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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

The journey of becoming a psychoanalytic psychotherapist is profoundly transformative, reshaping not only how we understand others but also how we come to know ourselves. Training involves navigating complex theoretical landscapes while developing the capacity for deep emotional attunement—a process that mirrors the very work we hope to facilitate with our clients.

The water we swim in

There’s an old joke about two fish swimming past each other. One says, “Morning, water’s warm today isn’t it?” The other replies, “What’s water?” This captures something essential about psychoanalytic work: we often operate within psychological environments so fundamental that they become invisible. The “water” we swim in includes our unconscious processes, cultural backgrounds, and the unseen forces that shape our relationships.

My training organisation and professional body, AGIP, promotes a pluralist approach, encouraging critical engagement with diverse theoretical perspectives. Rather than adhering to a single school of thought, it draws from Freud’s insights about transference and the unconscious, Winnicott’s concepts of holding and transitional space, Bion’s theories of containment and thinking, and contemporary relational approaches. This pluralism is not about collecting theories like tools in a toolkit, but rather encourages developing the capacity to think psychoanalytically—to remain curious about what lies beneath the surface of human experience.

Cultural liminality and identity

For professionals like myself, who identify as ‘third culture kids’— individuals who have lived between different cultural systems—there is a particular resonance with the liminal spaces that characterise psychoanalytic work. Living between cultures creates what the late Psychoanalytic Psychotherapist, David Henderson, called ‘cultural homelessness’, not merely geographic displacement, but a more fundamental sense of existing between worlds without complete belonging in any.

This experience of liminality, while sometimes challenging, can become a therapeutic asset. It fosters comfort with ambiguity, sensitivity to different ways of being in the world, and appreciation for the complexity of identity formation. However, it also requires careful attention to potential over-identification with clients who share similar experiences of displacement or cultural complexity.

Finding meaning in the third space

Training in psychoanalytic psychotherapy ultimately invites an ongoing dialogue between self and other, theory and lived experience. It is in this interplay (the “third space”) that we cultivate the capacity to hold complexity without collapsing into certainty, to listen beyond words, and to remain open to the ever-shifting emotional landscapes of our clients. The work challenges us to embrace our own vulnerabilities, confront the limits of our understanding, and continuously reflect on how our histories shape our interventions. In doing so, training becomes not just an education in technique or theory, but a profound journey of self-knowledge, where the spaces between cultures, minds, and hearts reveal both the fragility and the resilience of 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?

More articles like this:

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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How AI tools between therapy sessions are undermining the therapeutic relationship

The space between psychotherapy sessions is not empty. It is saturated with psychic material such as fantasy, frustration, longing and resistance. It is where the work reverberates, where the transference lives on, where the unconscious continues its motion. Yet increasingly, this space is being colonised by something that feels helpful: AI therapy.

Apps that prompt, soothe, or mirror back “empathy” through an algorithm are now pitched as the perfect between-session companion. They offer structure, safety, even surrogate support. But what seems like a supportive bridge is, in psychoanalytic terms, a subtle sabotage. It redirects the patient’s libidinal energy away from the therapeutic relationship, diluting its potency. And it replaces the analytic third with a pseudo-subject that can only simulate understanding.

The therapeutic relationship is not interchangeable

Psychoanalytic psychotherapy is not about problem-solving or advice. It is about the patient’s relationship with the therapist—as a representative of their internal object world.

The real work unfolds within that living, breathing relationship, often shaped by longing, disappointment, anger, idealisation, eroticism, hate.

When a patient turns to AI between sessions to “process,” “journal,” or receive “support,” they may believe they are helping themselves stay connected to the therapy. In fact, they are often displacing the relationship, venting into a vacuum rather than containing the affect and bringing it back into the room.

This has consequences. Psychic energy that should charge the transference is siphoned off. The unconscious, which needs a real human mind to be received and thought about, is instead met with a programmed echo. A fantasy of self-sufficiency takes hold, and the very dependency that fuels therapeutic transformation is split off.

