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Holding the frame: the role of boundaries in psychotherapy

Why psychotherapists must remain vigilant about boundaries

Despite training, supervision, and ethical guidelines, psychotherapists—like all human beings—remain vulnerable to lapses in judgment. At best, these take the form of clinical misattunements. At worst, they can result in serious boundary violations with lasting harm. Understanding the structural and psychological functions of boundaries is essential to safeguard both therapist and client.

Clients come to psychotherapy principally to work on their relationship with self and others. Usually these relationships are not working because of dysfunctional patterns that are learnt in childhood and repeated in adulthood.

These patterns invariably also show up in the relationship with the therapist, also called transference. The client transfers onto the therapist their past relationships and acts as if in the past with their family of origin. This manifests in a number of ways, and it is the job of the therapist to point this out and work with it – also called ‘working through’.

Awareness of how transference plays out both in therapy and in the client’s wider relationships is essential to stopping or reducing these unhelpful and dysfunctional patterns so that the client can live in the present and relate accordingly, instead of acting as if they were still back in the traumatic past.

Regardless of whether the therapeutic approach is relational, behavioural or analytic, understanding how transference shapes the therapeutic relationship is essential, and an ability to work with it is key in addressing the root causes of the client’s relational issues. Alongside transference, therapists must attend closely to their countertransference—the emotional and bodily responses elicited by the client. These responses can be fertile ground for insight or, if unexamined, a pathway to boundary violations.

Hence the importance of tight professional and ethical boundaries which can contain reenactments (repetitions) of the past in the present, and a framework which enables the client to work through painful losses, stuck belief systems, and destructive behavioural loops.

Failure to notice how the past manifests in the present can lead to all sorts of reenactments of the client’s past in the relationship with the therapist which can in turn lead to ethical breaches, poor therapy, and conduct which is unprofessional and harmful to the client. Here are some common examples:

How dual relationships undermine safety, blur roles, and risk psychological harm

Therapist enters into a personal or business relationship with their client. This is one of the most serious ethical breaches, the main source of complaints and the most harmful scenarios in a psychotherapy relationship. Clients are not supposed to gratify the therapist in any way, be it through a professional relationship other than the therapeutic one, or in a personal way through a romantic, sexual or friendship liaisons. Of course some situations are more harmful than others, but all entail a crossing of boundaries from which there is no return.

The moment these boundaries are crossed, the therapy has ceased to be helpful and has become harmful. Whether this takes place during the therapy or after it has ended has equal damaging consequences.

It is the job of the therapist to protect the work and treat the client as someone who is seeking the help and support of a professional who is safe, boundaries and professional. The therapist is in a position of power. Therefore these boundary breaches are an abuse of their power. 

Therapeutic relationships should always remain as such and the boundary held during and after the work, to protect the good work done. Some clients will wish for the relationship to become more. The therapist in his or her role becomes over time many things for the client: authority figure, mentor, teacher, parent, malevolent or benevolent figure, etc. These have to be held as projections and not-real. This isn’t to say that the rapport and good working relationship is not real, but the therapist has to be comfortable with being projected onto and hold these projections and feelings, whether positive or negative, with neutrality and not act on them.

When the therapist succumbs to impulses to gratify themselves or the client by changing the relationship into something else, the therapist has left their professional role and thereby their usefulness to the client. Moreover, it takes away from the client their opportunity to work through patterns that cause suffering. 

The Rule of Abstinence: resisting personal gratification in service of the client’s process

The rule of abstinence in psychoanalytic psychotherapy in simple terms entails not giving the client direct satisfaction, for instance by offering personal information or explanations that do not aid the therapy or furthers the client’s development. Psychotherapy is not about satisfying the curiosity of either client or therapist. Arguably, anything that goes against the rule of abstinence is not a useful intervention and therefore does not help the client. This is because direct satisfaction takes away from the client’s capacity to symbolise (Etchegoyen, 1999 p.12). Symbolic meaning is essential in any therapeutic work and what leads the client to a deeper understanding of their psyche and therefore of themselves. Developing the capacity to symbolise is essential in that it is what enables the client to observe, understand, think and reflect on their life situation, and ultimately what enables a person to change.

Therapists are human beings and therefore experience human responses to their clients all the time. Some of these feelings can lead them to feel compelled to explain themselves (different from accountability), answer personal questions, defend themselves or overshare. Unfortunately there are many cases where therapists have acted on strong feelings with disastrous consequences for the both the client and themselves.

Offering up information or answering certain direct questions without exploring the symbolic meaning behind the client’s curiosity, or the therapist’s motivation to share, bypasses an opportunity for both client and therapist to truly understand what is happening in the client’s inner-world. This isn’t to say that every question the client poses needs to be interpreted or analysed, but it is a skill to navigate through the different possibilities a client presents us with in every session. 

Some of the questions we need to ask of our interventions are:

  • Does it further the work?
  • What is the therapeutic use to the client?
  • Does it aid the client’s development?
  • Is this for my benefit or for the benefit of the client?

As Etchegoyen states: “The aim of Psychotherapy is to cure, and any process of communication that does not have this purpose will never be Psychotherapy”. 

Holding the frame in practice

Therapists must not only understand boundaries intellectually but embody them in their clinical stance. This means cultivating emotional neutrality, self-reflection, and supervision as ongoing supports in maintaining the therapeutic frame. Ultimately, boundaries are not barriers—they are the structure that makes healing possible.

 

Sam Jahara is a UKCP registered Psychotherapist, Supervisor and Executive Coach. She is also the co-founder of Brighton and Hove Psychotherapy. Sam works with individuals and couples from Hove and Lewes.

 

Further reading by Sam Jahara

The psychology of the cult leader

Why therapists need their own therapy?

Radical self-care as an antidote to overwhelm

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Flirting with the void: On nihilism and the will to meaning (part two)

“… the truth is that if division and violence define war, the world has always been at war and always will be; if man is waiting for universal peace in order to establish his existence validly, he will wait indefinitely: there will never be any other future”. (Beauvoir, 1948, p.128-9)

It is hard to look at the state of the world sometimes and not lose faith. Historically and currently war and division are seen everywhere, just as Beauvoir wrote. How do we make sense of many ambiguous translations of events and all the pain and suffering that emerges out of them? How do we find a way to feel and express our vitality within the messiness of human existence?

I often feel there are a lack of stories about the significance of division, rupture and brokenness and how some sort of freedom and subjectivity might well emerge and journey out of the fractures and uncertainties we encounter. We are told and often feel we must be stable, certain, knowing, healed, happy, at peace, integrated, and become whole or unified first. We must feel safe and comfortable. But as Beauvoir points out, are we ever able to feel those things for long, if at all? Of course these are not insignificant needs, feelings and experiences. The need to know and the drive for self-preservation and safety are important for our survival. However, we could be curious about the notion that we have to be sure footed to thrive and flourish. What if that is not always the case? Can we press up against all the uncertainties and intensities of life (the joys, the divisions, the sufferings and the ambiguities) and get curious? Wonder about these currents of life, affirm them rather than disavow or become nihilistic, cut it off or avoid?

As Beauvoir asks of us, in the ethics of ambiguity, can we imagine an ethical life that is not in a fixed or diminishing position, or one that throws us into a nihilistic angst, but a living of life in a continual responsiveness to ambiguity and our fundamental uncertainties? Like Nietzsche, Beauvoir highlights the significance of affirmation “the joy of existence must be asserted … if we are not moved by the laugh of a child at play. If we do not love life on our own account and through others, it is futile to seek to justify it in any way.” (p. 146). Whilst also recognising our  ontological ambiguity and its paradoxes. Those being something like; yes, life happens to you, there are forces beyond our control, but we must work with this ambiguity, adopt an active not passive attitude and work dynamically with the obscurity and ambivalences. Ethics, like life, are not a forever known shape and collection of principles and ideals. It is an ongoing, affirmed and active creation and movement, “Ethics is not an ensemble of constituted values and principles; it is the constituting movement through which values and principles are constituted”. (Beauvoir, 1948, p. 188)

Sometimes we fall into despair and hopelessness. It is unavoidable and we all experience this at times, some more than others which can feel so unjust. Can the perilous journey of pain, of not knowing, of falling, getting disturbed, affected and inconvenienced, or even being broken-hearted and betrayed, become a creative gift and the very way to transformation? I am not entirely sure we can think ourselves out of these dilemmas or paradoxes. I believe we must directly and intimately feel them, somehow. Become affected and more aware of the continual movements in and as life. Somehow embody and accept these understandings and make attempts to respond actively not passively.

