BHP, Author at Brighton and Hove Psychotherapy

The importance of generosity and forgiveness in a hostile world

September 11, 2023 by BHP Leave a Comment

Do you have Unrelenting Standards?

Put another way, is getting anything less than 100% not acceptable to you, and a trigger for uncomfortable feelings of failure, of not being good enough, of self-criticism, self-doubt and shame?

In my experience as a psychotherapist, a personal drive for perfection is often the root cause of distress in many of those seeking therapy. It can be a hard issue to resolve. After all, why would we not try our best?

An illustration of how much pressure unrelenting standards (US) can generate is a client I saw who, for ‘relaxation’ – as she saw it – became a triathlete. Nothing wrong with that, of course, but for this thirty-something woman, who for this blog I will call Caroline, her hobby required a series of log books and electronic aids to record every jog, every swim and every bike ride with painstaking notes about her heart rate, timings and much more (1).

It emerged in therapy that Caroline took any sign that her performance was not improving as a trigger of dismay. Was it because she was getting old? That she was physically too weak? Or that she was simply not good enough? She spoke about her ‘hobby’ almost as if it was a military exercise. The physical benefits were clearly being offset by that the effort involved was itself yet another source of worry. Worry about worry!

So how do unrelenting standards develop as a pattern of behaviour that can have maladaptive and counter-productive overtones? In a previous blog, I wrote about basic human needs, and pointed out that, according to US psychology researcher Caroline Dweck (2), in order to feel safe we need to come to feel that we exist within a secure base. How is this generated? Key elements are that we need to grow up feeling that the world is reasonably predictable, that we are accepted and loved (by those around us) and that we are sufficiently competent.

If that happens and we believe we are indeed broadly secure, the Dweck paper also says that we come to believe we can trust other people, we feel that we have a reasonable degree of agency and control over what happens to us in the world, and we develop a healthy and balanced sense of self-esteem.

Against that background, how do unrelenting standards develop? The current theory is that if we feel we have been abandoned in any way during our lives (for example by bereavement or as a result of divorce), and/or if we have been badly mistreated or abused, and/or if we come to believe we are basically defective, feelings that we are fundamentally unsafe develop. Our secure base is seriously compromised.

Those feelings are triggered in a part of the brain called the limbic system, which exists to monitor danger and to provide the tools for dealing with perceived threats. It is an extremely powerful and fast-acting structural network and if was not, we would soon be dead. Our fight-flight-freeze responses – all there to protect us – originate in the limbic system and they are activated by the five basic emotions: fear (through which we become aware of danger); anger (with which we can deal explosively and rapidly with threats); disgust (which, when triggered, prevents us ingesting poisons); sadness (loss of a loved one is perceived as a threat because we evolved as pack animals); and joy – the one positive emotion, which is an expression of the pleasure and sense of safety we feel when connected with the world and others.

The upshot of this is that if we feel we are in danger, the limbic system goes into overdrive.

We cannot relax. Any signal, however small, of abandonment, or abuse, or of defectiveness has to be countered by effort and that involves making sure that every aspect of what we do is ‘safe’.

How can this be treated? A vital step is to obtain an understanding of the root causes. In Caroline’s case, it gradually emerged that a significant factor was that her father – though otherwise very loving – never seemed satisfied with what she achieved. He regarded a ‘B’ grade in an exam as a failure and even an ‘A’ was not good enough unless she was also top of the class. Caroline often turned to her mum for reassurance, but instead, she sided with dad. The result was that Caroline first came to dread exams and then went into constant
overdrive to make sure she got the highest possible grades and left nothing to chance. She became locked in what felt like a desperate battle to prove she was not defective. A relentless drive towards perfection felt like the only way she could get love and affection from her parents.

Once Caroline became aware of the nature of the pressure involved, she could begin to see that as an adult, she could make her own choices about the amount of effort she wanted to expend on tasks, and could begin to experiment with dealing with day-to-day demands in a less stressful way, including that sometimes- and maybe even often – 70% is not failure.

Further information about unrelenting standards is contained in this You Tube video.

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.

Resources –

(1) Details changed to ensure client cannot be identified.
(2) https://moodle2.units.it/pluginfile.php/358466/mod_resource/content/1/2017%20Dweck%20PR.pdf

September 4, 2023 by BHP Leave a Comment

Cultivating a Tolerance for Uncertainty

The 13th century Persian poet Rumi invites us to wait in the unknown in his well known poem Guest House, to wait and see what transformations might occur.

