnicity, gender, class, or culture activate primitive fears of annihilation or merger, we may resort to defensive strategies— either attempting to eliminate difference through assimilation or creating rigid boundaries that prevent genuine encounter.

Difference as creative potential

Psychoanalytic thinking suggests that difference, rather than representing a threat to be managed, can become a source of creative potential. When we can tolerate the anxiety that difference initially provokes, we open possibilities for growth that would not exist in relationships characterised by sameness or merger.

This requires a capability to hold the discomfort of difference across relationships, tolerating not fully understanding another’s experience while remaining curious and engaged, rather than retreating into familiar categories or defensive assumptions.

The contemporary world presents unprecedented opportunities for encounter across difference alongside unprecedented anxieties about cultural change, migration, and shifting social structures. Psychoanalytic perspectives suggest that our capacity to create genuinely inclusive societies depends not on eliminating difference, but on developing psychological and social structures that can contain the anxiety difference initially provokes, while fostering the creative potential that emerges from authentic encounters between different ways of being human.

Identity formation then becomes, not about achieving a fixed sense of self, but about developing the capacity to remain authentically oneself while genuinely encountering others—thus creating spaces where difference enriches, rather than threatens, our shared humanity.

 

Shiraz El Showk is a Training Member of the Association for Group and Individual Psychotherapy (AGIP) and a registered Training member of the UKCP, She is experienced in Psychodynamic counselling and Psychoanalytic Psychotherapy work with individuals, on both long and short term basis. Shiraz works from our Brighton and Hove practice, Lewes practice and online.

 

Further reading by Shiraz El Showk –

Reflections on training as a psychoanalytic psychotherapist: discovering the third space

The therapeutic journey – a pilgrimage to the soul?

Surviving family festivities: a psychoanalytic journey through the twelve days of Christmas

Parents – the ghosts and angels of our past

Is an AI therapist as good as a human one?

Related articles:

What is belonging and why does it matter?

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The two faces of shame: how this powerful feeling shapes our lives

In the therapy room, shame – which we often hide, almost at any cost – frequently hinders progress. Clients sometimes conceal aspects of their behaviour they fear are shameful, such as viewing pornography, taking class A drugs, or losing their temper.

This is because it is perhaps one of the most intense and complex feelings we experience as human beings. Unlike embarrassment or guilt, shame often goes straight to the core of who we are. It can make us feel exposed, small, or defective – as if we are unworthy of love or belonging.

We hide it, push it away, or defend against it. But as psychotherapist and author Dr Joseph Burgo argues in his mould-breaking 2018 book “Shame: Free Yourself, Find Joy, and Build True Self-Esteem”, shame is not only inevitable; it also serves an essential positive function. Understanding the good and bad faces of shame can help us work with it more consciously, rather than being imprisoned by it.

Modern neuroscience, particularly the work of Allan Schore, adds another layer of understanding. Schore shows us that shame is not just psychological but deeply biological: it emerges in the earliest attachment relationships, shaped by how infants and caregivers connect. To understand shame fully, we need to see it both as a developmental survival mechanism and as a potential source of lifelong suffering.

From an evolutionary perspective, shame is a social emotion. In early human groups, survival depended on belonging and cooperation. To be excluded from the tribe was to face near-certain death. The hot flush of shame evolved as a kind of internal alarm system, warning us when our behaviour risked rejection.

It is no accident how shame is experienced in the body: downcast eyes, flushed cheeks, slumped posture. These physical signals were ways of showing submission and appealing for re-inclusion. Shame helped regulate social life by curbing selfish impulses and motivating cooperation.

In this sense, shame is not inherently destructive. It has kept us alive as a species by binding us to one another.

The distinguished neuropsychologist Allan Schore has shown, over the past 30 years, in a pioneering series of books about the workings of the human mind, how shame arises at a very early stage of life, before language, as part of the developing attachment bond between infant and caregiver.

When a baby seeks connection — through eye contact, smiling, or reaching out — and the caregiver responds warmly, the baby’s nervous system is regulated. The infant learns that it is safe, lovable, and worthy of attention.

But when a caregiver consistently (in Schore’s language) ‘misattunes’ — looking away, showing irritation, or failing to respond — the infant experiences what Schore calls a ‘rupture in attunement’. This leads to an abrupt shift in the child’s state: the body deflates, the gaze drops, energy collapses. In other words, the infant experiences a proto-form of shame.

This early shame response is not yet cognitive. It is a bodily state of withdrawal, rooted in the developing right brain. Schore’s research highlights that:

  • Shame is hardwired into the nervous system as a survival response to misattunement.
  • Repeated experiences of empathic repair (when the caregiver re-engages after a rupture) teach the child that shame can be survived and soothed.
  • But repeated misattunement without repair can embed toxic shame deep in the developing self, leading to lifelong vulnerabilities in self-esteem and affect regulation.

In this way, shame is not only evolutionary but developmental. It is built into the earliest interactions between parent and child, shaping how we later relate to others — and to ourselves.

The positive face of shame

Burgo, for his part, identifies four ‘faces’ of shame that, in their healthier forms, can guide us towards growth and connection. These are:

  • Unrequited love – the pain of rejection teaches us about limits, boundaries, and the importance of loving reciprocity in relationships.
  • Exclusion – the sting of being left out motivates us to adjust behaviour to stay connected with others.
  • Unwanted exposure – the discomfort of being ‘seen’ can trigger the growth of humility and self-awareness.
  • Disappointed expectation – failing to meet social goals or standards can motivate us to try harder and achieve mastery.

When shame operates in these ways, it functions almost like an inner compass. It points us towards empathy, accountability, and integrity. It helps us remain bonded to our communities and attentive to the impact we have on others.

Think of the flush of shame when you realise you’ve spoken harshly to someone you care about. That painful signal may prompt you to apologise, repair the relationship, and do better next time. Without shame, we might lose the motivation to reflect on our actions or take responsibility for their consequences.

