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Poetry: A space to ponder

How many of us feel we don’t want to be known beyond what we present to the world and are relieved when our presentations are not tested? When we’re not found out.

The poem below by the American poet Jane Hirschfield, is an uncomfortable look at our response when we read about the shameful acts of others. Is it relief? Is it pleasure? Is it confirmation that we have maintained a reassuring surface?

For Horses, For Horseflies

We know nothing of the lives of others.
Under the surface, what strange desires,
what rages, weaknesses, fears.

Sometimes it breaks into the daily paper
and we shake our heads in wonder –
‘Who would behave in such a way?’ we ask.

Unspoken the thought: ‘Let me not be tested’.
Unspoken the thought: ‘Let me not be known’.

Under the surface, something that whispers.
‘Anything can be done’.

For horses, horseflies. For humans, shame.

The last line is curious and makes a comparison between horses and their experience of horseflies and human beings and our experience of shame. Perhaps it asks a question about an ever-present sense of shame that we might share. An irritation that occupies the space between human fallibility and the drive to be civilised. Rosanna Warren says Hirschfield’s poetry invites us to pause ‘our fast-forward habits of mind’ and ‘clear a space for reflection and change’.

Quotes from Warren’s award citation for Hirshfield’s 2004 Academy of American Poets’ Fellowship.

 

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

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

What is Andropause and what happens to men when their testosterone levels decline?

Am I cracking up or is it my hormones? Pre-menstrual Dysphoric and the importance of tracking symptons

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

New Year’s Resolutions – Why change might be so difficult?

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Name That Tune

How can an old parlour game help us reflect on the way we communicate? Quite a lot it would seem.

Many of us will have played the game where we tap out the rhythm of a tune or song and ask our partner to guess the name of the piece. The challenge for the person doing the listening is that they have to use only limited information (the rhythm) to piece together something much more complicated in its whole. It is a different story for the person tapping out the rhythm. For them, the whole tune is in their head and it seems obvious that what they are hearing (in their head), is also what is being heard by the recipient.

In a study using the game to explore expectations in communication, over 90% of the people tapping the tune expected the recipient to guess correctly – some admitting to be dumbfounded that their recipients could not understand them. Sadly, this expectation was not matched by the results, where only 14% of recipients managed to guess the tune correctly. Imagine the frustration on both sides!

The fact that the large majority (over 9 in 10) of the tappers (as we will call them), felt they had supplied all the information required for their message to be understood, makes a useful reminder of the difference between the message we think we are communicating and the meaning that is created by the recipient. It is interesting that in the study of the exercise referred to above, the recipients did not just say they didn’t know the answer – over 8 in 10 of them named a tune they were sure was correct even though it was often some distance from the one in the head of the tapper. In other words, they created a meaning from the message which was quite different from the one being communicated by the tapper – which, of course, led to even more frustration: ‘How could you possibly misunderstand that? It’s so obvious!’ Worryingly, when it comes to communication, what seems just so obvious to us, can lead to confusion or misunderstanding for those on the receiving end.

The tapping game might also make us reflect on just how limited words can be when it comes to communicating the thoughts and feelings we carry. Like the complex melody, much of the nuance may be lost without access to the pitch, timbre and colours which make up the detail. As humans, we are meaning-seeking creatures. If there are gaps in our understanding, we will fill them in an effort to make sense. But in those fillers, we often go awry – gloriously so in many cases, which is why metaphor and symbolism can be such fun – but awry, nonetheless.

It takes a lot of work to be really understood and a great deal more to understand fully. But when we feel anger or frustration at others for not getting our message, or when we deal with similar feelings when our friends or partners never seem to appreciate our understanding, we would do well to remember that the gap between what is being communicated and what is being understood is considerably wider than what might at first appear.

 

Kevin Collins is a UKCP registered Psychotherapeutic Counsellor with an academic background in the field of literature and linguistics. He worked for many years in education – in schools and university. Kevin is available at our Lewes Practice.

 

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

 

Further reading by Kevin Collins –

I never thought my son would be addicted to pornography

Why is it hard to make decisions?

Communication, communication, communication

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Football, psychotherapy and engaging with male clients

I recently read that an English professional football team has a resident psychotherapist. Whilst the connection between clinical psychology and sporting outcomes is well established, having a team psychotherapist is something new. The therapist explained that they’re there to support the players, coaches and a team of staff through the emotional highs and lows of the professional game. Scoring goals isn’t the sole focus of the role, but it’s hoped that a happy and supported team will be more likely to score.