This being human is a guest house.

Every morning a new arrival.

A joy, a depression, a meanness,

some momentary awareness comes

as an unexpected visitor.

Welcome and entertain them all!

Even if they are a crowd of sorrows,

who violently sweep your house

empty of its furniture.

Still, treat each guest honourably.

He may be clearing you out

for some new delight…….

Rumi (Guest House)

Psychotherapy invites something of the same experience as that which Rumi describes – an opportunity, a space, to sit with and pay attention to news from within. The more we sit with experience the more happens – new feelings , thoughts and perspectives emerge and shift and as time passes our tolerance for experience grows. When we pay attention to (rather than acting on) the many conflicting urges within, sitting becomes a different form of action.

Being right/ Being wise

An attitude of unknowing, whilst challenging when in search of solutions, might also protect us against false omnipotence. In a conflict with a partner it is all too easy to be convinced that you are right and they are wrong – to blame the other and exonerate oneself. The reverse might also occur. Either way aggression can turn against the other and/or the self. Misery and/or righteousness are quick to follow.

Like the universe though, we are mostly unknown to ourselves. Assimilating the fact that we do not know everything about ourselves or the other can help facilitate a condition of greater openness and humility. Becoming more interested in learning who (else) we might be requires a different attitude, an attitude of unknowing, wholly different to that of omniscient (although not entirely conscious) dogma with which we so often proceed. Our investment in being “right” will often do more harm than good. Cultivating a more exploratory appreciation of complexity is not a new concern – Socrates taught that much of what passes for knowledge is opinion. It is one thing to be right, it is another altogether to be wise.

My truth v your truth

In couples work in particular it is not unusual to witness people bludgeon each other with their “truth.” Whilst it is not difficult to take sides with truth against lies, realities are often far more complex, and thinking one’s truth is the truth is not truthful. In the context of couples therapy “truths” will often fly across the room like bullets from a gun. Weaponising truth, using it to distance and wound another might feel good in moments of high tension, but using truth to a more compassionate (productive) end means paying attention to how it is delivered.

Growth requires us to allow a space for ignorance in the face of knowledge. This can be difficult …particularly in a long term partnership where so often we are inclined to think that we know our partner better than they know themselves. Knowing ahead of time what is going to happen next is more often a defence against the intensity of experience….. (if we already know it then we don’t have to experience it). In the psychotherapeutic meeting we allow space for and pay attention to psychic realities… conscious and unconscious. It is possible to hold a lived experience and investigate it at the same time. When we experience life in the present we are also less inclined to become stuck in ruminating about the past.

To enquire about psychotherapy sessions with Gerry Gilmartin, please contact her here, or to view our full clinical team, please click here. Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

Further reading by Gerry Gilmartin

Understanding sexual desire

Reflections on freedom and security in a turbulent year

Reflections on getting back to normal

The Passage of Time and the Discipline of Attention

August 28, 2023 by BHP Leave a Comment

Subjective Perception, Shared Experience

Nel Tuo Tempo…….In Your Yime

The artist Olafur Eliasson’s exhibition ‘Nel Tuo Tempo’ was described as addressing the ‘subjective perception and shared experience’ of a Florentine building.

He did this using light, colour and shadow. Some of the twenty exhibits were complex structures, others were more about how we see the building in which the exhibition was staged. In one room, a series of lights outside the building cast shadows of the windows on an adjacent surface, be it a wall, floor or screen. The windows were high on the wall, but the shadow was right there in front of us. Detail that wasn’t possible to see in the window became crisp and clear in the reflection and shadow. The minute particles in the glass were visible in a way that was impossible to see without the artist’s intervention.

Artistic works can resonate with us emotionally in ways that are unexpected. These exhibits not only provoked an emotional response, but also raised question about what we could understand about the fabric of the building.

Moving between detail

Psychotherapy is about how we experience and relate to our emotions and that through our emotional world we can gain insight into the ‘fabric’ of ourselves. We begin thinking about how we feel now, what is going on in our world and how we relate to it. The gentle exploration of emotions, history and our lived experience gives a sense of what makes us who we are. Like the exhibits in the museum, we can be curious about so much more than what we see.

You could observe people moving in close and seeing the details of the glass panels, then standing back and looking at the window as a whole felt. This felt like moving between detail in a similar way to how we move between thoughts and feelings during psychotherapy. The detail of daily life, which puts emotional demands on us, alongside a wider view of life and history, shifting between thoughts to build a complete picture. Like the artist does, it’s about creating a space in which we can be curious about what is there and what is less easy to see, moving from what is subjective into something shared. Asking ourselves if it’s possible to not fully understand and remain curious.