Containment versus substitution

One might argue that AI provides containment. It offers a holding function, particularly when the therapist is not available. But containment outside of relationship is not neutral. It begins to function as a substitution. The patient who journals into an AI app after a conflictual session may feel soothed but they are no longer metabolising that rupture with the therapist. They are metabolising it elsewhere, safely, sanitised, and in private.

This avoids the essential confrontation: bringing the frustration, confusion, or hurt back into the session and into the relationship. That is where meaning is made. That is where change occurs. Bypassing this moment not only flattens the affect, it reinforces the very defences the therapy is trying to loosen.

Undermining the transference

Psychoanalysis hinges on transference, not as an abstract concept, but as an embodied, lived experience between two people. The space between sessions is part of this structure. It is meant to generate feeling. Missing the therapist, resenting the wait, idealising or devaluing them in their absence—these are not problems. They are the
material.

AI, when used between sessions, acts as a relational decoy. It absorbs and deflects feelings that should be directed at the therapist. It creates a false container for transference affect, preventing it from returning to its source. The result is a therapeutic encounter increasingly starved of psychic charge that is clean, calm, and sterile.

This is not therapy. It is emotional outsourcing.

False self meets artificial other

For many patients, especially those with early relational trauma, therapy becomes the first place where a real self can begin to emerge in the presence of a reliable other. But when that process is interrupted by prematurely discharging affect into AI. A different relational dynamic takes hold: the false self meets the artificial other.

Here, the patient curates their affect. They perform emotionality for a system that cannot truly respond. And over time, the patient may come to prefer this safer interaction. The unpredictable, disappointing, demanding reality of the therapist feels intolerable in comparison. But growth does not come from comfort. It comes from staying in the real relationship, even when it hurts.

The psychotherapist’s absence is part of the frame

Therapy is bounded by time and structure. The session ends. The therapist is not available at all hours. This absence is not incidental, it is analytic. It creates space for projection, for fantasy, for psychic digestion. Patients are meant to feel the gap, to stew, to wish, to rage.

They are meant to wait.

AI collapses this space. It is always available, never absent, never unpredictable. It removes the limit. It flattens the emotional topography between sessions into a manageable plain. But in doing so, it erases the edge. There is no longing, no tension, no psychic residue. Just answers. Just relief.

The promise—and the poison

To be clear: this is not a purist rejection of technological support. Some tools may offer genuine help outside of therapy. But when these tools begin to replace the therapeutic relationship in the patient’s inner world, they no longer support the therapy. They displace it.

The promise is comfort and the poison is disconnection.

Therapy asks something different. It asks the patient to feel, to wait, to hold their experience and bring it not to an app, but to another human being who can sit in the mess with them. Who can disappoint them, hold them, survive their projections, and reflect something true.

Good psychotherapy demands the space between psychotherapeutic work unfolds not just in sessions, but between them. That space matters as it is where the unconscious stirs and something forms that has not yet been said. Where the patient discovers whether they can bear not-knowing, not-solving, not being rescued by words on a screen.

In filling that space with AI, we risk not only weakening the therapy, but we risk weakening the patient’s capacity to think, to feel, and to relate.

Between sessions is where the work deepens. Let’s not give that away to an algorithm.

 

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

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

What do dreams mean?

 

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Rewiring the past: EMDR demystified

EMDR has become one of the most talked-about psychotherapy treatments – and for good reason. Extensive research has shown that it is one of the most effective approaches developed so far for trauma and chronic pain. It is recommended by the National Institute for Clinical Excellence (NICE).

The acronym stands for Eye Movement Desensitization and Reprocessing. That’s a bit of a mouthful, but it is a relatively simple approach which is helping thousands of people worldwide.

I first trained in the modality with EMDR Europe seven years ago and have since worked using it with a wide variety of issues. They include:

  • Phobias, including of snakes and air travel
  • Traumatic life events such as rape, physical abuse and the impact of war
  • Sudden, devastating bereavement
  • Psychosomatic immune system conditions such as fibromyalgia and suspected endometriosi
  • Chronic pain

What is EMDR Therapy?