I read this not from a football supporter’s perspective, but from that of a therapist who is always mindful of how we engage with clients, especially men. There is no secret that men are less likely than women to engage with psychological services. Men are also more likely to hold gender based beliefs as to why they shouldn’t be sensitive to their own mental health.

The football team therapist spoke of how the engagement with players was less formal that traditional psychotherapy and could be anything from a few minutes chat to a longer session. It seems that being understanding and sensitive to the schedules of the players and being flexible around this, worked best for all parties.

Debating changing styles of therapy is a whole other discussion but it does make me question how greater engagement with men might be based on challenging concepts of masculinity whilst not taking men out of their own understood gender roles. In effect to reframe masculinity in a way that still feels masculine.

As a trainee therapist being in your own therapy is a requirement. The experience of being a client is something that shapes how we are as practitioners. The understanding of what it’s like to explore your own mind and how you can gain a deeper understanding of yourself can feel like a huge luxury. It can also feel like the most anxiety inducing and impossible task when you feel your own vulnerability in the face of another. As a trainee male practitioner this was the moment when I began to understand that I held many gendered views of what men did and didn’t do and how could I shift my perceptions without losing my own sense of my gender.

As therapists we are well aware of the challenges when clients begin to explore and think about their feelings. Knowing how that can feel for us we can empathise and think with them. When this is seen through a series of deeply held beliefs around gendered roles it can feel impossible. Here a myriad of gendered terms about ‘men not crying’ and being a ‘strong, silent type’ spring to mind. Is it any wonder that men can struggle to acknowledge, let alone engage with thoughts about mental health when there is so much messaging that it isn’t ‘masculine’?

Reading about a football club with a psychotherapist felt very positive. It wasn’t only an interesting article, but it very gently reminds us that attitudes towards men’s mental health, are changing. If the knowledge that a football team are supported and as a result successful by being sensitive to their own mental health it sends a subtle, yet positive, message. This can only be a good thing for helping men to think that being aware of their own mental health is not challenging their sense of their own masculinity, it is merely offering a different perspective.

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

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 –

When Home and Work merge

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‘The Wisdom of Trauma’ a film by Gabor Maté – A Critical Review

Both the name, Gabor Maté, and the word, trauma, have become synonymous and ubiquitous in recent years.

Dr. Maté is a Hungarian born physician and author of ‘In The Realm of The Hungry Ghosts’, which was first published back in 2008 and offered a compassionate and insightful understanding of addiction as a response to trauma. Since then Dr Maté has steadily risen to fame as an addiction and trauma expert. He has now released a documentary film entitled ‘The Wisdom of Trauma’, which was brought to my attention by a couple of my clients. I decided to watch it.

The film follows Dr Maté on his journey of defining trauma, most specifically, childhood developmental trauma (CPTSD) and covers his work and learnings from treating street addicts in Vancouver’s Downtown Eastside.

As a mental health professional and clinician, I am all in favour of any well-researched productions that aim to highlight the impact of CPTSD, educate the masses and ideally bring about change at a societal level in how we conceptualise trauma and treatment. I therefore had high hopes for Dr Maté’s oeuvre. Sadly, as the film progressed, I because increasingly uneasy with the content and was ultimately left with the impression that the film was more about glorifying Dr Maté and his self-professed ‘new’ trauma informed approach to treating trauma, than a piece of work aimed at bringing together the teachings and learnings of many clinicians over the years on whose shoulders Dr Maté, like the rest of us, stand (see Alan Shore, Babette Rothschild, Pat Ogden, Steven Porges, Antonio Damasio, Daniel Siegel to name a few).

There is a powerful sequence in the film filmed in a prison where Fritzi Horstman, founder of the Compassion Prison Project, undertakes some meaningful work with inmates based on the ACE principles (see Adverse Childhood Experiences study 1995 – 1997, conducted by Kaiser Permanente). The work of the Compassion Prison Project is clearly meaningful, research based and healing, however, the link between this project and Gabor Maté remained at best utterly unclear and secondly, there was no reference to the original ACE study and the importance of it so viewers were left in the dark around context and thus perhaps invited to imagine that this was somehow connected to Dr Mate. To be clear, the ACE study has nothing to do with Dr Maté.