Subjective Perception, shared experience

The connections and considerations of psychotherapy and art are numerous and much commented on. This exhibition brought to mind the fact that both art and psychotherapy can give us a much greater insight into our emotional world, by moving beyond what is seen and what is not seen, but is felt. It can also reveal some of how when we engage with certain art works, we also mirror what goes on therapeutically between the practitioner and the client. Shifting between detail, emotions and understanding, the subjective perception becomes the shared experience.

Psychotherapy is about moving from the subjective to the shared. Being heard and seen as a means of gaining a deeper understanding of who we are and our relationship with our selves and those around us.

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove . To enquire about psychotherapy sessions with David , please contact him here, or to view our full clinical team, please click here.

Further reading by David Work –

In support of being average

Collective grief

The challenge of change

Thinking about origins

Bridging Political divides

August 14, 2023 by BHP Leave a Comment

Are we Becoming more Narcissistic?

We are living in the age of narcissism – or so the media would like us to believe. People in The West seem to be focussed largely on themselves and the pursuit of happiness – the answer to which for increasing numbers of the populace is to be found in the soundbites of TikTok celebrities or from the wisdom of other social media ‘influencers’.

But are we collectively becoming increasingly narcissistic and what does this mean?

In my last blog I dispelled some of the myths around this condition and explained rather than it being a description for a set of behaviours, it is a personality style and in its more rigid manifestations, a debilitating one from a relational perspective. I shall therefore not be revisiting all that again and you can read my in-depth blog on what narcissism actually is here.

The argument that behaviour tells us anything much about a person’s personality structure – particularly when it comes to narcissism – is naïve and reductive.

Changes in behaviour online

We know that people behave differently in online interactions as compared to when they are face-to-face with another human being. It is the actual, as well as the perceived distance, from the other’s humanness that seems to give many licence to behave in selfish and thoughtless ways.

Whenever we cease to view the other as human and objectify them, we are not acting relationally as the very word ‘relational’ implies a willingness to understand another’s perspective and to be able to tolerate difference, even if we don’t much like their views.

Is modern man (and women) less able to tolerate differences than prior generations? I am not so sure. What I do know is that the internet, and specifically social media, provides platforms to both those who rather like the sound of their own voice (but arguably have little actual wisdom to impart) and it provides a huge scope for attracting an audience.

Where not so long ago an individual may have believed that they held the key to a successful life (whatever that means), they may have attracted a few lost souls in their tribe, village or town. Now, with expert ‘curation’ of their message and image, they can reach the whole world.

On narcissistic personalities

Behaving in a selfish or egocentric way does not mean that someone is a narcissist. Certainly narcissists can be grandiose, self-centred, entitled and enjoy the sound of their own voice, however we can all at times behave in this way.

Narcissism is a personality style, and we all have a mix of personality styles, generally with one or two that dominate a little more than others. If someone has a narcissistic personality then this particular style of personality is dominant and can be viewed on a continuum (of rigidity) from pathological through to personality disordered.

In psychoanalytic theory, clinicians view these personality styles as being primarily laid down by our early infant and childhood experiences (generally up to around the age of two).

Someone who has a narcissistic personality has not been related to as a separate individual but rather has learnt from a very early age to adapt their behaviour to the needs of their caregiver. In essence, they have internalised the message ‘do not exist’. As a result of learning that their role is to meet the needs of others (their primary carers), the child in question develops a ‘false self’ to compensate – they present a front to the world suggesting that they are perfectly fine.

Beneath this front is a vulnerable child who cannot show his or her feelings for fear of abandonment by the parent. For narcissistically structured people, others – relationships – are a major problem. They need others, however, they also profoundly fear being used or ‘taken over’ by others and so to defend themselves by objectifying those around them. Relationships are about doing or being done to, rather than love.

How might this apply to the collective?

My sense is that it is unlikely that there is now a sudden increase in parents who are failing their children and raising narcissistically structured personalities. However, as the old adage goes, ‘it takes a village to raise a child’ – no child is solely influenced by their parents.

The clinical research would suggest that we are not becoming more narcissistic in terms of personality style, however, what has exponentially changed are two major factors: we have lost collective meaning because the world is changing too fast for us to cultivate and uphold meaning, and secondly, technology is playing an all encompassing role in dehumanising us.