EMDR is a structured, evidence-based psychotherapy originally developed by its founder, Francine Shapiro, to help people recover from traumatic events in their lives. Unlike traditional talk therapy, EMDR doesn’t require you to go into great detail about the traumatic experience. Instead, it uses a structured process which helps your brain “digest” the distressing memory and reduce its emotional charge.

It’s based on a simple but powerful concept: the brain can heal from psychological trauma just like the body heals from physical injury—if it is given the right conditions.

The EMDR Process in a Nutshell

EMDR follows an eight-phase protocol. After preparation and history-taking, the first stage is to identify a distress-linked memory suitable for treatment. The client describes the intensity of discomfort experienced and then is invited to link this to a negative cognition now felt in relation to the event, such as “I am powerless” or “I am not good enough”. The next stages are to identify how strong the disturbance now feels on a scale of 0-10; to notice the basic emotions (of fear, disgust, anger or sadness) involved; and finally, where in the body that distress was and is felt.

After this, the key part of EMDR begins. This is called bilateral stimulation (BS). First the client is asked to bring up the negative scene in their mind, along with associated feelings and negative cognition. The therapist then starts the BS, usually by moving his raised right hand from right to left rhythmically and asks the client to follow the movement with their eyes. Each block of BS lasts about thirty seconds, and after each one, the therapist asks the client what thoughts have come up. It’s like going on a train journey in the mind with each pause in the BS the arrival at another station – our brains access our difficult memories and link them together.

This might sound unusual, but research shows that this kind of rhythmic stimulation helps the brain reprocess the memory, moving it from a “stuck” emotional state to a more adaptive, integrated one.

Why EMDR Works

The current thinking is:

  • It Mimics Natural Brain Processes
    EMDR’s bilateral stimulation mimics what is also thought to happen during REM (Rapid Eye Movement) sleep—when your eyes naturally move back and forth while your brain processes and tries to make sense of emotional experiences. EMDR taps into this system while you’re awake, allowing you in effect to consciously rewire how traumatic memories are stored.
  • It Reduces the Emotional Charge
    EMDR doesn’t erase memories. Instead, it changes how they feel in your body and mind. A memory that once felt overwhelming can become more neutral—like something that happened in the past, rather than something you’re still reliving.
  • It Targets Core Beliefs
    Trauma often shapes our beliefs about ourselves. You might walk away from a painful experience thinking, “I’m not safe,” “I’m powerless,” or “It was my fault.” EMDR helps challenge and replace these beliefs with more balanced, compassionate ones—such as “I did my best” or “I am strong.”
  • It can be Faster Than Traditional Talk Therapy
    In my experience, many clients find that EMDR works more quickly than other types of therapy. Because it taps directly into the brain’s natural processing systems, people often see results in fewer sessions—especially for single-event trauma. For more complex trauma or chronic stress, EMDR is still highly effective, but it may take more time.
  • It’s Empowering
    EMDR isn’t about rehashing your trauma over and over. It’s about accessing your brain’s capacity to heal itself. Clients are active participants in their own healing and often describe the process as feeling “lighter” or “freer” after sessions.

Because EMDR focuses on the root causes of distress—not just the symptoms—it can create deep, lasting change.

Is EMDR Right for You?

If you feel stuck, triggered by past events, or burdened by memories that won’t go away, EMDR may be worth exploring. It’s especially helpful if you’ve tried talk therapy but still feel like your past is holding you back.
Sessions are tailored to your pace and your needs. Safety is paramount. I always guide clients carefully, ensuring they feel grounded and in control throughout the process.

Finally . . .

EMDR therapy is more than a trend—it’s a transformative tool backed by decades of research. It gives your brain the chance to heal old wounds and frees you to live more fully in the present. Whether you’re dealing with trauma, anxiety, or want to shift long-standing emotional patterns, EMDR offers hope and real results.
You don’t have to keep carrying the weight of the past. Healing is possible—and EMDR can help light the way.