As the film progresses, Dr Maté moves into sharing his experiences of healing through the use of psychedelics, namely Ayahuasca, with footage shown of a ceremony taking place in Peru. The study of psychedelics and their possible use in treating mental health problems is in its absolute infancy and the research being conducted is done so in strictly controlled environments where participants combine the use of medical doses of psychedelics with psychotherapy – no mention was made of this. Whilst promising in specific clinical settings (as opposed to the Peruvian rain forest) and for specific applications, psychedelics can potentially do more harm than good,
particularly for patients with weak egos or personality disorders. There also remain valid questions about the long-term benefits of psychedelics in treating trauma, with most studies showing that symptoms tend to return over time once psychedelic use was suspended (generally 6 months to a year).

There is then a sequence wherein a man in his early 50’s with a stage 4 prostate cancer diagnosis appears to enter into remission through therapy with Dr Maté with the implied cause of his previously terminal illness being put down to trauma. I am a clinician who profoundly believes in the body-mind connection as have many more learned clinicians before me (see Winnicott and psyche-soma integration), however, whilst our emotions are experienced through the body and the ACE study has shown correlation between adverse childhood experiences and illness,
correlation is not the same as causation.

Finally, there are numerous sequences where Dr Maté is conducting his own brand of ‘trauma informed therapy’ which he suggests is in some way unique and the way to heal trauma. And yet again, trauma informed therapy is neither a new phenomenon nor something that has been invented by Dr Maté; indeed, any well-trained and experienced psychotherapist who works with trauma (and we all do), should be educated in understanding the presentation and defensive structures around CPTSD.

The message of the documentary – a trauma informed approach to healing society as a whole – is a positive one and yet despite his profile, I was disappointed to see how Dr Maté fails to engage and influence policy makers, educators, physicians and mental health professionals and actively seems to undermine his own message through an irresponsible focus on psychedelics, terminal illness being healed through trauma talk-therapy and a guru-esque approach to practicing his own therapeutic approach.

The sad reality of relational trauma is that it occurred in relationship and so can only be treated and worked through in relationship. And working through is not necessarily the same as ‘healing’.  Good psychotherapy is painful and slow and the main reason it takes time is because the traumatised part of the patient (client) needs to overcome resistance and form a dependent relationship on their therapist; thus the client dictates the speed of therapy.

The Wisdom of Trauma seemed to me to subscribe to an all too common narrative of recent years – there is a ‘fix’ for everything and it can be quick. This is not my experience of working with trauma and nor is it that of my clients, many whom learn to live with their trauma rather than somehow leave it behind. Perhaps a better title would have simple been: ‘The Wisdom of Gabor Maté’ as the documentary was essentially about him and his views, despite the enormous work in this field undertaken by the likes of Freud, Winnicot, Bowlby etc., all the way through to ordinary
psychotherapists like myself and all my ‘ordinary’ colleagues.

 

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

 

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 Wisdom of Trauma’ a film by Gabor Maté – A Critical Review

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

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Is a Therapy Group Right for Me? Am I Right for a Therapy Group?

Are you finding it hard to know if group therapy is what you need or want? Below, I outline a few of considerations that might be helpful when thinking about joining a group.

Considering a Therapy Group?
You may have had a group suggested to you or know someone who is in or has been in a group. Perhaps you are aware of difficulties arising for you in groups and want to explore these further. And/or maybe you have had individual therapy in the past or recently and feel you have explored what you needed to in that work.

Whatever has led you to think about joining a therapy group, the idea is likely to feel a new and unknown prospect for you.

Group Therapy and ‘Real Life’
Group Therapy is often described as being closer to ‘real life’ than individual therapy. The other people in the group are not there in a professional role and although the group therapy culture is one of respect and support, members are also encouraged to respond and relate in authentic and spontaneous ways to each other. For some people this is off-putting but for others this is an attractive proposition and seen as a way of more directly experiencing some of the relationship dynamics they might have struggled with in the past or present.

The constant mirroring in groups between members offers ongoing feedback (what happens in groups: mirroring). Many people find this helps them develop a stronger idea of who they are in relation to others. If you are aware that you struggle with your sense of self or identity you will likely benefit from being in a therapy group where you can experience feedback from others as well as observe for yourself your similarities and differences.