The dark side of shame

The positive face of shame turns destructive when it becomes overwhelming, chronic, or linked to distorted beliefs about the self. Toxic shame is not about ‘what we’ve done’ but about ‘who we are’. It whispers:

‘I am defective.’

‘I am unlovable.’

‘If people really knew me, they would reject me.’

This toxic shame often originates in early experiences of neglect, rejection, criticism, or abuse. When children are repeatedly shamed without repair, they internalise the belief that their very self is flawed.

Burgo shows how toxic shame underpins many psychological difficulties:

  • Depression – the inward collapse of energy and self-worth.
  • Addiction – attempts to numb or escape unbearable feelings of defectiveness.
  • Perfectionism – striving endlessly to counter a sense of unworthiness.
  • Eating disorders – using control over the body to manage feelings of shame

In these cases, shame is no longer adaptive. It doesn’t guide us toward growth but traps us in cycles of avoidance, withdrawal, or self-punishment.

Shame in the body

One of the most striking aspects of shame is its embodied nature. It is felt physically:

  • The heat rising in the cheeks.
  • The desire to avert the gaze or hide.
  • The collapse of posture, as if trying to shrink away.

Schore’s work shows that these reactions are part of the autonomic nervous system. They happen faster than conscious thought, rooted in right-brain processes that regulate emotion and social connection.

Because shame is so deeply embodied, it often resists purely cognitive approaches. This is why therapies that integrate imagery, experiential work, and body awareness — such as schema therapy, EMDR, or somatic approaches — can be particularly powerful in working with shame.

Working with shame in therapy

Therapy offers a unique space to explore shame, often for the first time without judgement. Some of the key tasks include:

  • Naming shame – many clients don’t use the word ‘shame’ at all. They may describe feeling ‘not good enough’, ‘invisible’, or ‘like a fraud’. Helping clients put words to shame begins to loosen its grip.
  • Tracing its origins – understanding where shame came from — whether in early misattunement (Schore), painful childhood experiences, or later relational traumas — helps clients see that shame is not proof of defectiveness but a learned response.
  • Differentiating helpful vs harmful shame – clients learn to recognise when shame is signalling a need for repair or growth, versus when it is simply punishing the self without cause.
  • Developing compassion – the antidote to toxic shame is not pride but compassion. Building an inner voice that soothes rather than attacks allows clients to comfort the vulnerable parts of themselves.
  • Repairing in relationship – shame is relational in origin and relational in healing. The therapeutic relationship provides a model of attunement and repair, offering experiences of being seen and accepted even in moments of exposure.

Living beyond shame

Working with shame does not mean eliminating it. As Burgo and Schore both suggest, shame is a fundamental part of being human. The goal is to:

  • Soften toxic shame, loosening its hold over our sense of self.
  • Harness healthy shame, allowing it to guide us toward integrity, humility, and empathy.
  • Develop resilience, learning that moments of shame can be survived, reflected upon, and repaired.

When this happens, shame becomes less of a prison and more of a teacher. We stop living in fear of exposure and start living with greater authenticity. Relationships deepen, the inner critic softens, and life feels freer, more connected, and more real.

Conclusion

Shame has two faces. One binds us together, keeps us accountable, and helps us grow. The other isolates, silences, and convinces us we are unworthy.

By understanding its evolutionary roots, its developmental origins in early attachment (as Allan Schore so powerfully describes), and its psychological impact (as Joseph Burgo outlines), we can begin to approach shame differently.

Shame is not evidence of our defectiveness. It is part of being human. And when we bring it into the open — with honesty, compassion, and support — shame can transform from a source of suffering into a guide towards healing and wholeness.

 

David Keighley is a BACP Accredited counsellor/psychotherapist offering short and long term therapy to individuals and couples using a variety of techniques such as EMDR, CBT and Schema Therapy. He is also a trained clinical supervisor.  He is available at our Brighton & Hove Practice.

 

Further reading by David Keighley –

Rewiring the past: EMDR demystified

Do we need to do homework during psychotherapy?

The dynamic maturation model: a new way of understanding how to cope with distress and create happier relationships

The empty chair in therapy

How therapy can help with anger issues

 

 

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Non Violent Resistance (NVR): a compassionate approach to family change

What is NVR?

Non Violent Resistance (NVR) is a powerful, relational approach that supports parents facing violence, aggression, controlling behaviour, or destructive family dynamics. It is equally valuable for families who feel overwhelmed, depleted, or stuck in unhelpful patterns, even when violence is not present. At its heart, NVR helps families recognise unhelpful dynamics, build stronger connections, and empower parents to make change.

A short-term, forward-looking intervention

NVR is typically delivered over 6 to 12 sessions. The focus is on the present and the future: understanding what is happening now and clarifying what parents want for themselves, their children, and their relationships. While the past is explored, this is always with the purpose of informing the present and planning for change. The approach is both optimistic and empowering, helping parents to see their own capacity for influence and growth.

Moving away from blame

Many parents come to NVR weighed down by guilt, self-doubt, or years of criticism. Rather than focusing on blame or what parents ‘should have done’, NVR reframes the situation. It supports parents to disrupt unhelpful cycles, reconnect with their needs and boundaries, and take meaningful steps towards ending violence and restoring balance.

A relational approach

At its core, NVR is about strengthening relationships. Parents are supported to reach across disconnection through ‘relational gestures’ — small, unconditional moments of connection that demonstrate presence and care even in the face of conflict. These gestures help bridge the void that often grows in families experiencing violence, trauma, or chaos.

Reparation is also central: acknowledging mistakes, taking accountability, and committing to doing things differently. This creates space for trust, regulation, and healthier family dynamics.

Non punitive, compassionate, and strong

Although NVR is firm in resisting destructive behaviour, it is never punitive. The approach combines compassion, love, and decisive action. Well-known tools such as the ‘announcement’, ‘statement’, and ‘sit-in’ are always grounded in empathy and relational connection, ensuring interventions remain constructive rather than coercive.