The role of meaning

Human beings are meaning making creatures and we live in a symbolic universe which is probably what renders us unique amongst animals. I have previously written a piece on the role of Culture and the need for belonging in enabling us to have healthy self esteem, which you can read here.

Essentially, as traditional values and means of making meaning either fall away or are dismantled, we are left with two problems: higher anxiety and less collective means of gaining self esteem.

This may then cause us to both behave in more individualistic and hedonistic ways to feel alive but without substance – we deny our vulnerability by becoming more narcissistic.

The role of technology

We are at the start of a technological revolution where only our imagination can predict what the world, and by extension, our relationship to it and others in it, will look like.

Technology is not intrinsically good nor bad – it depends on how we use it. And to date how we have used it is in a rather dehumanising fashion. Convenience has trumped connection and this can be seen in the proliferation of parasocial relationships (where we have relationships with influencers or YouTubers and believe they are real and personal, when they are in fact one-way), and the evolution of dating through online apps whereby we have commoditised ourselves.

On the symbiotic relationship between Echo and Narcissus

The origins of narcissism were taken, largely by Freud, from the 2,000 year old myth written by Ovid. This Greek myth – a myth being a story that reflects a collective truth – is entitled ‘When Echo meets Narcissus’ and whilst most people are to some degree familiar with the myth, it is often misconstrued: many believe that Narcissus fell in love with his reflection in a pool of water; And few even know of the role of Echo.

Narcissus is someone who is admired by all and who cannot tolerate intimacy. Echo, meanwhile, is a river nymph whose voice has been taken by Juno, the Goddess, for gossiping. Echo can therefore only repeat the last words she hears.

This is how the stage, and the symbiotic relationship, between Narcissus and Echo is set both on the myth and for all time: Narcissus needs Echo just as much as Echo needs Narcissus but neither can have a relationship with the other – they are in symbiosis.

Returning to the question of whether technology and specifically how online relationships are being shaped is rendering us more narcissistic, if it is it is, it also rendering us more like Echo – willing to sacrifice our voice to be in the shadow of those we admire; we believe that there is a relationship happening but there simply is not.

Narcissistic people need echoists; we are collectively responsible for admiring those who need to be admired rather than having something of substance to offer. Human beings are adaptable to our environment – it is why we have been able to colonise every corner of the globe. Equally, we absolutely need relationships, as we are shaped and formed not only in childhood by relationship, but throughout our lives.

My view is that as a result of a combination of both a loss of meaning and the ease of online interactions, we dehumanise both ourselves and others and thus become more narcissistic, or at least egocentric. However, unlike those with true narcissistic personalities, it is reversible and as a clinician I know only too well the power of change that comes from a therapeutic relationship.

Further reading by Mark Vahrmeyer

What is a narcissist?

The medicalisation of mental distress

Client or patient; patient or client – does it matter?

The psychological impact of the recession

July 31, 2023 by BHP Leave a Comment

What Psychological Processes make us ‘Choke Under Pressure’?

It is a process whereby our bodies experience environmental stressors as a threat to our physical survival, thereby releasing stress hormones such as cortisol and adrenaline. This is an essential part of all mammal’s fear or threat response, which has become maladaptive in the modern world, as the threats we experience in modern life often do not require us to fight or flight, but rather be calm and think. The threat response, or ‘fight/ flight/ freeze’ responses draws on a more primitive part of the brain which shuts down all other systems to gather its energies and resources to survive danger. This means that our more evolved thinking and reflecting part can’t be accessed either.

Are some individuals more prone to ‘choking under pressure’?

Some people have this survival system more activated than others. Usually this is linked to having experienced more emotional, psychological or physical threat and danger in childhood, when the brain is still developing. These individuals can end up perceiving life as dangerous a lot of the time. There are also certain triggers for chocking under pressure, such as a major past event or failure, a significant poor performance in a certain area which has led to loss of confidence, or certain negative associations. It could also be that a person is experiencing a lot of stress in their present life and therefore the resources for good performance just aren’t there.

How can we prevent ‘choking under pressure’?

Usually by gradually increasing exposure to situations which are perceived as threatening and checking these against reality. The idea is to challenge our false perception of certain situations. If your threat system is often activated, then I would suggest working with a psychotherapist on past traumas that are being re-activated by present events. Increasing self-confidence in certain areas, challenging negative self-belief and self-perception, and also teaching your body to relax through breathing and other activities that help regulate your emotional system. By increasing the focus on the task at hand, rather than on the outcome, takes focus and a calm state of mind. All of these tools can help either in isolation or in combination, depending on how bad the “chocking “ and how often it occurs.