Group members tend towards being supportive to each other but do, when the group is working well, offer a realistic mix of positive and challenging responses to each other. Some people who feel particularly fragile in the face of less positive feedback from others can find this too threatening a prospect.

Is this the right time for a group?
If, for example, you have had a very recent trauma or bereavement you may feel you need some more focussed one to one help on your individual circumstances and a group may not therefore be the place at this stage for you. However, this might not feel clear cut and the group therapist would be able to explore this with you. They might even be able to offer to work with you individually over your recent experiences until you feel ready for a group.

Groups and Belonging
Group therapy can be particularly helpful for people who have conflicts around belonging. This might relate to their family history, perhaps feeling they were always outside the family for different reasons, or it might connect to other aspects of their history or identities. Groups give a powerful sense of belonging. Once you join a group you are always part of it. Even after people leave, they are remembered as part of the group’s history. Groups also allow members to move in and out of experiences of outsider and insider-ness. This can offer experiences of, and help understand, relationships to belonging.

Isolation and shame
Like issues around belonging, groups can be particularly helpful for those who feel trapped by feelings of shame and alienation (shame). Most people find an immediate relief in a therapy group when they start to share their worst feelings and thoughts. The chances are always likely that at least someone in the group (and very often the majority) will feel similarly. Usually new members find that shameful thoughts, feelings or experiences become quickly normalised by the rest of the group.

For some though, the idea of making public what feels shameful is too big a step. Some people might benefit from seeing an individual therapist first where they can ‘test out’ their secret feelings, if the idea of speaking in a group feels too frightening.

Some feelings of isolation are easier to dispense with than others. Being in a group does not necessarily stop the individual having these feelings, and indeed the public nature of the group can heighten them. However, it is this very nature of group therapy that creates an opportunity to directly understand and address these difficulties.

The Therapy Group as Alternative Family System
Being in a group can feel like being in a family. Group members can start to represent family members to each other.
Families have their own ‘systems’, but the group creates an alternative (generally more benign and authentic) system which challenges the unconscious assumptions of members’ family systems.

This aspect of groups includes the opportunity to explore dynamics from past and present with siblings (Sibling Rivalry Part 1 and 2). Group members can often feel strong sibling-like feelings towards each other.
People who have had difficult family dynamics growing up, in my experience, gain a lot from the way the therapy group offers this alternative family system and allows explorations of sibling relationships.

What if you don’t like Groups…
If you do not like groups and the idea of being in a group scares you, you may, understandably, not want to join one. However, this might well be why a group could be the right kind of therapy for you. I explored this in more depth in another blog called ‘if you don’t like groups, could it be time to join one‘.

Commitment and Ambivalence
Joining a group requires making a commitment from the outset. Most group therapists will ask that you agree to a minimum of between 6 months and a year. This is an important requirement because someone arriving and leaving quickly can disrupt the group. So, I end this piece with the first question you perhaps need to ask yourself – can you practically make this commitment at this time.

This is a different question than having mixed feelings or ambivalence which is very normal and common when thinking about joining a group.

If you are not sure about whether you can or want to make the commitment, the group therapist can explore your uncertainty with you and help you decide.

Summary
This piece touches on some of the different considerations about joining a therapy group. I have not covered all aspects but focussed on those dilemmas and considerations that, have come to light most often in my experience of helping people think about joining a therapy group.

 

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

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

The Problem with Change

What is it like being in a Psychotherapy Group? Case study – Joe

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

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Do Psychotherapists Need to Love Their Clients?

Freud is an extraordinary and greatly misunderstood individual (and mental health practitioner).  Many believe we have ‘evolved’ beyond his ‘outdated’ theories and indeed, there are views and  theories of his that are no longer literally relevant. However, to dismiss him on this basis is myopic and superficial in that Freud’s writing has taken us to where we are today in the world of  psychotherapy; and so many of his theories are increasingly becoming ‘evidenced’ through technology and our understanding of brain plasticity and the need for relationship to grow a mind.  So, with this in mind, I shall now start my piece with a Freud quote: 

‘Psychoanalysis is in essence a cure through love’ Freud, S. (1906) correspondence with  Jung. 

What is love? 

The first question that must be considered in Freud’s statement is the question of what love is? 