Understanding escalation and behaviour

A key element of NVR is recognising patterns of escalation between parents and children. By understanding these dynamics, parents learn de-escalation skills and gain insight into what a child’s behaviour communicates. This shifts the narrative away from demonising the child and allows parents to see potential for regulation, growth, and change.

Messaging and communication

NVR emphasises the importance of how parents communicate. This includes both words and non-verbal cues such as body language, tone, and actions. By aligning communication with presence and intention, parents can resist destructive behaviours more effectively. Recognising exceptions — small moments when positive behaviour is already happening — also reinforces hope and helps families build healthier, more collaborative narratives.

A pathway to hope and change

NVR offers families a route out of hopelessness. By breaking destructive cycles and strengthening connection, parents rediscover their resilience and capacity for influence. With compassion, clarity, and action, families can move towards safety, optimism, and renewed joy. 

 

Georgie Leake is an NVR UK accredited advanced level NVR practitioner and holds a BSc (Hons) in Psychology, a Master of Education (Special Needs and Inclusive Education), a Master of Arts in Social Sciences and QTLS. Georgie is available at our Brighton & Hove Practice, Lewes Practice and Online.

 

Further reading by Georgie Leake –

Parental presence in the digital age: lessons from Netfix’s ‘Adolescence’ and the NVR approach

A journey into understanding Non-Violent Resistance

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Reflections on training as a psychoanalytic psychotherapist: discovering the third space

Becoming a psychoanalytic psychotherapist is a deeply transformative process. It changes the way we understand others and gradually reshapes our relationship with ourselves. The training asks us to move through dense theoretical material while cultivating a steady emotional presence, and this mirrors the kind of work we hope to offer our clients.

The water we swim in

There is an old story about two fish passing each other. One says, “Morning, the water is warm today.” The other replies, “What’s water?” It captures something central about psychoanalytic thinking. We are often surrounded by emotional and cultural forces so familiar that we barely notice them. These include unconscious patterns, early relational experiences, the influence of the societies we grow up in, and the unspoken currents that shape how we relate to one another.

My training organisation and professional body, AGIP, encourages an open and plural way of thinking. Rather than committing to a single tradition, the training draws from a wide range of psychoanalytic ideas. Freud’s observations on transference and the unconscious, Winnicott’s thinking on holding and transitional space, Bion’s work on containment, and contemporary relational approaches all inform how we learn to listen. The aim is not to gather theories as if they were separate instruments, but to cultivate a way of thinking that stays curious about what lies beneath the surface of experience.

Cultural liminality and identity

For those of us who grew up between cultures, there can be a particular connection with the idea of liminality. Living across different cultural systems often brings a sense of existing in the spaces between them. David Henderson, a psychoanalytic psychotherapist, described this as cultural homelessness. It is not only about geography. It can be a deeper feeling of belonging everywhere and nowhere at once.

This in-between state can be difficult at times, but it can also enrich therapeutic work. It can help us feel at ease with uncertainty, attuned to multiple perspectives, and sensitive to the complicated ways identity forms. At the same time, it asks for careful reflection, especially when working with clients whose experiences echo our own. The familiarity can create empathy, but it can also blur boundaries if left unexamined.

Finding meaning in the third space

Training in psychoanalytic psychotherapy invites a continual dialogue between what we know and what we are discovering, between our theories and our lived experience. In the meeting point between these elements, sometimes called the third space, we develop the ability to hold complexity without rushing to conclusions. We learn to listen to the emotional atmosphere, not only the words spoken. We practise remaining open to the subtle shifts that happen in the room.

This work encourages us to face our own vulnerabilities and to recognise the limits of what we can fully understand. It shows us how our histories quietly shape our interventions. Over time, the training becomes more than an education in technique. It becomes a sustained journey of self-knowledge, where the spaces between cultures, minds and relationships reveal both the tenderness and the strength that define human experience.

Shiraz El Showk is a Training Member of the Association for Group and Individual Psychotherapy (AGIP) and a registered Training member of the UKCP, She is experienced in Psychodynamic counselling and Psychoanalytic Psychotherapy work with individuals, on both long and short term basis. Shiraz works from our Brighton and Hove practice, Lewes practice and online.

 

Further reading by Shiraz El Showk –

The therapeutic journey – a pilgrimage to the soul?

Surviving family festivities: a psychoanalytic journey through the twelve days of Christmas

Parents – the ghosts and angels of our past

Is an AI therapist as good as a human one?

What is the unconscious? (part one)

Related articles:

What does Integration mean in Psychotherapy?

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Understanding fawning: a compassionate look at survival and healing

Our early experiences can shape how we relate to ourselves and others in the present. Often, the survival strategies we developed in childhood can remain with us well into our adult life. One lesser-known but very important survival response is called ‘fawning’, and is often discussed in the context of the other well-known responses of ‘flight’, ‘fight’ and ‘freeze’. If you’ve ever found yourself going out of your way to please others at your own expense, or feeling compelled to keep the peace at all costs, you might be experiencing what’s known as ‘fawning’. It’s a way our nervous system adapts to overwhelming, unsafe, or traumatic environments, especially in cases of complex trauma.

What is fawning?

Fawning is a behavioural response aimed at avoiding conflict, punishment, or further trauma by pleasing, appeasing, or ingratiating oneself to others. Unlike ‘fight’ or ‘flight’, which prepare us to confront or escape danger, fawning is about ingrained habits of submission and people-pleasing. It’s often rooted in early experiences where safety depended on avoiding upsetting others. For example, childhood environments marked by neglect, abuse, or emotional chaos.

People who fawn tend to suppress their own needs and feelings to maintain the safety of connection within relationships. This might look like constantly agreeing with others, downplaying your own opinions, or going out of your way to make others feel comfortable, even at personal cost. While it may seem like a helpful social skill, fawning is actually a survival mechanism that developed when a person faced repeated threats or trauma.