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

Further reading by Sam Jahara

Finding Contentment in the Age of Discontent

Having Healthy Conversations with Men about the Menopause

What causes low self esteem?

What causes low self esteem?

July 10, 2023 by BHP Leave a Comment

Having Healthy Conversations with Men about the Menopause

The menopause is an important life transition for women. In more recent years there has been more awareness about the menopause, meaning women are more willing to talk about it with each other and their partners. The question is what is the best way to talk about the menopause with your partner, formerly still a taboo topic and one much associated with shame for many women?

As with any conversation about life transitions, creating time and space for these conversations is always a good start. When both partners feel relaxed and more receptive usually conversations flow more easily.

Then it is important that there are feelings of trust between you and your partner from the start. It is going to be difficult to talk about things that make you feel vulnerable if you don’t feel that your partner is someone who is able to support you emotionally.

It is also good to know what it is that you want to say and what you would like to gain from the conversation. Would you like your partner to have more understanding and awareness of what you are going through, leading to them being more supportive? Or maybe there are more specific things that you would like from them? In a way, talking about the menopause is no different than talking about other bodily changes such as hormonal changes during pregnancy, PMS, etc. Men don’t go through the same hormonal cycles as women, and unfortunately historically this has been seen purely as women’s domain, to be kept amongst women only and mostly hidden. We still live with this legacy today.

It is also good to be realistic – it is unlikely that your partner is going to be able to fully understand and appreciate what you are going through. Every woman is different and therefore will be in a different journey with the menopause. The uncertainty of what our bodies are going to do is a part of this, and therefore one that your partner needs to be aware of.

To share how you feel and what you are struggling with should be a part of any couple’s dialogue. To get skilled at talking about bodily changes, such as fluctuations in sex drive, hot flushes and fatigue, or mood changes such as feeling more energised and creative, less tolerant, etc., are all a part of improving one’s relationship and something that needs to be done jointly. It could be that as a couple you will need to seek help from a therapist to have these conversations, or it could be a matter of trying it several times to see what works and what doesn’t.

The menopause is another transition in the life of a woman and in the life of a couple. Ignoring this or being in denial is not going to be helpful to you or your partner. Having these conversations, even if it feels imperfect or clumsy at first could lead to more intimacy and appreciation between you.

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

Further reading by Sam Jahara

Finding Contentment in the Age of Discontent

The psychology of mindful eating

Defining happiness

July 3, 2023 by BHP 2 Comments

What is Narcissism?

Since the time of Sigmund Freud, clinical terms around psychology have made their way into everyday language. Narcissism is no exception to this and yet it stands in a category of its own for both how ubiquitous it has become in popular culture, alongside also being so misunderstood.

Frequently used as a term of insult or abuse to describe someone who displays little regard for others, narcissists are defined in society by their outward displays of behaviour. However, for a ‘condition’ that evokes so much of a backlash, collectively we seem to secretly admire the fantasy life we attribute to narcissists and envy the way they glide through life unaffected by the trials and tribulations of us mere mortals. Narcissism and narcissists are envied and denigrated in equal measure.

Alongside the ubiquity of the term, there is no shortage of material available to enable us to navigate a world filled with narcissistic others. From podcasts to YouTube seminars, TikTok videos to old fashioned books, narcissism is everywhere. Many titles suggest an extreme danger or risk of being near or around narcissists with titles such as ‘surviving narcissism’, ‘narcissism epidemic’ and ‘defeating narcissism’ being common. And yet most of these resources fundamentally fail to understand the essence of narcissism and what constitutes a so- called ‘narcissist’.

Indeed, it is interesting that of all the personality styles, such as depressive or obsessive-compulsive, it is this personality style that has become a label for the entire human being: rather than having a narcissistic personality, people are simply labelled as narcissists.

Popular culture
In recent years few clinical terms have been adopted and taken on a life of their own outside of the clinical context above and beyond narcissism.

When popular culture references narcissism or labels an individual as narcissistic, this is generally based on witnessed behaviour, rather than on any deeper understanding of what may have driven that particular behaviour. Popular culture is not wholly to blame for this as the field of mental health has for years been steadily shifting to diagnosing and labelling based predominantly on outward behaviour, rather than from an understanding of personality dynamics.