Clearly Freud is not talking about Eros, or erotic love; he is referring to Agape, love towards fellow human beings. However, I believe Freud is saying something significantly more profound and more important: By using the terminology ‘love’ Freud is drawing a comparison to the role of the analyst (or psychotherapist) in the transference – the role of the parent who has let the child in the client down. 

Parents should love their children and most do. However, loving a child is complex as it means to allow and encourage that child to have their own experience – emotional and psychological – separate to the parent. It is about being able to encourage and tolerate difference and then celebrate it in own’s child. 

Children who have been let down – neglected, abused or abandoned – have learnt that their survival depends on ‘keeping their parent happy’ – they sacrifice their own separateness and own experience in order to hold on to a parent. This is not a child who is ‘loved’. But a child who is owned. 

Love therefore in Freud’s sense of the word is about true empathy – to be able to understand and accept another’s experience without becoming threatened by it, without collapsing and without colluding with it. And without sacrificing our own experience. 

Does loving a client mean accepting their behaviour? 

Behaviour, when driven unconsciously by effect (emotion) is termed ‘acting out’ and ‘acting out’ is mindless. Furthermore it is an attack on the therapy and an attack on the therapist. 

Much like a good parent will have empathy for a child’s fear of the dentist, or a child’s desire for sweets placed next to the till, this does not mean that the child gets what they want – the avoidance of the dental appointment or the indulgence of sweets. A ‘good enough’ parent is able to empathise with the child’s feelings but withstand their demands. In short, a parent’s job is to hold their child in mind and advocate for their best interests rather than the child’s self interests (or their  own self interests). 

Is Psychoanalysis in essence the same as a Person-Centred Approach? 

Now we have established what Freud probably means by love, we can consider whether the analytical approach is in essence the same as a person-centred approach – one of unconditional positive regard. Is this not love? 

To a point it is, however, in my view (and that of analytically minded clinicians) the person-centred approach leaves the whole idea of ‘the unconscious’ just there – in the unconscious: in other words it does not exist. What you see is what you get.

Without working with the unconscious and in the transference, a clinician cannot really ‘love’ their client as they are oblivious to the drives and projections that are paying out in the room – the meaning behind the strength of emotion from the client. And they remain oblivious to whom they represent for the client and thus where the loss or trauma resides relationally. 

An analytical clinician will work to understand whom the client is projecting onto them – the transference – and will work within the context of that to provide the client with a different experience of relationship 

Evicting the bad parent 

We all ‘internalise’ our parents – working models of how we experienced them. If this process of internalisation goes ‘well enough’ then we can draw on a solid sense of sense that is supportive of us taking up space in the world and in other relationships: we can bear our inner world However, if it goes awry somehow, then that working model can be punitive, critical and unsupportive and we avoid contact with our inner world at all costs. The process of analytical therapy is to ‘evict’ the bad  parent and offer the client an alternative object (person) to introject through the consistent therapeutic relationship. 

How to ‘love’ our clients 

Loving our clients is a hard thing to do not because they are unlikable or unlovable, but because it  means consistently offering the client a different experience of relationship that they will be unconsciously trying to sabotage in subtle ways. Freud also spoke of our fear of change and suggested that in order to mitigate against change, going forward we always seek to replicate the past. Abused and neglected children feel unconsciously ‘safe’ in abusive and neglectful relationships as then the ‘world makes sense’ and they can simply use their old defensive  mechanisms to carry on surviving. They also don’t need to feel vulnerable. 

Loving a client means holding appropriate boundaries, offering them support and understanding whilst resisting either being seduced or offended by attacks. And as with real life evictions, the internal parents will protest and fight back to stay put. 

Ultimately loving our clients means to hold them in mind in ways they never were – their best interest rather than self interests. 

 

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

 

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 –

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

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Are our emotions shaped by our relationships?

This particularly influences us during infancy, childhood and adolescence.  These early experiences can be activated if they have led to the development of unhelpful defenses.  The lack of attunement in parental relationships can result in an infant developing an unhealthy attachment style, divorced from reality in the form of fantasy or withdrawal and detachment.  This initially protects the infant from the pain, emotion and feelings.  Later due to the blocking of the ability to connect emotionally the protector becomes the persecutor.

A chaotic attachment experience can impact on vital neurological developmental pathways leading to permanent damage to later functional performance. Hence the recent research on childhood services from pregnancy to five years of age. 