Can therapy be a space where all the forces in living be considered and explored, and felt intimately, in solidarity? Can we look at it together and imagine, experiment and engage with our ethics, values, passions, capacities and capabilities as they are, in continual movement, often uncertain and ambiguous? Can we consider them and allow them to be generative and life affirming? As Beauvoir’s states (1948) living a life politically and ethically “resides in the painfulness of an indefinite questioning.” (p.144) and grasping not evading the paradoxes. This ambiguous ethics asserts that existence’s “…meaning is never fixed …it must be constantly won” (p. 139).

 

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

Susanna Petitpierre, UKCP accredited, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

 

Further reading by Susanna Petitpierre

Some ponderings on nihilism, with some inspiration from Paglia, Nietzsche and Beauvoir (part one)

Some living questions

Some existential musings on love, generosity, and the relationship between self and other – (part two)

Some existential musings on love, generosity, and the relationship between self and other – (part one)

On living as becoming – (part two)

 

References:
Beauvoir, S. de ((1976) The Ethics of ambiguity, Trans. Bernard Frechtman. New
York: Citadel Press
Beauvoir, S. de. (2004) Philosophical writings, Chicago: University of Illinois Press

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Beyond the label: Rethinking assessment and diagnosis in psychotherapy

The rise in diagnosis

Talking therapies are a well-established means by which we think about and work with mental health. They don’t sit in a traditional clinical framework where we think of consultation, diagnosis and treatment. They offer a much more nuanced approach which breaks down the dynamic of specialist and patient. It is more about being able to reflect and think together, than being diagnosed and offered a treatment pathway.

The insight that we all now have into health and wellbeing means that we can have a much greater awareness of what is going on for us. This crosses over into mental health and raises the notion that we can explain, by diagnosis, what we think, feel and observe in ourselves as a category of medical disorder. For example, we see depression described as being due to low levels of serotonin, as opposed to a reflection of life experiences. We seem to be both biologising and pathologising mental health and behavioural disorders in ways that are more clinical and definite.

The increase in mental health awareness has corresponded with a rise in the number of people being diagnosed with a mental health condition. According to The Journal of Child Psychology and Psychiatry, between 1998 and 2018 the rate of diagnosis of autism rose by 787% (Russell et al., 2021). This is not a reflection of a rise in the numbers of people with autism, more that we are much more likely to consider such conditions.

In psychotherapy, some individuals are interested in mental health assessments. The hope that what we feel and experience and how we behave, can be explained by a diagnosis.

How we feel, think and behave can be both the thing that makes us feel connected to others and ourselves, or the reason why we feel separate and ‘othered’. Not being able to make sense of this and the feelings that this gives rise to, is a strong motivation to explore.

What would a diagnosis feel like?

What do we want from this exploration? Are we looking for a diagnosis or just some more understanding? In  thinking about this, we need to ask what a diagnosis would feel like. Does being diagnosed with a clinically recognised condition help to make sense of how one feels, or is there a fear of such knowledge? In knowing that we have a recognised condition, do we feel labelled? If one were to find that a condition that fit with your own experiences and feelings, what would that knowledge be used for? It would be easy to attribute one’s feelings and behaviour to the diagnosis. In other words, ‘I do this, because I am…’.

As in a clinical model where diagnosis is followed by a curative process, surely, we should be seeing any  identification of a condition in the same way? The diagnosis is treated as the beginning of a way of learning how to live with the condition.

Psychotherapy after a diagnosis

Psychotherapy offers an opportunity to go beyond the confines of a diagnosis and focus on the individual as a whole. While clinical diagnosis often categorises and characterises someone’s experience in terms of symptoms and behaviours, psychotherapy focuses on understanding the emotional, psychological, and social factors that contribute to a person’s mental health. It creates a space for individuals to explore their feelings, thoughts, relationships, and behaviours.

One of the strengths of psychotherapy lies in its ability to complement clinical diagnosis. While a diagnosis can provide a concrete framework for understanding a person’s mental health, psychotherapy allows for the exploration of how that diagnosis plays out in the person’s life. For example, a person with a diagnosis of depression may benefit from understanding how their past relationships, family dynamics, and personal beliefs have contributed to the development of their depressive symptoms.

In therapy, individuals can work through the impact of their diagnosis in a way that feels developmental rather than limiting. By reflecting on themselves and examining their perspective, individuals can start to consider how to live with their diagnosis.

Psychotherapy is about self-reflection, distinguishing it from treatments like medication that primarily focus on alleviating specific symptoms.

It’s not uncommon for people to feel anxious, overwhelmed, or even ashamed after learning that they have a mental health condition. Therapy provides a space to process these feelings and move forward with a deeper sense of how we relate to ourselves and others.

 

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 

Wearable tech: when is there too much data?

In support of vulnerability

Trauma and the use of pornography

Reflections on bereavement

Compulsive use of pornography

 

References –
Russell, G., Stapley, S., Newlove-Delgado, T., Salmon, A., White, R., Warren, F., Pearson, A. and Ford, T. (2022), Time trends in autism diagnosis over 20 years: a UK population-based cohort study. J Child Psychol Psychiatr, 63: 674-682.

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

We can get confusing mixed messages when it comes to understanding vulnerability. Some people tell us that it’s vital to show our vulnerable side in our relationships, though for reasons that often seem less than clear to us. Whereas our typical response to vulnerability might more realistically be to run away as fast as we can. How can these opposing views make sense?

In this article we’re going to look at how we’ve historically been conditioned to view and deal with vulnerability, what our unconscious motivations might be, and the impact on our lives and relationships. We’ll end by reframing vulnerability in a way that might serve us more usefully.

The Illusion of Strength: Why We Learn to Hide Our Real Selves

From infancy onwards we receive unconscious messaging that we should aim to be strong and capable in the world, that this is the route to success and happiness. This in itself doesn’t seem an unreasonable strategy, right?

However, it turns out that this messaging is fundamentally flawed. This seemingly positive goal can make us work desperately hard to be seen as strong and invulnerable above all else. An additional consequence is that we unconsciously believe that being authentically ourselves is less important than the strong persona we present to the world – outer appearance over inner reality.

This develops into an ever-widening gap between the invulnerable version of us which strives to show no problems or flaws, and the real, inner us who lurks inside, feeling unwanted and unworthy. This is at the heart of our fear of being vulnerable – that this deeper part of us, which we have worked so hard to hide, will be seen and condemned. The illusion we try to create about being strong is not only a façade, at least in part, but it also fails to make us truly strong. Instead, it weakens us by making us scared of who we actually might be.

Wired to Protect: How Evolution Made Vulnerability Feel Dangerous

There is a further reason we avoid vulnerability. Humans have survived and evolved partly through successfully  avoiding existential harm – a survival response which comes from a more primitive environment when humans were hunted by bigger and more dangerous predators. In this sense, vulnerability can be associated with feeling existentially threatened, producing a powerful desire to escape.

And being a hypersocial species, we have always been deeply fearful of rejection by our tribe or social group. In more primitive times, this could equate to death. In our times, the threat is really more of a conditioning pressure, though it can feel existential. These reasons combine to help explain why we are likely to have powerful instincts to get away from vulnerable feelings at any cost.

And yet, if we don’t examine and come to understand these feelings, the impact can be negative and significant.