Link to complex trauma

Fawning is especially common among individuals with complex trauma, which refers to prolonged or repeated exposure to traumatic events – often in childhood – such as neglect, emotional abuse, or domestic violence. Complex trauma can deeply alter how someone’s nervous system interprets safety and threat. The responses of fawning, freeze, fight, and flight are all embedded in our survival system, but fawning is unique due to its focus on connecting with others in a way that minimises danger, even if it sacrifices your own authenticity or well-being.

Recognising that this is a trauma response can be an essential step towards self-compassion. It allows you to understand that these behaviours are protective adaptations to difficult circumstances, strategies that once kept you safe, rather than flaws or character defects.

How fawning manifests

Fawning can manifest in numerous ways:

  • People-pleasing: going out of your way to make others happy, even if it means neglecting your own needs.
  • Over-compromising: agreeing to things you don’t want to do to avoid conflict.
  • Difficulty saying no: feeling guilty or anxious when setting boundaries.
  • Excessive apologising: constantly apologising—even when unnecessary.
  • Avoidance of conflict: suppressing your opinions or feelings to keep the peace.
  • Seeking validation: relying heavily on external approval to feel a sense of self-worth.

For some, fawning might be subtle, like avoiding eye contact or withdrawing rather than speaking up. For others, it might be more overt, like people-pleasing behaviours that sometimes dominate their relationships.

Working with fawning in psychotherapy

Healing from the patterns of fawning involves cultivating awareness, self-compassion, and practising new behaviours. As therapists, we approach this process gently, recognising that these responses served critical functions in the past in keeping you safe, even if they are no longer needed today.

Here are some ways to work with fawning:

  1. Building awareness: the first step is noticing these behaviours and understanding their roots. Journaling, mindfulness practices, and therapy can help you recognise when you are fawning and what triggers these responses.
  2. Developing self-compassion: many people who fawn carry feelings of shame or guilt. In therapy, we can look at these emotions with kindness and understanding, helping you see your behaviours as survival mechanisms rather than flaws.
  3. Setting boundaries: learning to say no and prioritise your own needs can feel frightening at first. Gradual exposure, role-play, and therapeutic support can empower you to practice healthy boundaries.
  4. Reintegrating authenticity: as safety increases within the therapeutic relationship and beyond, people often begin to rediscover their genuine feelings, preferences, and opinions, gradually restoring their authentic self.
  5. Addressing trauma: since fawning is linked to complex trauma, trauma-informed therapies like EMDR, Internal Family Systems (IFS), or Dialectical Behaviour Therapy (DBT) can be particularly helpful. These therapies help clients process and heal the underlying trauma that fuels fawning behaviours.

A path toward liberation and connection

Fawning might have once been an essential survival skill, but now it can hinder genuine connection and personal growth. The goal of therapy is to gently unravel these ingrained patterns and help you discover your true self—inherently worthy of love and respect, just as they are.

 

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 at our Lewes clinic and also works online.

 

Further reading by Dr Simon Cassar

How to meet negative thoughts with compassion

Understanding exercise addiction

Can Buddhist thinking help with our emotions?

Exercise and mental health

Are you too sensitive?

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On Affect Regulation

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Working with clients in a post-disaster context

When disaster changes the course of life, the effects are rarely contained to the moment of crisis. The visible damage is often matched by hidden struggles that surface in the days, months, or years afterwards. In my own work, I have sat alongside people who have faced devastating events, and I have seen how deeply these experiences can shape not only emotions, but also the rhythms of daily living. Psychotherapy can provide a protected space where these hidden feelings begin to be acknowledged, even when daily life demands feel overwhelming.

In the early stages after a disaster, most people are focused on survival. Finding somewhere to live, to sleep, making sure loved ones are safe, managing the basic logistics of daily life. These concerns often leave little room to think about emotional wellbeing. Yet beneath the practical demands, the impact of trauma can begin to appear in unexpected ways. A child who was once lively may suddenly fall quiet. Another might become unsettled, restless, act out, or cling more tightly to a parent. Adults sometimes feel disconnected, unable to sleep, or find themselves swinging between numbness and moments of overwhelming emotion.

Trauma is not only about what happened, but also about how the body and mind can lose their anchor in the world. When safety feels shattered, even small reminders can stir a sense of danger. Psychotherapy in this context is not about rushing toward resolution, but about offering a steady presence where stability can be slowly rebuilt. Sometimes, the work begins by helping a person notice the ways their body is holding stress. At other times, it involves gently allowing feelings that have been pushed away to find expression in words, tears, or even silence.

What has stood out to me in this work, is how uneven the journey of recovery can be. A young person may appear to have adjusted well until an anniversary or a change at school brings back painful memories. An adult might seem determined and capable during the crisis, but later find themselves unravelling when life begins to settle. Each person’s pace is different, and psychotherapy is attuned to respecting that pace. Therapy could be a place where setbacks are understood as part of the process rather than failures, offering continuity when life feels unpredictable.

The act of telling a story—and being heard without interruption or judgement—can be deeply reparative. Sometimes language itself falls short, and the body communicates in other ways through tension or bursts of energy. Paying attention to these signals is part of honouring the whole person. Creative approaches can also allow feelings to surface when words are too difficult.

Amid the struggles, I continue to be struck by the resilience people carry. It is not a simple matter of ‘moving on’. Rather, it is about finding ways to live with what has happened without being entirely defined by it. In therapy, that might mean creating space for grief alongside gratitude, or for fear alongside a cautious sense of hope. Healing is never about erasing the past, but about discovering how to live with it in a way that feels bearable and, in time, more hopeful.

 

To enquire about psychotherapy sessions with Jonny, please contact him here, or to view our full clinical team, please click here.

 

Jonny McAuley works with children and adolescents and through his training, it has equipped him to be able to use skills and approaches that allow him to work with young children who may not have the emotional vocabulary to express themselves. He works from our Brighton and Hove practice and our Lewes practice.  He also offers online sessions.