If a “good enough” environment is NOT available for one reason or another during a person’s childhood there will be aspects of this early experience that appear to act at an unconscious level, a shadow of the early object relationship. This can be brought into consciousness and worked with in the therapeutic process.   Forming a trusting relationship with a therapist or a stable relationship within a group to hold and contain feelings and emotions to be internalized, made sense of in order to be restored. However, we must not conflate this process by apportioning blame on the parent but as a means of unfolding the neurological pathways that block the capacity for integration.  This is re-experienced in the therapeutic alliance as an imago of the infant / child with an immature mind as the “unthought known”     

Our brain and therefore our mind can remain adaptable throughout our lives and given the right support can  make a conscious decision with a mature mind not that of the infant /child.  A similar process occurs in trauma.  It can respond making the shifts necessary to live a valued and happy life.

 

To enquire about group sessions with Thea Beech, please contact her here, or to view our full clinical team, please click here.

 

Dorothea Beech is a Group Analyst with many years experience working in the UK and overseas.  She worked as A Group Analyst in South Africa as a Lecturer at Cape Town UCT and at Kwa Zulu Natal University in Durban, lecturing on a Masters Program in Group Work.  Her MA in Applied research was on Eating disorders. Her interests are in cultural diversity and trans-generational influences on the individual.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

Group Analytic Psychotherapy – the slow open group

It is never too late!

The Unconscious Mind

Groups for Mental Health

Group Psychotherapy in a post ‘Pandemic World’

 

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What The Role of the Therapist in Therapy Groups?

This piece is part of a series offering thoughts on the experience of being in a therapy group. It may be helpful to read if you are thinking about joining a group or running groups or if you are already in a group. 

When I am discussing with someone about joining a group, a common question is often around my role as therapist in the group.  Below I outline different aspects of the group therapist’s role as I see it. 

Dynamic Administrator

One important aspect of role of the therapist is to take care of the administration of the group. This includes managing boundaries and making decisions that maintain the group as a safe therapeutic space. This is called Dynamic Administration. 

This role includes assessing and deciding who will be in the group and establishing a physically safe and uninterrupted space for the group to meet in. It also includes setting out and maintaining boundaries for the group to keep it operating safely, consistently, and therapeutically.  

Group Preparation

The group therapist will also help the individual prepare for joining a group. As part of this, they will invite the potential member to speculate what kinds of experiences could be helpful, and what might feel more challenging, in the group. This can sometimes be a general discussion but is particularly useful when based on what the therapist and individual already know about their history – especially their history of groups. (see How important are our groups?)

The Group Therapist in the Group

One of the things I always say, in response to questions about how I will be in the group, is that I follow the group rather than lead it. This rejection of the role of group ‘leader’ is central to group analysis and its democratic principles. Instead of being called a leader, the therapist in Group Analysis is called a conductor. 

In group analysis, the therapist as is viewed as another member of the group. This does not mean they are not present in the role of therapist but more that the task of therapy is also shared with the group. 

The therapist as another member also refers to the concept of a network that all the members create together through their communications and relationships in the group – consciously and unconsciously. The group therapist is a part of this network and influences it – and is influenced by it – like every other member. 

Although they are a member of the group the conductor is very much there as a therapist and not a patient. So, they will act in similar ways to a therapist in individual work. They will not – or very rarely – disclose personal information and their focus is on the therapeutic needs of the group and the individuals in the group. 

My experience as the group therapist or conductor is that I move in and out of different positions in the group process. Sometimes I feel very central and very much a part of discussions, other times I am more in an observer’s role. When I speak it can sometimes be to the group as a whole or other times to an individual or individuals in the group.

As a group develops and becomes more used to working therapeutically together, I find how I take up my role often changes as well. What the group might want from me at the very start is often different as time shifts. And these changes can also take place from session to session. Individuals also might need or want different things from me as they do from other members, and this changes as well. 

Summary

This is a brief account of the role of the group therapist or group conductor, but I hope it has been able to give a flavour of what it might be like in a therapy group in relation to the therapist. I have described three aspects of the group therapist’s role – dynamic administration, preparing the individual joining a group, and the role of conductor in the group. 