The Hidden Cost of Invulnerability: Disconnection, Anxiety, and Loneliness

The cost of us walking around the world presenting a strong and invulnerable persona can profoundly affect how we experience ourselves and our relationships. As a significant part of us is potentially hidden, it prevents the people we are in relationships with getting a full picture of who we are. In fact, the deeper and truer parts of us, which we’ve rejected and kept inside, unseen and unheard, are surely the very parts that make us who we are, and are the very parts that others want to see and connect with.

This keeping ourselves locked away can therefore create distance and disconnection from others, with the negative consequences of us feeling misunderstood and even isolated, potentially leading to issues such as social anxiety, depression, and feeling disconnected from our own lives. As profoundly social beings we need connection with others, just as we need food to survive.

The disconnection goes further because being disconnected from our own experience means we can lack self-understanding and reject hearing or learning from our experience. This can leave us struggling to deal with life’s problems or knowing how to make ourselves happy.

Reframing Vulnerability: A Path to Connection, Courage, and Self-Knowledge

Contrary to striving for an illusory defence of strength, we can reframe vulnerability as the route to getting to know ourselves at a deeper and more authentic level. Through opening to our own inner and vulnerable experiences we are able to access more vital parts of ourselves. This enables developing strength in being who we really are, gives us access to self-knowledge, and enables deeper and more meaningful connections to ourselves and others.

However, bearing in mind that we’ve spent much of our lives avoiding vulnerability, we will inevitably come up against our own deep-rooted patterns of avoidance and conditioned messaging to turn back to familiar safety – even when we know that the old ways are not working. It is for this reason that psychotherapy aims to create the conditions where you feel able to connect with your own experience step-by-step and allow your vulnerable feelings to unfold. This process aims to help you engage and prosper from experiencing the deep value of your own vulnerability.

To return to the title of this article, perhaps the question isn’t: do you want to feel vulnerable? But instead: can you afford not to?

 

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

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

 

Further reading by Thad Hickman

Is life dragging you into unwanted change?

What is the role of creativity in psychotherapy?

No space to be heard?

Does your life story make sense?

When something has to change

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Flirting with the void: on nihilism and the will to meaning (part one)

What emerges for us when we consider capability and capacity (i.e. passion, ethics, power, and potential) as a continuous living question and movement? One that never ceases to be reshaped, if we open into our experiences and recognise and intimately feel the sensorial and impermanent nature of human existence. What happens if we do not consider capability and capacity as a continuous and important living question and movement? One answer might be nihilism and a kind of stagnation.

Often nihilism is utilised as a concept to signify people who hold values, beliefs and attitudes that pertain to something like ‘without purpose and significance nothing matters’ or ‘there is no point or meaning to life’. Nihilism may veer towards people having an absence of any ethical beliefs and values.

I once heard someone say that ‘nihilism is a diagnosis of the present’ and this can sometimes trap us and hold us hostage. Unable to transform. Nihilism may well be seen as a possible coping mechanism for life’s challenges of course. However, it is also a reductive and reactive discernment that attempts to reduce the impermanence, complexity, ambiguity and multiplicity of life and existence. It might also be considered as a sort of bad faith, limiting the creative possibilities that can sometimes emerge out of all encounters with, in, and as life, including experiences of trauma, suffering, pain, loneliness and despair. I believe these effects and dynamic forces are and can be incubators of transformation. Can we feel them intimately, whilst also breaking, or at least disturbing, our attachment to life, relationship and ourselves being and remaining a certain way? Can we keep looking afresh? Can we retranslate? Can we somehow make friends with the perilous journey of falling and transformation? Perhaps we must accept uncertainty, and ambiguity will come along for the ride?

“I love those who do not wish to preserve themselves. I love with my whole love those who go down and perish: for they are going beyond” (Nietzsche, 1969, p. 217).

Nietzsche viewed nihilism as a type of psychological position. A reactive and life-diminishing force which can  sabotage us and get in the way of moving beyond. It can be a type of denial, rejection, avoidance and condemning of life. A disengaging with life itself, a devaluing of life as it actually is. A life-diminishing energy rather than a life-affirming force. Nietzsche would say without a purpose or higher meaning, life is still well worth living and asserting one’s expression, and it really matters that we do not fall into fatigued thinking. We must reject the devaluing of life for our capacity to flourish, because otherwise, at the very least, we become detached and disconnected from life and we might miss it, caught up in the spirit of revenge, ‘ressentiment’- simply stated as ‘it is your fault or mine’. Of course, his notion of ressentiment is more complex than this, but the point is that this position, if held on to for too long, will become a stagnated one. He asserts we must move beyond this, when we can, by accepting the conditions of our existence and create from there.

One might say the antidote to ressentiment is letting it go. Easier said than done. However, can we wonder about anger as an example of moving beyond. Anger is a natural emotional energy. However, we often feel it is  unacceptable, we may suppress it and become stagnated in reactive and destructive anger. However, can we relate differently and utilise it as an active, creative, and potent force that can clarify what matters and open new possibilities in living and acting, so that we find a new direction of travel and move beyond?

“…metamorphosis was the master principle of Goethe’s speculations in science and art…” (Paglia, 1990, p. 255)

 

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

Susanna Petitpierre, UKCP accredited, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

 

Further reading by Susanna Petitpierre

Some living questions

Some existential musings on love, generosity, and the relationship between self and other – (part two)

Some existential musings on love, generosity, and the relationship between self and other – (part one)

On living as becoming – (part two)

On living as becoming – (part one)

 

References:
Paglia, C. (1990) Sexual Personae. Art and Decadence from Nefertiti to Emily Dickson. New York: Vintage Books.
Nietzsche, F. (1969). Thus spoke Zarathustra (R. J. Hollingdale, Trans.). London, UK: Penguin Books. (Original work published 1883-1885)

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Wearable tech: when is there too much data?

Data as part of our lives

There must be very few people who don’t own or use a device that is in some way taking note of their day-to-day lives. Steps taken, hours slept, calories burned. The list of data that our wearable devices can generate for us is sizeable. It might not be something that we’ve actively asked for or are looking at, but it’s there.

What is our relationship with the data that is available to us? There are many people who are either unaware that such data is even there, or who just chose not to take much notice of it. For others it can be a source of motivation, the tool that they need to keep them focused and help them to achieve and maintain goals. A feeling that the data gives them the knowledge and support to optimise their lives and rewards them for doing so.

The volume of data available is potentially huge and could easily become overwhelming. What might be motivating and supportive to some, could also become onerous and feel like a pressure to perform for others. The data that is both compelling and challenging.

What if data isn’t helpful?

The potential to constantly have data on our daily lives and performance can speak to that part of us that likes to be informed. The relationship with data could also be revealing of other parts of us that may be more about being perfect. What effect does it have on us when we feel that we are being monitored and that we are responding to that? Does the constant stream of data go from being motivating to being a source of anxiety about performance?

The data from wearable devices invariably skews towards individual performance and an emphasis on health-related data. It can feel like we are being monitored and judged by a device that we chose to wear. The pressure to ‘optimise’ every aspect of life can lead to patterns of behaviour, where people could become driven by and focussed on hitting targets. It could be that ultimately people may begin to measure their self-worth against arbitrary data, leading to feelings of inadequacy if they fail to meet their targets.

The shared nature of data brings in the dimension that one might also be performing against others. What does it feel like to have day-to-day activities compared to that of others?

We can ultimately distil the relationship with data down to a sense of performance and the feelings that come with it. Raising the thought that we are either feeling supported and encouraged or becoming unsettled and anxious.

Does the data make us feel good about ourselves or are we questioning if we are good enough? How can we limit what we see and have a sense of ourselves that doesn’t need to be supported by data?

Challenging the data relationship

The more unsettling aspect of wearable tech is that it can resonate with a part of us that strives for perfection, but also that we might need something external to inform us of how we feel about ourselves. One’s self-worth has become tied up with data and comparison which are externally derived.