The problem is that the word that in a clinical context is used to describe traits or the style of a person’s whole personality, is being used as a description of behaviour – ‘he is behaving really narcissistically’ – which may or not have anything to do with the person’s personality; the behaviour tells us very little. In fact, I am not really sure what ‘behaving narcissistically’ even means!

It is not that there is no truth to the ‘watered-down’ formulation of narcissism in the mainstream, it is just that like so many other mental health terms, the nuance and balance has been lost, not least in the context of the ‘narcissists’ experience of being this way. Fundamentally, what’s lost is empathy.

Narcissism is not an illness, it is a personality style
I would suggest that the psychoanalytic field provides us with the most accurate understanding of narcissism and its impacts, as rather than focusing on external patterns of behaviour, psychoanalytic theory considers both the inner world of the patient – what it is like to be them – and their relational world – how do they relate to themselves and others. In other words, when clinicians talk about narcissism they are referring to a particular type of personality that has ‘narcissism’ as its dominant style.

What is a personality?
Personalities are something we all have and whilst we generally have a mix of styles, most of have a dominant one. So, when we consider somebody’s personality style, we are thinking about what trait is dominant and how rigid their personality is – this can be imagined as a scale from healthy functioning, through to personality disorder (and just to further muddy the waters, there is little agreement on at what point someone is personality disordered).

However, there is a further complication when considering narcissism: narcissism like all more dominant personality styles, one that has come about through relational injury during the first two years of development. It rarely appears in isolation to other personality styles and the other main personality styles frequently, if not always, show elements of narcissism in their foundations. It is therefore not always easy to spot.

What are the traits of a narcissistic personality style?
Most people who have a narcissistic personality present outwardly as grandiose, entitled, selfish and are constantly looking for external validation. However, what presents externally as grandiosity belies an internal world characterised by a deep sense of inadequacy and fear.

People with narcissistic personalities fear ‘being found out’ – they fear intimacy and vulnerability as they imagine everyone will see what they see: that they are unlovable.

There exists in the narcissist a constant drive to shore up their fragile self esteem through the external world – what they buy, who they are seen with, what they achieve. Whilst we all garner external validation to some extend in these ways, most of us have a solid enough sense of self to hold onto a real sense of self esteem that does not need scaffolding.

When it comes to relationships narcissistic people face an enormous dilemma as they desperately need others – to both tell them how wonderful they are, as well as to avoid their primal feelings of abandonment. However, they cannot relate in a two-person manner, meaning that whilst they need greatly, they love shallowly.

Narcissistic people protect themselves at all costs against ‘narcissistic injury’ which comes about when their feelings of shame are triggered. And feelings of shame arise when narcissistic people are challenged or called out – it is unbearable for them and they respond with shame which is transformed into rage. This holds the key to why narcissistic people cannot have real relationships: they cannot content with difference which is what we encounter when we are in a real relationship with another ordinary complex human being.

There is one other ‘type’ of narcissistic style which often gets missed in clinical diagnoses and that is the depressed, or collapsed, narcissist. On the face of it this person would seem to be the opposite of the grandiose narcissist and this is in fact correct! However, what looks to be collapsed, depressed and an outward expression of worthlessness, hides an inner world where this character feels utterly entitled to far more than they have and are. They are rageful that the world has treated them in this way and secretly feel entitled to specialness.

Final thoughts
Narcissim is a complex topic to grasp and even clinicians often struggle to fully make sense of whether someone if a narcissist or not.

One of the problems is that people with this structure tend not to present for psychotherapy and if they do it is never because they feel ‘narcissistic’. It is therefore not a condition that is in their awareness.

There are no dependable tests to check for narcissism and just because someone behaves in selfish or egocentric ways, it tells us nothing about their personality structure – after all, can’t we all be selfish at times?

Ultimately, a skilled clinician works out through the therapeutic relationship whether someone is narcissistic. It is a combination of understanding the clinical theory as well as relying on their felt experience. Being in relationship with a narcissistic personality does not feel like an ordinary relationship. They may greatly need you or ‘brush you aside’, or a combination of both but what they cannot do is relate in an equal two-person manner. Their vulnerability and humanness is hidden for fear of shame and abandonment – the narcissistic injury.

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.

Further reading by Mark Vahrmeyer

The medicalisation of mental distress

Client or patient; patient or client – does it matter?