 

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

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

The Problem with Change

What is it like being in a Psychotherapy Group? Case study – Joe

Silences in Therapy

Sibling Rivalry – Part 1

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Group Analytic Psychotherapy – the slow open group

The name ‘Slow Open Group’ was adopted to reflect the nature of the psychological process of opening ourselves to our collective experience in our families, culture and social milieu. Slow, because it takes time, Open because people will come and go over time as they do in our lives.

The global pandemic has demonstrated, in a terrible way, the potential harm we are doing to our environment. It has reminded us of our connectiveness with others both at the level of our community and globally. The vaccine and getting it is both a personal act of protection whilst at the same time a civic duty protecting others.

The extraordinary benefits of our connectedness via social media and technology has raised our knowledge of the worldwide suffering from this disease. At the same time we are both informed and sharing in the emotional fallout of so many losses and bewildered at our personal suffering.

Therefore we seek psychotherapy or psychoanalysis in order to understand our emotional reactions; the implicit and explicit meaning of our lives. The implicit, what is going on in our mind and body. The explicit what is happening around us in our world and intimate relationships that triggers influence our responses. The act of choosing to enter therapy is a willingness to begin a journey that will continue throughout our lives.

 

To enquire about group sessions with Thea Beech, please contact her here, or to view our full clinical team, please click here.

Thea Beech is a Psychotherapist and Group Analyst. A Member of The Institute of Group Analysis and Registered with the UKCP. She now works in Private Practice after a long career in Healthcare related industries in the UK. She later taught in Universities South Africa on Group Work and Eating Disorders. She has written on Group Analysis and Eating Disorders. She was part of a small team who developed the Centre for Group Analysis in Cape Town. Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

Groups for Mental Health

Group Psychotherapy in a post ‘Pandemic World’

Termination and endings in Psychotherapy

What is Social Unconsciousness?

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Avoidance in therapy as the axe for the frozen seas between us

In this blog I will briefly discuss avoidant attachment strategies and how what can look like independence is actually a sort of suit of armour designed to protect and hide a locked box of vulnerability and need, preventing mutual dependency and intimacy.

The person who has developed the avoidant strategy has done so in order to cope with a lack of understanding and attunement to their needs from their caregivers, and have therefore had to deny their needs to themselves and make the decision (unconsciously) to repress or bury these needs and create an equilibrium for themselves where the pain, disappointments and griefs of these unmet needs are locked away. They can often find alternative ways to feel good about themselves and compensate for the shame of the disappointments and low self-esteem that they feel as a result of this lack of attunement. These alternative strategies can lead them to developing their intelligence as a way to circumvent their feelings and they are often very successful in their field of work. The problem of course is in their relationships, sometimes their relationship with themselves or parts of themselves.

The strategy seeks to enable them to have self-worth while keeping painful feelings of rejection at bay, they have found others unreliable and can therefore only trust themselves. They create an image of themselves that appears independent and strong but comes at the cost of denigrating others, especially those that are more comfortable with the parts of themselves that seek mutual reliance and inter-dependence on others. In extreme forms these others can stir up painful feelings of envy and hatred although these feelings too are disavowed. A calm state of coolness is sought that numbs any sort of emotional aliveness. However, this defence is often a fragile one and when a crisis occurs as it always does at some time or other in life then these defences can shatter, leaving the person distraught and desperate, unable to manage or deal with the emotions that now can’t be neutralized. Suicide can be one tragic outcome.

Brett Kahr, a British Psychoanalytic Psychotherapist, discusses the pain of this strategy which can be handed down generationally: – “Although many people inflict horrific cruelty upon their partners, the vast majority cause pain as a result of emotional unavailability, fuelled by avoidant attachment structures.”

Therapy takes time and requires an enormous amount of patience and keeping the patient in therapy is no easy task. However if they stay then perhaps the patient can slowly start to develop a more trusting relationship with the therapist, who can attune to them, who doesn’t need them to be other than who they are, who can accept their need for distance and who can digest their sometimes overt, but often covert denigrations, understanding them without retaliating or shaming them but not colluding either, calmly without judgment bringing to awareness what the patient is doing and the fear and pain behind these defences against relatedness.

The Author, Colum McCann, describes the work of literature, and I think his description also describes the therapeutic process.

“The job of literature is to acknowledge the heartbreak of the world and then to share that heartbreak in the hope that somehow you can find a little light, just a little, no matter how damaged and bruised. This light, then, must necessarily acknowledge the darkness. At the same time, it might just lift a portion of the dark, past the curtains, awaken us.”