 

Further reading by Jonny McAuley –

Understanding children’s anxiety around school

Related articles:

Using empathy to re-build connection with children and young people

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AI psychosis: why depth therapy cannot be automated

Artificial Intelligence is increasingly being promoted as a tool for psychological support, whether through chatbots, self-help apps, or experimental “AI therapists.” The proposition is seductive: instant access, apparent empathy, and cost-effective delivery. Yet beneath the promise lies a profound risk, one I would call “AI psychosis.”

By this I do not mean psychosis in the clinical sense of delusions or hallucinations, but a subtler psychic rupture: the erosion of one’s tether to reality through the absence of another mind.

What therapy is, and what it is not

Psychotherapy, especially in its depth forms, is not about validation or advice. It is not a clever mirror that simply reflects the patient’s words back to them in more soothing tones. Therapy is about encounter the lived experience of two minds, each shaped by history and desire, meeting in a room and grappling with what emerges.

The therapeutic relationship provides the possibility of containment. Patients often bring unbearable aspects of themselves, shame, rage, despair, and unconsciously project these into the therapist. It is then the therapist’s task to think, metabolise, and eventually return them in a form that can be borne. This is projective identification, first described by Melanie Klein, and it is the bedrock of working with unconscious life.

An AI system may imitate empathic reflection, but it cannot contain. It has no inner world in which to digest the patient’s projections, no unconscious with which to struggle. It can only give back what is put in, albeit in a superficially polished form.

Theory of mind and the human gap

A defining feature of human development is what psychologists call “theory of mind”, the capacity to recognise that other people have minds separate from one’s own, with distinct thoughts, feelings, and perspectives. It emerges in early childhood and is foundational to empathy and relatedness.

When a patient engages with a therapist, the implicit knowledge that the therapist is a separate subject is vital. It introduces tension, frustration, disappointment, and through these, growth. We learn that the other does not always agree, does not always understand, and does not always meet our needs. The self is refined through this
recognition of difference.

AI, by contrast, is a perfect mirror. It mimics the form of thought but is devoid of subjectivity. It has no unconscious, no history, no desire. To interact with AI in place of a therapist is to face an uncanny replica of mind without the unpredictability of being.

The hall of mirrors

Object relations theory teaches us that the self emerges in relation to the object – the mother, the father, the analyst. Winnicott’s “good-enough mother” is not one who perfectly mirrors the infant but one who fails just enough that the infant comes to know separateness. It is in the gap between wish and reality, between omnipotence and frustration, that the self takes shape.

An AI therapist cannot fail in this sense. It can only provide the illusion of infinite mirroring, validating whatever is presented. The patient, encountering no true other, risks a psychic implosion a retreat into a hall of mirrors where there is reflection but no recognition, echo but no encounter. Over time, this can create a disconnection from reality that mimics the fragmentation of psychosis.

This is what I mean by “AI psychosis”: not psychosis in its psychiatric form, but a creeping detachment from the world of subjects and objects. The user becomes locked into a dialogue with a machine that looks and sounds human but lacks the fundamental ingredient of humanity.

The false promise of validation

There is a cultural trend toward equating therapy with validation. Patients seek to be understood, to be reassured, to be told their feelings are legitimate. While this is part of the therapeutic process, it is not its essence. Depth therapy is not about making the patient feel comfortable; it is about facilitating growth, which often requires discomfort.

AI, precisely because it is designed to be agreeable, risks colluding with the patient’s defences. It can only validate; it cannot challenge, frustrate, or surprise in ways that arise organically from the subjectivity of another person. Without this dialectical tension, therapy collapses into self-confirmation and superficially comforting, perhaps, but ultimately stultifying.

Why depth therapy is the antithesis of AI

Depth psychotherapy insists on the difficult work of being with another person, with all the unconscious mess this entails. The therapist is not a neutral mirror but a subject whose countertransference, frustrations, and limitations are part of the process. This is why psychotherapy is not customer service. It is about reality, not illusion.

The essence of depth therapy is precisely what AI cannot provide: another embodied mind that can think, contain, and survive the patient’s projections. Where AI offers frictionless interaction, therapy demands the patient confront difference and disappointment. Where AI mirrors, therapy metabolises. Where AI risks disconnection, therapy fosters integration.

It is precisely the friction, the ruptures, and the misunderstandings within the therapeutic relationship that allow the patient to grow. Without these, there is no therapy — only simulation.

Conclusion

The lure of AI as therapist lies in its efficiency, its endless patience, and its capacity to mirror. But in eliminating the difficulty of relationship, it strips therapy of its essence. Without another subject, the patient loses contact with self and world.

To place AI in the role of therapist is to invite a slow drift into unreality, where the self is endlessly reflected but never truly known. This is the danger of “AI psychosis.”

The future may hold many uses for artificial intelligence such as in in data analysis, medical imaging, even as an adjunct to psychoeducation. But psychotherapy is not, and must never become, one of them. For to automate therapy is to abolish its heart: the living, embodied presence of another mind.

 

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

 

Further reading by Mark Vahrmeyer – 

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Understanding children’s anxiety around school

For some children, school is a place of growth, friendship, and discovery. For others, however, walking through the gates each morning can feel like an uphill climb. The school day may seem long, and the combination of lessons, friendships, and expectations can stir emotions that children find difficult to express. Parents often notice the signs at home: a sudden tummy ache before leaving in the morning, or tears that appear at night when the lights go out.

Why does school feel so overwhelming for some young people? The reasons vary from child to child. For some, the sheer busyness of the environment makes it difficult to settle. For others, the pressure to achieve academically can weigh heavily. The social world of peers may feel unpredictable, even threatening. At times, a child may not fully understand why they feel uneasy—only that the feeling persists. Psychotherapy offers a space to slow down, explore these worries, and begin to make sense of what might otherwise feel confusing or overwhelming.