How can we challenge this relationship? It would be simplistic to say that if we remove or disable the device then we are free of the data. Coming off data might be a challenge and can give rise to feelings of loss. What is it like to think of ourselves without data? Are we able to rely on our own instincts and feelings to have a sense of how we are preforming?

When our expectations of how we perform are based on what our devices show us, there is a need to create more realistic expectations. Psychotherapy offers a valuable space for individuals to explore the feelings that wearable tech and performance may have on their sense of who they are. Restoring a sense of agency in the individual’s choices and finding how to have expectations of performance that are not heavily based on data. This allows the development of a more balanced relationship with technology.

Wearable tech has undeniably transformed the way we approach our health and performance. However, when the data becomes a focus of our well-being, it can shift the relationship with both technology and the individual’s sense of self.

 

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 –

In support of vulnerability

Trauma and the use of pornography

Reflections on bereavement

Compulsive use of pornography

Mental health in retirement

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

After many years of hard work, when life was finally falling into place, does it feel like everything is suddenly changing? That you’re blinking into a life transition you neither asked for nor saw coming?

In this article we’ll be discussing life transitions: how they can challenge us at a deep and even existential level, how our natural response can be to resist at all costs, the opportunities this process offers that we don’t necessarily see, and how we might better navigate this process.

The shock of change – even when expected

Many of life’s transitions are a common and known feature of the human experience, whether in middle-age, as we approach retirement or, in fact, at any other time across a lifespan. However, this logical view doesn’t really help us understand how we ourselves experience these seismic shifts.

The lived experience of a transition is often unexpected, if not a shock, arriving when we’re focused on something entirely different. Many of the fundamental building blocks we’ve nurtured and lovingly grown in our lives can suddenly feel threatened: our relationships, our work, our identity, our health. Each transition is different and unique, but at their most extreme they can feel like everything we’ve built is suddenly being washed out to sea – and all we can do is stand on the shore and watch it unravel.

Resisting the tide: why we push back against change

It’s therefore not surprising that these unplanned-for life changes can make us feel giddy and fearful. Instead of enjoying the fruits of all our life’s work, we’re desperately trying to hold onto what hasn’t already been swept away, worried about where it will all end.

The truth is that we’re being confronted with the need to accept that the life we’ve known is now changing course, as if it had a mind of its own. And the future we thought we knew, we now realise we don’t. And as our worries deepen, our daily life can drain of colour. So, it’s not therefore surprising that we throw everything at stopping this uninvited invader; we dig in to resist change at all costs.

And yet, building up high walls to defend ourselves from change doesn’t work either, and will only cause us more pain. We simply can’t stop the transition happening, no more than we can stop the incoming tide. It therefore serves us better to work with and not against transitional change, though this can feel counterintuitive initially.

This isn’t to diminish the difficulty you’re currently experiencing, but the reality is that by engaging with the process you’ll waste less energy fighting it, and you’ll be more likely to benefit from its opportunities. It’s just difficult to see these opportunities when you’re crouched down in your bunker.

As fearsome as the transition might look to you right now, by working with it, it becomes easier to manage and more easily offers up its insights. Such as starting to see what’s really happening to you, seeing past the fears that preoccupy you, understanding yourself in new and deeper ways, and better equipping yourself for what lies ahead.

The role of psychotherapy when life shifts without warning

The aim therefore is to take an active part in navigating this vital transition. By breathing in and stepping into the process it is more likely to open up to you and present its riches. And there will be riches. Yes, there will also be difficulties to deal with, but it is through working with them that they will lessen and dissipate, enabling you to move forwards. This might sound easier said than done but this is where psychotherapy can play a crucial part.

The role of the psychotherapist is to be alongside you through this process, as you start to navigate your way, keeping you steady in choppier waters, and open to receive and make sense of what emerges. In this way, a transition is about learning to engage with where you are now, understand your experience in ways that better
help you, see the options available to you, and decide how you want to proceed.

Therefore, an active engagement with this vital process can enable you to steer your own course as you enter this new chapter in life.

 

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

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

 

Further reading by Thad Hickman

What is the role of creativity in psychotherapy?

No space to be heard?

Does your life story make sense?

When something has to change

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Why do boundaries matter in psychotherapy groups?

The importance of boundaries in psychotherapy

I think it’s probably fair to say that all models of psychotherapy view boundaries as important. Analytic therapies particularly emphasise the role of boundaries and see them as integral to the psychotherapeutic process.

There are many ways of understanding why boundaries are crucial. When I reflect on my work as a therapist, I particularly think about how boundaries seem to offer containment, safety and consistency. These conditions seem vital for many reasons, not least because many people who enter therapy have not had them met sufficiently in their childhood.

In one-to-one therapy, it is the therapist who is responsible for holding the boundaries and keeping the work feeling safe and contained. For example, you can reasonably expect that the therapist will be on time to sessions, will aim to give plenty of notice for cancelled sessions (except obviously for emergencies like sickness), will keep the things you share and your identity confidential. It would also be reasonable to expect that the therapist will not be eating food or drinking anything other than water in the session and not be under the influence of drugs or alcohol. Most models disapprove of therapists making any physical contact with you – so no hugging or touching. And of course, essentially, the therapist must not confuse or abuse the relationship by becoming, or trying to become, something else, for example a sexual or romantic partner, friend, confidante or fellow patient.

Not only do boundaries offer a particular containment to the therapeutic work, how a patient might respond to them will also provide information and insights. This can prove useful for helping to understand ways in which they might struggle in the present or how boundaries (or perhaps lack of) were experienced as a child. Sometimes when people challenge boundaries in therapy, they are really trying to check that they will hold.

While therapists will regularly find boundaries pushed in individual work, overall, those who have had sufficient training and are working ethically, and in a patient-centred way, are generally able to keep the boundaries intact and the work secure and contained.

Boundaries in psychotherapy groups

In a group, keeping the therapy and members feeling contained becomes more complicated and the role of holding the boundaries can’t just reside with the therapist.

Before joining a group, potential members are asked to consider and commit to maintaining the group’s therapeutic boundaries. These are pretty much the same as those outlined earlier. In addition, keeping relationships safe and protected is helped by an explicit boundary of not having contact outside. Sometimes this isn’t possible for various reasons. In this situation, members need support and help from the group and therapist to maintain enough personal distance outside the group so they can keep themselves and the group feeling safe.

These boundaries are not rules for group members (there are no consequences to breaking them – within reason at least), but it is understandable that they can feel like it. Some of these boundaries are more obvious and easier to adhere to than others. For example, I have rarely experienced a group member under the influence of alcohol or drugs during a session and my experience is members are also very respectful of the need to protect each other’s confidentiality.

Where the boundaries become harder to maintain is more likely to be around repeated cancellations or lateness, or leaving the group without the required notice period. Also drinking coffee, tea or juice in the session, as opposed to just water, is in my experience not an uncommon boundary flouting. It’s harder perhaps to register the importance of these kinds of boundaries being held and to see why it matters. It can feel difficult for group members to question when they are being pushed by someone in the group. It’s easy perhaps to feel that they are making a fuss or doing something that is really the therapist’s ‘job’.

Because in group therapy there is more than one patient, there are multiple possibilities of boundary reactions and breaches, sometimes simultaneously. The group can feel the unsteadiness this creates at times. The therapist and the group members need to hold firm to help the group feel safe enough. The best way to do this is to name and talk about those times when members might test or push at the boundaries and explore the impact on the group, as well as the meaning for the individuals.

The aim, however, is not for members to never push boundaries (although it is a reality that some group members feel less compelled to than others). A group situation with no boundary challenges is unrealistic and, given what can be learned, not necessarily always helpful.

The theory underlying group analysis sees problems as belonging to the group, not just located in the individual member, and so anyone shaking the group boundary will be viewed as not just acting something out on their own behalf but also – more unconsciously – on behalf of the group. The culture of the group analytic therapy group, which includes being curious, means there is rich and therapeutic potential in thinking about the meaning of a boundary push on several levels – what it means for the individual, for the other group members and for the group as a whole.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.  She also offers couples therapy at BHP.