The psychological impact of the recession

June 26, 2023 by BHP Leave a Comment

Finding Contentment in the Age of Discontent

The official definition of contentment is “freedom from worry or restlessness: peaceful satisfaction”. I would define contentment as a state of inner quiet and peace, and a satisfaction with oneself and with life. This is not linked to material satisfaction, which is usually temporary and unsubstantial, but more of an acceptance of who one is and a coming to terms with choices and situations in one’s life. This is usually linked to how a person perceives themselves, others and the world. One example would be the ageing process. Some people may struggle with getting older, and all the changes that our bodies go through. Others may see ageing as a natural process and one that can be embraced and even enjoyed.

How can we practice contentment in our everyday life?

As said above, contentment is linked to how we perceive ourselves and others. Freedom from worry or restlessness comes by cultivating patience and working on how we perceive things. It is also linked to an ability to trust in oneself and those who are close to us. Building and maintaining good relationships, spending time in nature and engaging in meaningful activities are some ways of achieving contentment.

Can external factors (politics, economy, capitalism etc) affect how we can feel content?

Contentment may sound like a luxury when there are serious external factors affecting our survival. However, if our basic needs are met and there is no imminent threat to our life or livelihood, contentment can be cultivated and maintained despite the ups and downs of political and economic factors. Contentment comes from within, so although external factors impact how we feel about the world and ourselves within it, it is also important to hold the bigger picture in mind and remember that we live in an ever changing world with no ultimate guarantees or certainty. I have seen people who are very content and live with very little under difficult circumstances. I have also seen people who have everything they can wish for materially but live in a contact state of anxiety and worry. This is not to say that environmental factors do not impact the way we feel and I believe that improving social and political factors can and will lead to a better society with is happier generally.

Feeling contentment in a materialistic world

I hope there is a movement towards prioritising contentment over material gain, however the rise in inequality around the world tells a very different story. Maybe there are certain sections of society who are able to make the changes they need in order to live better lives. Mental health has been in focus for a while now, and some people are realising that living a stressful life comes at a high cost.

If you want to cultivate contentment…

Start looking at what causes you discontent. Then look at these feelings in some depth – are these feelings about self-perception or external changes that you need to make? Work towards cultivating qualities and activities that lead to more contentment. And finally, simplify your life.

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

Further reading by Sam Jahara

What causes low self esteem?

The psychology of mindful eating

Defining happiness

What are the benefits of counselling and psychotherapy?

June 19, 2023 by BHP Leave a Comment

The Medicalisation of Mental Distress

The foundation of the paradigm shift in how we now view mental health, or as I prefer to consider to consider my field, emotional distress, is one where the problem is increasingly located in the individual as a disorder, rather than in the environment that the individual finds themselves.

The inception of this paradigm in thinking began with the publication of the third version of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) produced by the American Psychiatric Association (APA) which had a specific focus on meeting the needs of a wider clinical audience in the field of mental health. It was never specifically intended as a guide to clinical treatment and despite the introduction of specific clinical categories, there was an assumption that prior clinical wisdom across the field would endure, however, in practice it was the clinical categories that took precedence.

In no other field of medicine – which is the direction that mental health has taken – is symptomatology clustered together as it becomes fundamentally unreliable and invalid in understanding what may bring about a syndrome, condition, or as the DSM prefers to refer to it – a disorder.

For example, how mental health disorders are clustered is based on symptoms and were this to be replicated in the field of physical medicine, we would have groupings of ‘fever disorders’, ‘limp disorders’ or ‘headache disorders’ – an idea that would be absurd and yet is the basis for psychiatric classification.

The reality is that there is no consensus in psychiatry about what exactly causes ‘disorders’ and yet the list of disorders continues to grow with every revision of the DSM and with it more and more ‘disorders’ become both labels and terms of abuse in popular culture – after all the problem is now firmly located in the individual. We have seen an explosion of disorders from around 106 in the 1970’s through to 365 in the latest incarnation of the DSM (DSM-V)! And, not only has the number of disorders increased exponentially, but in parallel so too has the bar been lowered at which point a patient qualifies for having a particular disorder.

In clinical practice we now see the normalisation of these disorders with patients using disorder terminology to ‘self diagnose’ so rather than presenting for therapy with a statement such as ‘I notice that I feel very shy in social situations’, we are increasingly presented with statements such as ‘I have social phobia’. The problem with this is that it can serve to eradicate curiosity around why a person may feel shy in certain situations and inherently positions them as ‘wrong’ rather than suggesting a position of openness towards how this may be adaptive behaviour learnt during childhood.