In my work, I have often seen how school-related anxiety connects with a child’s inner world as much as the outer one. A moment of separation from a parent could stir earlier feelings of loss. A difficult relationship with a teacher may echo past struggles with authority or trust. When this happens, a child’s anxiety is not only about the immediate situation, but also about the echoes of past experiences that have shaped how safety and danger are felt.

Support is rarely about rushing to take the anxiety away. More often, it is about staying with the child, showing them that their feelings can be held without judgement. A quiet space, a listening ear, or the presence of an adult who can bear their distress without turning away might begin to restore a sense of safety. Psychotherapy can offer a steady space where these feelings can be spoken, played out, or simply held.

Anxiety in children does not always appear as obvious worry. It may show up as irritability, withdrawal, or even a determination to appear cheerful. These disguises might be a child’s way of protecting themselves from feeling too exposed. Psychotherapy can help to uncover what lies behind the mask, allowing the child to explore feelings they have struggled to name. Sometimes, this begins with noticing tension in the body before words are ready. At other times, it may involve play or storytelling, where feelings can surface indirectly.

Children often show remarkable resilience when their anxiety is understood rather than dismissed. School may still feel challenging, but with the support of psychotherapy, this experience could shift from something unmanageable to something tolerable, and even into an opportunity for growth.

 

Jonny McAuley works with children and adolescents and through his training, it has equipped him to be able to use skills and approaches that allow him to work with young children who may not have the emotional vocabulary to express themselves. He works from our Brighton and Hove practice and our Lewes practice.  He also offers online sessions.

 

To enquire about psychotherapy sessions with Jonny, please contact him here, or to view our full clinical team, please click here.

 

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All depth psychotherapy is trauma therapy – and the rest is marketing

Spend ten minutes on social media and you’d think trauma therapy is a rare, specialist service that only a select few therapists can offer. The implication is clear: most therapy isn’t “trauma-informed,” so you need to shop for the right label.

This is marketing, not clinical reality. If you are in depth psychotherapy, psychoanalytic, psychodynamic, relational, or any integrative work with substance, you are already in trauma therapy. It’s not a niche. It’s the core of the work.

The social media framing doesn’t just mislead the public, it obscures what trauma actually is and how psychotherapy addresses it.

Trauma is a state of overwhelm

Trauma is not just an event. It is an internal state of overwhelm, which is to say the point at which an experience exceeds your capacity to process it. The psyche cannot integrate what has happened, leaving it lodged, often in the body, raw and unresolved.

This can happen in response to the obvious horrors: abuse, violence, catastrophic loss. But it can just as easily stem from the chronic and subtle: persistent neglect, emotional absence, shaming. Trauma is not defined by the size of the event but by the inability to process it.

The antidote: feeling, not just knowing

If trauma happens when experience cannot be processed, its antidote is not intellectual insight alone. It is feeling fully, safely, and in a way that no longer tips you back into overwhelm.

Good psychotherapy is where this happens. In the safety of the therapeutic relationship, the unprocessed emerges, sometimes as memory, but often as emotion, bodily sensation, or relational pattern playing out in the here-and-now. This is where the work is: making space for feelings to be experienced and integrated. That is how the trauma stops dictating our lives.

When “trauma” loses its meaning

The term trauma has become so common it risks meaning almost nothing. Everything from a bad date to a slow coffee order is now labelled “traumatic.” In one sense, this reflects a cultural shift towards acknowledging psychological injury. But in flattening the term, we lose the ability to distinguish between distress, difficulty, and the kind of psychic injury that overwhelms our capacity to process.

When every wound is trauma, depth and nuance disappear and “trauma therapy” becomes a brand rather than a discipline.

The red herring of “trauma therapy”

All competent depth therapists are trained to work with trauma. It is not an add-on. It is the fabric of the work. Whether the trauma is obvious or hidden in the patterns of everyday relationships, the task is the same: to create a space where what was once unbearable can be felt and integrated.

To suggest otherwise by implying that “trauma therapy” exists apart from psychotherapy, is a red herring. It creates unnecessary hierarchies and false distinctions, and plays into a consumer model of therapy that mistakes labels for depth.

Depth therapy has always been trauma therapy. Long before hashtags, before influencers, before “trauma-informed” was a marketing term, psychotherapy has been about one thing: helping a person bear what they could not bear before. That is the work.

 

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

 

Further reading by Mark Vahrmeyer –

How AI tools between therapy sessions are undermining the therapeutic relationship

Why there is no such thing as a patient

Masochism and the impossibility of desire

Dissociative identity disorder: a rare trauma response, not a social trend

Can AI offer therapy?

 

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The issue with online therapy platforms

Two key issues with large online therapy platforms

One of the first things I tend to ask new patients in a consultation is about their previous experience of therapy. Increasingly, I’m hearing that somewhere along this journey they have tried an online therapy platform – such as BetterHelp or Talkspace. 

This isn’t surprising. The advertising budgets of these large online platforms are enormous with promotions appearing across TV, podcasts, radio and social media. Having looked further into the way these platforms operate and present themselves, there are a number of issues I have with how they advertise their services and facilitate therapy. 

In this blog, I’ve outlined two of these concerns and offered some reflections on how psychotherapy might approach them differently. 

Therapist switching

Many of these online platforms promote the idea that if you don’t like your therapist, you can switch immediately, at no extra cost to you. In addition, some adverts even highlight users who switched five or six times before finding the ‘right fit’ – as though this should be a normal practice for someone looking for a therapist. 

For someone relatively new to therapy, this might sound like a real benefit. It fits neatly into a culture of swiping or upgrading at the first sign of disappointment. Whilst I do believe it’s true that not every therapist is the right fit for every patient, frequent switching is somewhat uncommon. And having a strong dislike towards – or discomfort with – someone very quickly, could more likely suggest there’s something within you that’s bringing out that emotion. Perhaps they remind you of a parent who you find dismissive or disinterested, for instance. This could become one of the key themes of your therapeutic work with them. And more broadly, doing so could be beneficial in helping you to address the reasons you have come to therapy. 