 

Further reading by Claire Barnes –

What is transference and why is it important?

What happens in groups: free-floating discussion

It’s not me… It’s us!

What are the benefits of a twice weekly therapy group?

Understanding feelings of guilt

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Can AI offer therapy?

There is currently a great deal of noise and speculation about whether artificial intelligence (AI) can provide therapy. There are strong advocates on both sides of the argument, and evidence would suggest that, at least to some degree, AI can provide what some describe as ‘therapy’.

The NHS, in part driven by its chronic funding crisis, is using ‘chatbots’—a form of AI—to interact with patients. In principle, there seems to be no immediate harm in this, provided that data from patient interactions with chatbots remains wholly anonymous.

It also appears that some individuals find AI chatbots helpful in the context of their mental health. I am not in a position to dispute this. If such interactions offer some benefit, then—again in principle—I see no objection.

However, I believe that focusing on whether AI can offer therapy is the wrong question. This places undue emphasis on AI as a system, rather than addressing the far more important and nuanced issue of what actually constitutes therapy—more specifically, psychotherapy.

What is therapy?

‘Therapy’ is a nebulous, catch-all term. It describes something believed to be helpful to one’s mental health—a term which itself has, in recent years, been diluted and now often incorporates emotional, and even physical, wellbeing.

When members of the public describe something or someone as ‘therapeutic’, or beneficial to their mental health, they are usually speaking subjectively—referring to something that helps them feel better, whether temporarily or over the longer-term.

We all benefit from activities and relationships that support, calm, or stimulate us — depending on the context. This is a reflection of both individuality and temperament. Examples might include cold-water swimming, yoga, reading, eating nutritious food, or indeed seeing a psychotherapist. These may all be helpful, but they are not interchangeable. They are not all ‘therapy’, in the clinical sense of the term.

What is psychotherapy?

I have written extensively on this subject, but to summarise:

Psychotherapy, like counselling, emerged from the tradition of psychoanalysis. While counselling and psychotherapy may look similar on the surface—two people talking in a room—the depth, training, and  psychological work involved are fundamentally different.

In the UK, psychotherapy training typically takes 4–5 years at postgraduate level. It includes intensive assessment, a psychiatric placement, an ongoing personal therapy requirement, and at least 450 hours of supervised clinical practice. Counselling training is significantly shorter and less rigorous in all aspects.

UKCP and BPC-registered psychotherapists are trained to work at depth and to formulate—psychological diagnosis — based on the patient’s inner world and relational patterns. Counsellors are not trained to formulate.

Psychotherapy is an intimate and sustained relational process in which the clinician uses their mind and emotional presence to understand the patient’s unconscious processes.

The aim is to work through relational disturbances—most often rooted in early development—and to support the patient in grieving and integrating these experiences.

Psychotherapy helps patients disentangle themselves from the repeating patterns of their past so that they may live more freely and authentically in the present.

One could argue that psychotherapy involves a process of “re-parenting” the unconscious—a concept encapsulated in Freud’s idea of therapy being a “cure through love”.

Why can therapy only be provided by a human?

At its very core, psychotherapy is a human-to-human experience. It is a living, breathing relationship between two people—one of whom offers their presence, mind, and emotional attunement in service of the other.

We connect in relationships through a complex process that involves both our cognitive and emotional faculties.

What is a mind?

In psychotherapy, the mind refers not to the brain as an anatomical structure, but to the capacity to make sense of one’s own thoughts and feelings — and, crucially, to hold and make sense of another’s experience. The mind is what allows us to reflect, to empathise, and to regulate emotion.

What is an emotion?

An emotion is a physiological response to internal or external stimuli. It seeks to be communicated, first to ourselves, then to others. When we label our emotions using language, we call them feelings. Emotions originate in the body and without a body, there can be no emotional experience.

Why AI can never offer psychotherapy?

Psychotherapy can only occur between two (or more) human beings. It requires the full, embodied experience of another person in order to take place. The therapist must bring their humanness to the process—not only their intellect, but their feelings, their capacity to be impacted, and their ability to remain separate, yet deeply connected.

AI does not possess a mind. It simulates a mind.

AI does not feel emotion. It mimics emotional understanding.

AI is not embodied. It cannot reflect or hold another’s experience because it has no experience of its own, as it has no body.

If AI could truly offer psychotherapy, then AI could also raise children. The implication is chilling: we would, in effect, lose the essence of what it means to be human.

Can AI be helpful to mental health?

As I stated earlier, AI may well have a role to play in the broader realm of mental health—particularly as defined in its current, diluted cultural form. I meditate daily and do so for emotional and physiological benefit. Meditation may well quieten the mind, but it cannot grow one. Meditation is therefore not psychotherapy but may be a useful adjunct.

Minds are only grown in human-to-human relationships

This begins in-utero and throughout infancy—in the mother-infant dyad—where the child’s mind is shaped through emotional connection with a caregiving other. When that process is disrupted or fails, psychotherapy is the only viable path to develop a reflective, relational mind in adulthood. It is, in that way, profoundly unique.

 

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

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

What do dreams mean?

Is starting psychotherapy a good New Year’s resolution?

Twixtmas – surviving that dreaded time between Christmas and New Year

How to minimise Christmas stress if you are hosting

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Interdependence: between independence and dependence

Why interdependence is a healthy middle ground for mental and emotional wellness

How often do you hear people encouraging others to be ‘independent’ and ‘self-reliant’? Maybe you’ve even been that person trying to motivate someone to ‘stand on your own two feet’ and ‘try not to lean on others’.

Sentiments like this might be expressed when there seems to be an extreme level of dependence. Looking to others to always meet our needs can be familiar and comfortable, but it can also prevent personal growth and foster feelings of inadequacy. Even if we have legitimate needs that require us to depend on others, being informed and making your own choices can greatly enhance the experience of relying on other people.

On the opposite end of the spectrum is the concept of independence. The Cambridge dictionary defines it as ‘the ability to live your life without being helped or influenced by other people.’ While the idea of not needing others can be appealing, especially when trust has been broken or past relationships have let us down, excessive independence can lead to isolation, stress, and burnout. Though we all benefit from achieving success on our own at times, we may start to feel alone if we neglect to build and maintain healthy relationships.

Finding a balance between dependence and independence can be challenging, but the concept of interdependence offers a healthy middle ground.

Interdependence: no man is an island

We know, from both observation and scientific research, that no living thing on Earth can exist in complete isolation. Bees need flowers for pollen, plants rely on bees for pollination, soil requires plants for microbial health, and plants need soil for nutrients… and so on.

Interdependence describes a balanced, healthy reliance on others without total dependence and with give and take. It allows for stepping away and coming back together with trust and mutual respect. The 17th-century poet John Donne famously said, ‘No man is an island entire of itself; every man is a piece of the continent, a part of the main.’ His words emphasise the significance of our connection to others and the world around us.

The psychiatrist Donald Winnicott echoed this in his work with parents and infants, stating, ‘There is no such thing as an infant, meaning, of course, that whenever one finds an infant, one finds maternal care, and without maternal care there would be no infant.’ Winnicott highlighted the ideal bond between mother and child, suggesting that they cannot conceptually exist without each other. He believed this connection shapes the future relational experiences of the infant.

John Bowlby, the psychiatrist who pioneered attachment theory, also spoke to this, explaining that early relationships teach us how to form secure bonds later in life. A ‘secure base’ in relationships enables us to explore the world safely, with a stable place to return to when things become difficult, or we need rest and connection. This can be harder to develop in adulthood if it was not established in childhood.

Despite what can seem to be an emphasis on independence in our society, many social care and mental health services recognise the importance of relationships and connection in healing trauma and fostering fulfilling lives. One example of this in relation to interdependence is in therapeutic communities, designed for individuals often living with emotional distress and severe mental health challenges. These communities emphasise relational treatment, and the repair of early relational trauma through the experience of being with, doing with and, often, living with others. This, sometimes complex and difficult therapeutic process, creates space for belonging, connection and hope as members navigate conflict and care for one another through careful boundary setting and reflection. It offers an opportunity to relearn the value of healthy, supportive relationships.