 

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

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

Do you have unrelenting standards?

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Masochism and the impossibility of desire

Masochism is perhaps one of the most misunderstood clinical structures in psychoanalytic psychotherapy. It has been removed from the DSM for largely political reasons and has thus disappeared from the psychological lexicon.

It is a term that is conflated with victimhood, reactivity, or submission; however, its true meaning as a personality style is more complex. Contrary to popular belief, it is not about deriving pleasure from pain. Rather, masochism, as a psychic structure, speaks to a particular relationship to suffering in the context of relationship, and ultimately, it speaks of the impossibility of desire.

To consider masochism is to imagine a limited relational world—one in which the subject is organized around a chronic attempt to elicit an Other who is present, reliable, and real. It is a structure built on hope, but a hope entangled with despair; a hope that longs to be disconfirmed.

Understanding Masochism in Psychotherapy

In therapy, patients with a masochistic structure often present with an outward passivity or self-effacing compliance. This can be misread as submission, or worse, as a lack of conflict. But the truth is the opposite: the masochist is in a constant, silent war. Their submission is a strategy, not a surrender. It is a way of compelling the Other to see them, to care enough to object.

This is perhaps best understood through the lens of early developmental trauma—a landscape in which the child, faced with an unpredictable or unavailable caregiver, finds ways to bind that caregiver to them through their own diminishment. Pain becomes a means of tethering; the masochistic gesture is therefore a form of protest and
preservation.

Why Desire is Foreclosed in Masochism

Desire is relational. It arises in the space between self and Other. To desire is to risk separation, to accept lack, to move beyond the orbit of the parent and out into the world.

But for the masochistic patient, desire is foreclosed. To desire is to risk losing the tenuous connection they have built through suffering. To want something for oneself is to disrupt the fragile equilibrium that holds the Other in place.

Thus, desire is transformed into duty. The masochistic subject lives in a world where longing is transmuted into endurance. Pleasure becomes perilous and autonomy dangerous. They do not ask: “What do I want?”; but rather, “How can I continue to make myself indispensable through pain?”

Therapeutic Challenges in Working with Masochism

Working with masochism as a clinician can be excruciating. The patient often colludes in their own silencing, inviting the therapist into a bind where speaking feels like intrusion and silence like abandonment. They yearn for something new, but sabotage it before it arrives.

They compel the therapist to suffer with them, and then punish them for being affected.

Countertransference is a critical compass here. The therapist may feel drained, guilty, impotent, or enraged. These feelings are not obstacles to the work but rather the very territory in which the therapy takes place. Masochistic patients invite the therapist to feel what they cannot speak: the unrelenting burden of having to remain needed by never being whole.

How Psychotherapy Can Support Change

Change, if it comes, does not arrive in the form of insight or catharsis, as it never does with depth psychotherapy. It emerges slowly, through the painstaking work of tolerating ambivalence and separation. It begins when the patient can glimpse the possibility of being wanted without having to suffer to be seen. When the therapist can survive being hated and still remain. When desire is no longer experienced as a betrayal.

Masochism, then, is not about enjoying pain. It is about avoiding the terror of wanting. And therapy, at its best, becomes a space where the patient can begin to uncouple connection from suffering and recognize that to be desired is not to be destroyed.

Conclusion: Grieving the Loss of Desire

To sit with a masochistic patient is to sit with the unspoken contract of early trauma: I will suffer so you will stay. To work through it is to grieve not only what was done but what was never allowed to be desired. It is to open a crack in a closed system and let in the dangerous possibility that love need not be earned through pain.

Ultimately, the masochistic patient has to decide that rather than being punished, or becoming the punisher herself, she instead accepts that living well is the best means by which to take revenge on her internalized (m)other.

 

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

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

What do dreams mean?

Is starting psychotherapy a good New Year’s resolution?

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