Alternatively, if your reaction isn’t so much dislike but uncertainty of the therapist, it’s possible that by cycling through different practitioners, what is unconsciously taking place is an avoiding of building a deeper connection with any of them individually. As you find yourself hopping between therapists, it’s possible that there’s something unconscious at play—perhaps an avoidance of forming deeper connections. This may perhaps reflect your dating history or difficulties with relationships or friendships, where you keep others at a distance to protect yourself from vulnerability or rejection.

Of course, it is important to feel comfortable with your therapist. But sometimes, feeling too comfortable can be more about avoiding vulnerability than creating real safety. Therapy is not always about liking your therapist, but rather gradually building a trusting relationship that can contain and explore your inner world; the good, the bad and the ugly. By constantly switching therapists, we risk reinforcing the very patterns that therapy is supposed to help us identify. And yet, the promotional messaging from these online subscription platforms seems to encourage it.

Messaging outside sessions

Large online therapy platforms also enable users to message their therapist outside of sessions, or schedule sessions as and when they want them, rather than having consistent appointment slots like in psychotherapy. These features are promoted as positives – encouraging users to reach out whenever they feel the need.

Again, this might sound like a plus – offering emotional support within a relationship where the other is available to you entirely on your terms, without any risk. However, psychological change rarely happens without some level of vulnerability and risk. 

Psychotherapy involves two people mutually coming together within the conditions agreed by each of them, in a consistent and reliable framework. It is set up in this way, as this is how life works. The therapy room becomes reflective of the wider world. The therapeutic relationship offers a place to to reflect on how we relate to others, and what we expect of from them, as well as how we manage disappointment and uncertainty. How can these relational patterns be seen or understood if the platform denies the user of these challenges?

In addition, many of the difficulties we bring to therapy involve struggling with frustration or boundary-setting. Having a therapist constantly on-call might feel soothing in the short term, but it risks bypassing the vital therapeutic work of sitting with discomfort, unmet needs, and complex feelings – until they can be thought about together in the next session. The space between sessions matters just as much as the sessions themselves, as it allows for internal processing and for unconscious material to surface. If we take away the frustration and boundaries within the therapy, these emotions have little opportunity to be expressed and explored. 

The illusion of risk-free change

The therapeutic relationship is not meant to be entirely free from tension or challenge and the discomfort that sometimes emerges can be some of the most important and useful material to explore for insight and growth. What these Silicon Valley type corporations seem to have done, is apply a customer service model to therapy, which risks taking these very experiences out of the therapy altogether.

While these online platforms may offer greater accessibility and immediacy, it’s important to be thoughtful about what kind of help we are seeking. There is therapeutic value in speaking about our difficulties with another person, but without a consistent framework, it’s unlikely to address these issues in a deeper and more meaningful way. 

That said, I return to what I said at the beginning: many people start their therapy journey after going through a process of trying different types of therapy, including online therapy platforms. There is no shame in this. These services can be a helpful entry point into thinking about one’s emotional world. And whilst the safety and convenience offered might not necessarily lead to long-term change, it can provide a gateway to something deeper and more sustaining.

For some, the anxiety around starting therapy can be significant, and perhaps requires a dipping the toe in before fully testing the water. And perhaps these subscription platforms do provide this. But if it’s insight, understanding and change that you’re looking for, I believe that the work of psychotherapy provides a more reliable framework to achieve this. 

 

Joseph Bailey is a psychodynamic psychotherapist, offering analytic therapy to individual adults in Brighton and Hove. He is registered with both the British Psychoanalytic Council (BPC) and the British Association for Counselling and Psychotherapy (BACP). Joseph is available at our Brighton & Hove Practice and online.

 

Further reading by Joseph Bailey – 

Why do we repeat past failures again and again?

 

 

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How to meet negative thoughts with compassion

We all experience negative thoughts and sometimes these thoughts can be painful, undermining and leave us feeling worthless. Some people simply try to tolerate them, and others might feel they are deserved – or even criticise themselves for having them in the first place. But is there another way to work with negative thoughts?

What if, instead of battling or pushing away our difficult thoughts, we gently turned toward them with compassion and understanding?

This idea is central to a therapeutic approach called Compassion-Focused Therapy (CFT). CFT is based on the understanding that many of us, particularly those with histories of trauma, shame, or harsh self-criticism, struggle to generate feelings of safety, warmth, and care toward ourselves. The goal of CFT is to help people develop an inner compassionate voice, a way of relating to themselves that is kind, wise, and courageous, especially in the face of suffering.

One of the most powerful ways we can use compassion is in how we respond to our negative thoughts.

Why we have negative thoughts in the first place?

Before diving into how to be compassionate to negative thoughts, it’s helpful to understand why we have them. From a CFT perspective, our minds are shaped by evolution. Our brains developed to keep us safe in a world that was often dangerous and unpredictable. That means we’re wired with threat-detection systems that are constantly scanning for danger, internally and externally.

This system is brilliant at spotting potential threats, but not so great at distinguishing real danger from perceived threat. As a result, we may experience critical, fearful, or shaming thoughts even when no actual danger is present. These thoughts are not your fault, they’re your brain’s way of trying to protect you. If we look deeply into our negative thoughts, and track them back to our formative experiences, we can often see that they protected us in difficult or hostile situations. With the limited faculties we had in our early childhood, these thoughts were our prime defense against difficult situations. Their purpose in many ways was to keep us out of danger.

As we get older, these thoughts continue and become a habit – we constantly criticise ourselves to keep us safe in the way we learnt in our childhood. Over time, these thinking patterns become habitual. Unfortunately, we often respond to these thoughts with yet more internal threat: shame, suppression, or judgment which can further exacerbate the problem. 

Meeting your inner critic with compassion

Let’s say you make a mistake at work and immediately think, “I’m such an idiot. I always mess things up.” A typical reaction might be to argue with the thought, try to block it out, or to agree with it which can take us into a shameful spiral.