I’ve witnessed first hand, in my work, how people can transform when they move from an isolated, independent, or dependent state to one of interdependence. Through this shift, individuals learn to establish and maintain boundaries, while fostering mutually supportive relationships and a sense of belonging. This approach can also be applied to social groups, workplaces, and families. Workplaces can even cultivate a resilient and secure workforce by nurturing a culture of interdependence.

Reflecting on your own relationship with independence and dependence

It can be helpful to reflect on your own patterns of independence and dependence by considering these questions:

  • Do you allow others to help you, and can you ask for help?
  • Do you prioritise helping others over helping yourself?
  • How do you cope when others are not around?
  • How could you cultivate more interdependent relationships in your life?
  • What do you offer others, and what do you truly need from them?

The answers to these questions may surprise you. You might find that some of your behaviours are rooted in deeper beliefs you have or experiences from the past. You might also identify areas where you want to make changes. If these questions stir up feelings of uncertainty or discomfort, it could be helpful to explore them further, whether on your own or, in the spirit of interdependence, with the support of others, to better understand and navigate these challenges.

 

Kirsty Toal is an experienced psychotherapist with a decade spent offering therapy, training and clinical supervision in a variety of settings. Kirsty offers short- and long-term psychodynamic and psychoanalytic psychotherapy to adults, in person in Lewes and online.

 

Further reading by Kirsty Toal

Understanding and managing the ‘green eyed-monster’

To be creative as an adult

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A journey into understanding Non-Violent Resistance

Non-violent resistance (NVR) is a hugely effective, forward-looking and relational approach which helps parents to un pick what is happening in the family, to begin to recognise and disrupt entrenched patterns of interaction and to break down the barriers which stand in the way of change. In so doing, parents, who might start the work feeling lost and depleted, powerless and helpless against destructive dynamics which threaten the stability of their family, are able to regain their parental strength. The approach focuses on supporting parents to develop narratives and impactful methods of resistance, and to align themselves alongside their child while encouraging them to get back in touch with their own boundaries, wants, needs and wishes – alongside recognising those of their children.

Fundamental principles within the approach of ‘presence’, ‘resistance’ and ‘community support’, provide an over-arching structure, which enables the exploration of the complexities of behaviours such as violence, aggression, control and coercion which challenge family systems.

Below is an extract of a reflective summary provided by a mother to a fifteen-year-old son, J, who frequently displayed significant violence towards his parents and siblings. J was diagnosed with ADHD at age twelve. The parents completed a short-term intervention of NVR support. Her summary highlights some of the reticence experienced by parents in considering starting to work with NVR, and of the challenges encountered along the way:

“As you know I was sceptical to say the least when a friend recommended my husband and I start a program of NVR. In fact, I was actually pretty annoyed, as if silently and subtly they were suggesting that our parenting wasn’t somehow good enough. Despite this though I did reach out, maybe because things were feeling so unbelievably broken and I felt like I had tried so much that just wasn’t working. I felt really anxious about coming to the first session and even started typing an email to cancel but my husband was determined we had to give it a go. I tried to read up a bit about the approach before we came in. In my mind though I think really I was getting ready to defend myself and to assure myself, my husband, my friend (and you) that we really didn’t need to do this work, that it was J who needed to see someone, not us, whilst at the same time also feeling desperate that my friend was right and that this could actually help.

What I liked instantly about the work was that you challenged us to look forwards. We’d been stuck as a family for a very long time, and I was feeling exhausted, angry, devastated, hopeless, helpless – completely lost. I think we look back on that time as very dark days and so it feels great to be writing this from a place which honestly feels so much lighter, brighter and optimistic – all things actually that I think we agreed when we first started talking about what we were striving for.

I remember feeling from that initial consultation ‘wow someone actually gets this’ because the way you summarised things from your experiences with other families really resonated with me. You asked in the first session what I was striving for, and I liked that some of this focus was framed about me – as just me – as well as around me as Mum to J, me as part of a couple with my husband, me as Mum to my other children and for us as a family, and likewise for my husband. In just that first session we began to recognise that because of all the awful behaviour that J was showing at home we were living in a state of chaos and panic. We had neglected our care of ourselves and lost each other as a couple – and I could see that its hardly a surprise that it was so hard to resist the violence when we were feeling so lost and so broken ourselves. I liked the way we explored what we want things to be like.

Just allowing ourselves to imagine a different future helped to begin to move us out of the hopelessness. We reflected on what family life had become for us and we considered some of the things that stopped things moving forwards. It’s lucky we always had a box of tissues in the room because I remember doing a lot of crying in some of those first weeks – and I remember joking with you mid-way through the work that the fact I wasn’t in tears was a good sign of the progress we were making! There seemed somehow a real simplicity in breaking down our experiences and exploring the NVR themes within the sessions. We had a structure around us, that we were able to take away and begin to test out at home. As we began to move deeper into the work together and explore all the different principles within NVR, I could feel it really starting to bed into my thinking and it started to come more naturally to me at home. At first, I remember it feeling quite clunky, and some of it even jarring as it turned some of what we’d been doing on its head, as part of what you described as disrupting the status quo. I liked that we could lean back on the idea that those elements were where we could get our power back as parents and to really begin to get things back on track for our family.

We reflected a lot on the community around our family and I can definitely say at this point I am so thankful to my friend for suggesting this approach. She has been absolutely alongside us, and J, and because she didn’t stay as a quiet bystander to our struggles we are now in an unrecognisable place as a family. Finding the courage to open up our world and let other people in was by far one of the hardest elements of the approach – we had worked so hard to batten down the hatches, to stay compliant to the secrecy and to shield ourselves, J and others from people knowing how bad things were, that the idea of reaching out to others for help felt really scary for lots of different reasons – but this was impactful in so many different ways.

It has definitely been a journey – and we are very aware we have to keep working at the relationship, but it feels easier, and J gives back in so many different ways now that it all just feels very different from where we started. J is now back in college and smokes a lot less weed. We were belly-laughing together last week about something silly, and he even told me about his new girlfriend yesterday. It feels so special to be allowed in… and as you know the violence has stopped. We see J working really hard to control his behaviour – obviously he still gets very cross at times, but it feels like we’re all invested in doing what we can to resolve conflict in new ways together.”

NVR is an approach which can lead to transformation and enduring change within families.

With its focus on relational balance and principles of resistance it is a suitable approach for supporting families with children of all ages. In my practice I have worked with parents of toddlers, young children, teens and adolescents right through to parents of adult children who may not even live in the same home any longer. It is an individualised approach, centred around the needs of all the individuals within the family, recognising it cannot be a one-size-fits-all approach. As such the approach is effective for supporting children and/or parents with neurodivergence.

 

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.

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How do I stop overthinking?

This is a question that I am often asked. Everyone overthinks sometimes however for some people this can feel like a constant. Some people worry a lot about what others think of them, they can rehash conversations they’ve had, worry about what they’ve said and if they should have said this or that or whether they may have upset someone. Some people overthink making decisions and this can lead to immobilisation. Others think about worse case scenarios that could potentially happen.

This type of thinking is often accompanied with distressing images of possible disasters. Either way overthinking can be all consuming and have a significant impact on mood. Overthinking tends to fall into two categories, either rumination about the past or worry about the future. If we are ruminating on past, we are replaying situations or events in our mind or questioning decisions that we have made. Rumination is often linked to low mood and low self-esteem. Persistent worry thoughts involve negative predictions about the future, usually catastrophic, and often linked to anxiety.