Under pressure

The profession of psychotherapy is increasingly under pressure to comply with this new world of diagnostic criteria in that the language has been adopted by general practice in medicine, public health and by insurance companies. The latter meaning effectively that patients cannot get psychotherapy sessions reimbursed without a patient meeting the criteria for a disorder.

Arguably what has underpinned this shift in the field of mental health is how the sector has responded to meeting the needs of the economy, rather than those of the sufferers. The focus of public mental health and overarching classification system for psychiatry has shifted from being patient centred to being directly linked to economic productivity.

An example o this is how in the UK, The NHS’ mental health initiative ‘Improving Access to Psychological Therapies’, now renamed Talking Therapies for Anxiety and Depression has its foundations in getting people back into work. Whilst there is nothing intrinsically wrong with a drive to enable people to return to the workplace, in many instances it is a normal human response to environmental stressors that lead a person to feel anxiety or depression. This is the crux of the schism – are mental health disorders located in the individual and therefore indicative of a failing or are they responses to the external environment?

Suffering has been turned into a commodity

The problem is located in the individual rather than seen as an adaptation to past or present environment. This eliminates both a capacity for curiosity as to cause and blame – a person simply has a disorder. From a macro systemic perspective governments can provide a health service that treats’ the problem in the individual rather than consider how societal issues lead directly to emotional suffering – mental health problems.

Secondly, the industry that benefits from the drive towards specific disorders located in the individual is the pharmaceutical industry, which, despite there being little to no evidence of increased efficacy in psycho-pharmacological treatments over the past 40 odd years, This question pervades all types of emotional suffering and the past well-trodden path of linking emotional suffering with a broader and deeper developmental, social and economic narrative is being cast aside in favour of a diagnostic super-highway with disorders based on symptoms and neat psycho-pharmacological solutions. Essentially the invitation is to disconnect the threat response from the threat; to increasingly shift away from asking ‘what’s happened to you?’ to simply ‘what’s wrong with you?’

Further reading by Mark Vahrmeyer

Client or patient; patient or client – does it matter?

The psychological impact of the recession

Why do people watch horror movies?

June 12, 2023 by BHP Leave a Comment

What Causes Low Self-Esteem?

Low self-esteem stems from beliefs that we have about ourselves, a negative self-evaluation which is usually rooted in childhood experiences. The way we were spoken to, treated, and made to feel as children has a significant impact on how we see and therefore relate to ourselves later in life. Some of us may also have grown up with parents who were not very confident and had low expectations of themselves and their children. Social class, culture, race, gender, sexuality, and disability are also societal and environmental contributing factors to how we self-evaluate.

Knowing where negative self-belief and low confidence comes from is the first step in effecting change. Feeling things that we don’t understand can be confusing and cause anxiety and depression, further perpetuating negative self-belief. The next step would be to begin challenging these beliefs and check them against the reality of your life and achievements, skills, etc. Many of the beliefs we carry are just that: thoughts about ourselves that do not match reality. This can lead to perpetual feelings of failure, regret or agonising about every small decision for fear of making mistakes. Some of these feelings can be debilitating and hold us back from moving our lives forward with confidence in our decisions.

Awareness of negative self-talk is also useful in that we can choose to gradually replace this self-talk with more positive inner dialogues. Sometimes people are surprised at how much time they spend being self-critical. The way we think has a direct impact on how we feel, therefore it is important to work on these issues.

How Relationships Affects Self-Esteem

Cultivating positive and healthy relationships is essential in gaining more confidence. A sense of belonging and acceptance comes from a variety of places, but the main place that it comes from is relationships. Therefore, being in relationships that don’t make you feel good about yourself, where you are badly treated, taken advantage of, etc is only going to make you feel worst about yourself. This includes both personal and professional relationships.

The definition of a healthy relationship is one where there is mutuality and exchange of support, ideas, validation, trust and honesty. The more we base our relationships on these principles, the stronger they will grow. Sometimes low self-confidence can get in the way of building relationships or seeking career opportunities for fear that others will think that we have little to offer. Again, challenging these beliefs and checking them against reality can help us to start to behave differently, take more risks and challenge ourselves in a good way.

In Psychotherapy we work with the root causes of low self- confidence, for instance how early relationships have contributed to the beliefs that we have about ourselves today, and then gradually replacing these with more helpful and realistic beliefs about who we are and what we are capable of. This usually leads to making better choices in life in the areas of work, relationships and health.On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

Further reading –