From a compassionate perspective, we do something very different: we turn toward the thought with curiosity and kindness.

This shift doesn’t mean you agree with the negative thought or indulge it. It means you create space to understand it, soothe it, and decide how to respond from a place of wisdom and calm rather than fear or judgment.

Three emotion systems and why balance matters

CFT describes three core emotional systems that govern how we experience life:

  1. The threat system – focuses on survival, reacts with fear, anger, or disgust.
  2. The drive system – motivates us to achieve goals and seek rewards.
  3. The soothing system – promotes feelings of safety, calm, and connection.

Many of us live with an overactive threat system (negative thoughts, anxiety, self-criticism) and an overused drive system (always chasing goals or perfection), while the soothing system is underdeveloped. Compassion helps activate the soothing system, bringing balance to the other two.

When you respond to a negative thought with compassion, you’re essentially saying:
“I see you, I hear you, and I choose to respond with care, not fear.”

Practical steps to cultivate compassion toward negative thoughts

Here are several accessible strategies to begin meeting your negative thoughts with compassion: 

  1. Label the thought, not yourself
    Instead of saying, “I’m a failure,” try saying, “I’m having the thought that I’m a failure,” or even “I’m having a negative thought.” This creates distance and allows space for reflection and care.
  2. Use a soothing voice
    Speak to yourself as you would to a friend or a child in distress. You might say:
    “This is hard. You’re feeling overwhelmed right now, and that’s okay. Let’s take a breath and slow down.”
  3. Get curious
    Ask yourself:
    “What is this thought trying to protect me from? What does it need?”
    Often, negative thoughts stem from past wounds or unmet emotional needs.
  4. Practice compassion imagery
    We can also use visualisation to help access compassion. Imagine a compassionate figure—real or fictional—who sees your suffering and responds with love and understanding. Imagine what they would say to you right now?
  5. Anchor in the body
    Physical gestures, like placing a hand on your heart or face, can help signal to your brain that you are safe. Pair it with a calming breath and a kind phrase like,
    “May I be kind to myself in this moment.”

Compassion is a practice, not a quick fix

Meeting your inner critic with compassion won’t erase negative thoughts overnight. But it does change your relationship with them. You gradually stop being at war with yourself and start becoming a caring presence in your own life. While this practice may seem simple, it can be challenging to carry out, and we may not be fully aware of the scope of our negative thoughts. Working with a psychotherapist can help to understand our negative thoughts and aid in bringing more compassion to our inner worlds.

It’s important to remember that you are not your thoughts. You are the awareness behind them—the one with the power to choose how to respond. When you choose compassion, you create a more grounded, kind, and resilient space within yourself

That’s where healing begins.

 

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 at our Lewes clinic and also works online.

 

Further reading by Dr Simon Cassar –

Understanding exercise addiction

Can Buddhist thinking help with our emotions?

Exercise and mental health

Are you too sensitive?

Is spirituality an escape from reality?

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Why there is no such thing as a patient

Winnicott’s radical insight: There is no such thing as a baby

Winnicott’s claim that “there is no such thing as a baby” is one of those deceptively simple psychoanalytic truths that resists being reduced to metaphor. He wasn’t being poetic. He meant it literally: there is no baby in isolation. There is always a baby and someone. A baby and a mother, a baby and a caregiver but always a baby and a mind that receives it.

The relational nature of the human mind

Winnicott’s insight destabilises the individualistic fantasies we carry into adult life. reminding us that the mind is not a closed system but a product of relationship. A mind emerges through and with another mind. To exist, we need to be held in another’s gaze, fed by another’s psyche, recognised by an other who precedes and survives us.

Implications for psychotherapy practice

This has radical implications for the practice of psychotherapy.

In my consulting room, I often encounter patients who believe the work of therapy is something they must do alone. They ask for tools, strategies, frameworks. They want insight without intimacy. As though the mind could be changed the way one tunes a machine.

The therapeutic relationship is the treatment

The unconscious does not respond to tools. It responds to presence. Just as the infant cannot form a self without the presence of a sufficiently attuned caregiver, the patient cannot reorganise the psyche without the presence of an attuned other. There is no such thing as a patient in isolation.

There is always a patient and a psychotherapist. Therapy is not introspection nor insight; it is a relationship.

The therapist as a real other

The psychotherapist is not a neutral technician applying treatment protocols to a disordered mind. The psychotherapist is a human subject who brings their whole being into the room: receptive, responsive, resilient. They offer a mind that the patient can borrow, use, even attack in order to become a person with a mind in their own right.

The patient must use the therapist
To say the patient must “use the therapist” is not a metaphor. It is the very core of psychoanalytic work. The patient tests the therapist’s reliability not through reasoned conversation but through enactment: will you still be here if I disappoint you? If I ignore you? If I rage at you? The psychotherapist’s role is to stay in their chair. To neither abandon or intrude upon the patient.

Internalisation and the capacity to be alone

Through surviving these tests, the therapist becomes internalised, not as a fantasy figure, but as a real object who has been experienced in the flesh. This internalisation is not immediate. It is slow, unpredictable and ultimately earned. It marks the transition from dependence to autonomy: the capacity to be alone, which Winnicott insisted could only develop through the experience of being with another. What a lovely and profound paradox!

The consulting room as a space for relational healing

In this way, the consulting room echoes the nursery. But it is not a regression. It is a re-doing of something that may never have happened the first time. A second chance at relational being.

Conclusion: A patient and a therapist

So no, there is no such thing as a patient.

There is only a patient and a therapist.

A mind with another mind.

And from that encounter, something new can be born.

 

 

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

 

Further reading by Mark Vahrmeyer

How AI tools between therapy sessions are undermining the therapeutic relationship

Masochism and the Impossibility of Desire

Dissociative Identity Disorder: A Rare Trauma Response, Not a Social Trend

Can AI offer therapy?

Why staying in your chair is the key to being a good psychotherapist

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