Rumination and worrying can be seen as unhelpful behaviours. This is when we don’t consider the content, we try to change the behaviour. The content of the rumination and worry are the unhelpful thoughts and to work with these we use thought challenging. Ideally, we need to challenge both behaviours and thoughts to make a change. This is what CBT aims to do. Both worrying and ruminating can become habitual and so you don’t always recognise when you are doing it until you are well into a cycle. Increasing awareness is the first step. Really notice when you are getting into a worry or ruminative cycle. By increasing awareness, you can make an intervention to change sooner. Start to really try and notice when you are getting into these cycles. Usually there will be a shift in mood, either worry and anxiety or feeling low and depressed.

When you notice that you are ruminating or worrying, remind yourself that this is not productive, thinking in this way is only helpful if it leads to a positive action. Is what you are worrying about an actual problem or a hypothetical one? If it’s hypothetical or one that you have no control over, then a strategy that can be helpful is to really try and shift your focus of attention to something else and engage in the present. This might be doing something physical, such as gardening or exercise, or engaging in conversation, or doing an activity that you find really absorbing such as baking, creative arts, a word puzzle or Sudoku. It’s normal for your thoughts to try and hook you back in. Just notice that this is what is happening, don’t engage with the thought, let it go. Focus on the activity that you are doing, notice what’s going on in the here and now. It might help to think about what you can see, hear, smell, taste. You want to try and be truly present to your external surroundings. The principle of this strategy comes from mindfulness. You are doing something in a mindful way. This strategy can also be used for ruminating on the past. We can’t change the past, so it is not helpful to keep going over it. Often when we are ruminating, we are being self-critical and understandably this is going to negatively impact our mood. We can get stuck in cycles of worrying about the future or ruminating on past. We want to shift our focus of attention to the present and be truly present to the here and now.

It can be helpful to write worry thoughts down, to ‘park’ the worry. Then allocate yourself a limited period of time later in the day to come back to these worries and allow yourself to think about them. This is referred to as ‘worry time’.

If what you are worrying about is an actual problem or something that you do have control over, then you can problem solve. Consider all the possible solutions, pick one that you consider will be the most do-able and helpful, and devise an action plan. Once you have your plan of action decide if you can implement this right now or do you need to schedule it. This is a positive action and productive. Once you have implemented your plan you can let it go and shift your focus of attention.

When getting into lots of negative thoughts it can be helpful to thought challenge. Firstly, it can be useful to consider if you are getting into unhelpful thinking patterns such as mind reading, catastrophising, emotional reasoning, being self-critical, making judgements, black and white thinking, negative mental filter, shoulds and musts. If this is what you are doing, remember thoughts aren’t facts, even if they might feel that they are. Ask yourself, is there any factual evidence to support these thoughts or are they opinions? Would your evidence be permissible in a court of law? (This is the fact/opinion approach). You can also use the STOPP approach. STOPP is an acronym: Stop, Take a breath, Observe, Pull back and put in some perspective, Practise what works. Ask yourself is there another way of looking at this? What would your best friend say to you in this situation? What advice would you give to someone else in this situation? Will it matter in six months’ time? Answering these questions can help you to gain a different perspective, hopefully a more realistic one. Once you have a more realistic perspective you can test this out by doing something different, consider what would be more helpful to you at this time and is it in line with being the person you want to be.

These are different CBT strategies used to manage overthinking. Change is difficult and takes time.

It’s a challenge. As with anything, these strategies will take practice. They may not always work and that’s okay too. Often, we are trying to change a way of being that has been around for a long time, so it is important to try and be gentle with yourself. Remember, you’re not alone, overthinking is something we can all do.

 

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

 

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Do we need to do homework during psychotherapy?

For many people the word ‘homework’ stirs up rather negative memories of being forced to stay in when the sun was shining, or toiling over the complexities of maths equations rather than enjoying computer gaming or other hobbies.

But in psychotherapy, engaging in relevant tasks connected with mental wellbeing during the week between sessions can be hugely beneficial in consolidating and enhancing the changes involved in the therapeutic process.

One example of this is practising mindfulness. Time spent in reducing bodily tension and the down regulation of mental processes can yield important new insights and reduce levels of anxiety. It takes only a few minutes of session time to learn simple meditation techniques and they can be practised at home on a daily basis.

A second approach is through journaling. But how can writing help us to relax and lessen mental tension and worries?

Neuroscientist and psychotherapist Louis Cozolino, whose book “Why Therapy Works: Using Our Minds to Change Our Brains” (1), brilliantly explains in accessible terms the key elements of psychotherapy, outlines the important role of narrative and writing in improving our mental health.

A key point here is that all of us develop – as a result of our upbringing and life experiences good and bad – an endlessly shifting internal narrative and dialogue about who we are, our strengths and weaknesses and things that have gone right and wrong in our lives. This translates into the daily barrage of thoughts that enter our brains, and can become a key component in neurosis, a kind of internal echo chamber that intensifies our distress.

Cozolino states (2) :

“Putting feelings into words has long served a positive function for many individuals suffering from stress or trauma. Writing about your experiences supports top-down modulation of emotion and bodily responses … Therapists hope to teach their clients that not only can they edit their present story, they can also be authors of new stories. With the aid of self-reflection, we help our clients to become aware of narrative arcs of their life story and then help them understand that alternative story lines are possible. As the writing and editing proceed, new narrative arcs emerge with the possibility of experimenting with more adaptive ways of thinking, feeling and acting.”

In this context, journaling – broadly writing down what has happened to us and why – can be pivotal in both understanding the events in our lives and the possibilities for change. My recommendation to clients in this domain is to buy a simple hardback A4 sized ruled notebook and then to experiment. There are no hard and fast rules other than making the time to make entries on a loosely regular basis.

The benefits cannot be precisely quantified, but in my experience, they include (as well as those already pointed out by Cozolino):

  • The availability of a vent for the expression of pent-up primary negative emotions: fear, anger, disgust and sadness, as well as – more positively – joy.
  • Gradually gaining deeper insight into our internal experiences.
  • Identifying patterns in thoughts, behaviours and emotions, as well as bringing into focus the triggers that contribute to distress, such as bullying or being subjected to another’s anger.
  • Facilitating mood tracking and the safe processing of difficult experiences.
  • Our minds generate endlessly changing thoughts; journaling allows us to check progress over time, noting changes in thoughts, feelings and behaviours.
  • The writing process can continue the work done in the therapy room and allow clients to rehearse and practise the new approaches that are discussed.

Another key point is that journaling can also become relaxing – a way of unwinding – and even fun. The process of articulating and crystallising our thoughts can be challenging but it also brings its rewards. Our internal thoughts are hard to keep track of, but this is an outlet which can also become like a close friend, a place to unload and unwind.

I have personally written a journal for more than thirty years and began doing so when I first experienced therapy following a panic attack at work (in my then job in the media). It was among my then therapist’s first recommendation to me as his client. With the benefit of hindsight, it was a major turning point in my life that enabled me to build both greater self-esteem and a better sense of competence and agency – essentials in the creation of a secure base, the subject of another blog by me available on this site.

 

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 –

The empty chair in therapy

How therapy can help with anger issues

Do you have unrelenting standards?

Why we need a ‘secure base’

 

(1) Louis Cozolino, Why Therapy Works: Using Our Minds to Change Our Brains, W W Norton & Company, 2016

(2) Ibid p.24-5

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Understanding exercise addiction

In a previous blog we discussed the links between exercise and mental health and how exercise can be hugely important for raising and maintaining our mood. In this blog, we will discuss how the healthy habit of exercise can sometimes become addictive, and can actually harm both our physical and mental health.

When healthy habits turn harmful

For most people, exercise is a beneficial part of life. It boosts mood, enhances cardiovascular health, and offers a constructive way to manage stress. However, when the pursuit of fitness becomes obsessive, it can lead to exercise addiction. This condition is characterised by a compulsive need to work out, even in the face of injury, illness, or social isolation. Exercise ceases to be a pleasurable activity and becomes a ritualistic behaviour performed out of anxiety or guilt.

Often, exercise addiction emerges in tandem with body image issues. Many people who develop an unhealthy relationship with exercise are also preoccupied with how their body looks, which can overlap with symptoms of eating disorders. These eating disorders—such as anorexia nervosa, bulimia nervosa, or binge eating disorder—are complex mental health conditions where food intake and self-image become interwoven with one’s emotional state.

The psychological roots of compulsive exercise

At its core, exercise addiction is often about more than just physical fitness. It may represent an attempt to gain control over other areas of life that feel unpredictable or overwhelming. For some, the gym or running track becomes a sanctuary, a place where effort translates directly into visible progress. The immediate gratification of sweating out stress can mask deeper emotional pain or unresolved trauma. Over time, this behaviour can become a maladaptive coping mechanism—a substitute for addressing the underlying issues.

Often people can initially view their commitment to exercise as a form of self-care, only to later recognise that their routines are fuelled by deeper emotional distress. They may feel compelled to maintain rigorous exercise schedules to compensate for feelings of inadequacy or to assert control in an otherwise chaotic world. This psychological dependency can lead to a cycle where the body is pushed beyond its natural limits, resulting in physical injuries, chronic fatigue, or even immune system suppression.

It is also worth pointing out that a highly competitive sports person might also display characteristics of exercise addiction. There often needs to be a level of discipline and obsession in the sports to get to the championship winning level. So, understanding if the level of exercise and the obsession with the sport is healthy or not can be a difficult balance.

Intersecting pathways: exercise addiction and eating disorders

The connection between exercise addiction and eating disorders is profound. Often, the excessive drive to work out is linked with a distorted body image and a harsh inner critic. For instance, those who suffer from anorexia may engage in relentless physical activity as a way to further lose weight, believing that burning more calories will bring them closer to an ideal self-image. Similarly, those with bulimia might use exercise as a means to counterbalance episodes of binge eating. Also, an eating disorder can morph into exercise addiction – so food is no longer restricted, but exercise entirely replaces the need to restrict.

Both exercise addiction and eating disorders share a common trait: the relentless pursuit of perfection. This obsession can trap individuals in a vicious cycle where progress is measured by self-imposed, often unrealistic standards. The result is a continuous loop of reward and punishment, where every workout or meal becomes a test of one’s worth. Recognising this interconnectedness is crucial, as treatment must address both the behavioural components and the underlying emotional triggers.

Paths toward recovery

Recovery from exercise addiction and eating disorders involves a holistic approach. Cognitive behavioural therapy (CBT), mindfulness practices, and support groups can play pivotal roles in helping individuals regain balance. Also, creating a more compassionate relationship with yourself can be a key component in overcoming exercise addiction. This involves challenging the notion that self-worth is solely determined by physical appearance or performance in the gym or sports field.

An important part of the healing journey is understanding that recovery does not mean abandoning exercise altogether. Instead, it’s about reclaiming exercise as a healthy, enjoyable activity rather than an obligatory chore. Professional guidance from both a personal trainer and a psychotherapist can help reframe exercise habits, ensuring that they serve as a tool for wellbeing rather than a source of self-punishment.

While exercise is an essential aspect of a healthy lifestyle, it’s important to remain mindful of its potential to become addictive. When combined with factors like body image issues and eating disorders, the consequences can be both physically and emotionally damaging. Seeking psychotherapy can be an important step forward to acknowledging and tackling exercise addiction.

 

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 –

Can Buddhist thinking help with our emotions?

Exercise and mental health

Are you too sensitive?

Is spirituality an escape from reality?

Sleep and mental health

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How can I manage my emotions better?

This is a common question clients ask therapists.

Sometimes clients describe having mood swings, one minute they are feeling fine and the next are feeling very low, and for others it can be suddenly feeling irritable or angry. Sometimes there is an obvious trigger to the change in mood but often clients report no trigger, just a general feeling of their mood having changed.

Understandably this can feel frustrating as well as being difficult for those around them – clients often say that their mood swings impact on their relationships.

In therapy we might start by looking at the bigger picture. We might ask the client if this is something they have always experienced or is relatively new. It could be that there has been a build-up of stressors or that the client’s work-life balance has become unbalanced, and so as stress has increased it has become more difficult to manage their moods. Often stress can creep up on us. We have an expectation that we can maintain a permanent level of ‘doing’ however this isn’t true. Often people think because they used to do all these things they should be able to keep on doing all these things. We can often compare ourselves to how we used to be and hold an expectation that we should be able to keep going. However, stress can accumulate and over time this can become more difficult to manage. The analogy of the stress bucket is useful here. If you imagine the size of the bucket represents a person’s stress tolerance and this is influenced by personality, genetics, upbringing and experience. The bucket fills up with stressors from home, work, family, finances, illnesses etc. When the bucket is full up it can lead to problems such as low mood, anxiety, fatigue, headaches, sleep disturbance and overwhelm. We need strategies to stop the bucket overflowing.

This is where therapy can help. Together we can explore stress management strategies and talk through the stressors. Often difficult experiences build up and we don’t allow ourselves time to properly process them.

For others it could be that they have always found it difficult to manage their emotions. This could be because they’ve never really learnt to manage difficult emotions and so they struggle with tolerating them. Sometimes unhealthy ways to manage develop such as drinking too much alcohol, comfort eating, sleeping or taking drugs. These are different ways to avoid feeling difficult emotions. However, these only work in the short term, can be difficult to give up and can lead to mental health difficulties such as depression, anxiety and low self-esteem.

Cognitive behavioural therapy (CBT) is an effective treatment in managing emotions. It looks at the interaction between our thoughts, moods, physical symptoms and behaviours. It can be useful to use the basic CBT model to start to breakdown what’s going on when you first notice the shift in emotion/mood. When you first notice that shift in your mood ask yourself what was going through my mind at the time, what were the words my mind was saying (i.e. your internal dialogue); name the moods/emotions that you were feeling at the time (there can be more than one mood); how were you feeling inside of your body, what were the physical sensations; and what is it you were doing or not doing (behaviours). Also try to identify the trigger, what were you reacting to? Was it an event or situation or was it that you started to think about something, and this triggered a shift in your mood. By breaking down your experience in this way we can really look at what is going on. We can start to identify early signs and symptoms that happen when your mood changes. We can look at what might be unhelpful in the way you are thinking that could inadvertently be maintaining the cycle. We can see what you are doing or not doing that also might be contributing to maintaining the cycle.

It can help to write these answers down. The process of recording can help to give us clarity and can be a strategy in its own right. Once we have gathered this information and identified what’s unhelpful, we can start to look at ways to make changes, what might be more helpful.

Noticing your emotions and naming your feelings can be useful, but it’s not always easy to do this if it’s something you’re not used to doing. When we notice physical sensations happening in our body, we can think about why these might be happening. Was it that you were thinking of something that’s happened in the past or worrying about something in the future? Or was it that you were feeling a certain way and started to give a meaning to what you were feeling? How we are thinking impacts on how we feel emotionally and physically. Just as how we are feeling in our mood and in our body will impact on how we think.

When managing our emotions it’s important to be kind to ourselves: to think self compassionately; to treat ourselves how we would treat others; to forgive ourselves when we make mistakes; and not give ourselves a hard time when we don’t achieve everything we would’ve liked to. Be mindful of the way we talk to ourselves. We need to accept our different emotions rather than trying to fight them. It’s okay to feel ‘negative’ emotions, it’s part of being human. Telling ourselves we shouldn’t feel like this, judging ourselves harshly or criticising ourselves doesn’t help. Just as trying to avoid or dismiss the emotion doesn’t help. We need to learn how to self-soothe and reach out to others for support.

CBT helps us learn how to recognise unhelpful thoughts and challenge them, and to identify unhelpful behaviours. If we can make changes in these areas this will have a direct impact on our emotions.

We can all experience difficult emotions at times, it’s normal, just as we can all need a little help in how we manage them.

 

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

 

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49 Church Road, Hove, East Sussex, BN3 2BE

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