He goes on to quote Kafka, “A book must be the axe for the frozen sea within us.”

So too must therapy.

 

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

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

What’s wrong with good advice?

Psychiatry, Psychology and Psychodynamic Psychotherapy 

Analytic Therapy for Addictions

Loss

Post Natal Depression in Mothers & Fathers

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Is it ever too late to start psychotherapy?

Is it too late to consider going into therapy once we reach a certain age? As I walked through the gardens on an early spring morning, this was the question going through my mind. I intended to get down to writing this blog, an unfamiliar task, when I got back to my office.

We seem to have heard all year about mental and physical decline as we age so it was refreshing to read Levitin (see below) that the brain retains plasticity or the capacity to learn and change through out life. And if we are not taken down by dementia, brain injury or stroke, we can in fact retain a lively and flexible mind throughout life. We have to do the obvious things like follow a balanced diet, exercise, not give up purposeful activity (work) and maintain a good and diverse social network.

Throughout life, our close friends and family are important to our wellbeing. These relationships take enormous strain in a world where change is the only hope for survival. And they need looking after even if this means we might end a relationship, if we have children developing and sustaining a healthy connection can help our children to adjust to the world with a healthy out look.

Transitional periods, retirement, divorce, bereavement, empty-nest syndrome, can benefit from psychotherapy for one or both partners providing the space for increased awareness of ourselves, an opportunity for gaining insight and change.

Considering the later years are often filled with opportunities for reflection on a life lived there is always plenty material to explore in the therapy room. David Levitin, an American Neuroscientist, sees this period of life as an opportunity to see life afresh. His premise is the brain retains its capacity to change through out life, at its greatest in childhood and old age.

 

To enquire about group sessions with Thea Beech, please contact her here, or to view our full clinical team, please click here.

 

Dorothea Beech is a Group Analyst with many years experience working in the UK and overseas.  She worked as A Group Analyst in South Africa as a Lecturer at Cape Town UCT and at Kwa Zulu Natal University in Durban, lecturing on a Masters Program in Group Work.  Her MA in Applied research was on Eating disorders. Her interests are in cultural diversity and trans-generational influences on the individual.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

The Unconscious Mind

Groups for Mental Health

Group Psychotherapy in a post ‘Pandemic World’

Termination and endings in Psychotherapy

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What happens in Group Therapy: Mirroring

In this and other blogs I try and describe and discuss what it is like being in a therapy group. Here, I focus on the phenomenon of mirroring in groups which is an important group analytic concept, process, and experience.

Mirroring and Early Development

To understand why mirroring is important in any therapy, it is helpful to understand its role in early childhood development. Early in life, the baby relies on the care giver/s to provide ‘mirror reactions’ – that is, responses mirroring back their self. An obvious example might be a baby smiles and a parent mirrors back the smile they see the baby making. This helps the infant develop a distinction between ‘what is me’ and ‘what is not me’. In other words, a sense of self. Many of us have not had enough or effective enough mirroring early on in our lives and one of the key therapeutic elements of all talking therapies seems to be the corrective experience of having oneself mirrored back.

The Therapy Group as a Hall of Mirrors

Mirroring is a particularly important experience in group therapy and Foulkes (a founder of group analysis) likened groups to ‘a hall of mirrors’.

In a therapy group, members constantly reflect their responses to each other, while at the same time see themselves reflected, or not, in the behaviours and communications of others. As an individual in the group over time these reflections and reactions help to create a picture of oneself in relationship to others. As Foulkes put it:

A person sees themself, or part of themself – often a repressed part of themself – reflected in the interactions of other group members. They see them reacting in a way they do themselves, or in contrast to their own behaviour. They get to know themselves … by the effect they have upon others and the picture they form of them. 

Foulkes p 110 Therapeutic Group Analysis (my changes from masculine to neutral pronouns)

Vignette

To give a picture of mirroring at play in a group, below is a fictionalised account of a fictional group discussion between 4 members A, B, C, D

A is talking about his childhood and his experience of his disapproving father. B comments that the way A describes his father reminds her of sometimes how he is in the group. A goes quiet.

C says to B that she felt she came in too critically towards A, she often seems to be down on him. B says that A reminds her of her own critical father.

C says she is always much more struck by A’s vulnerability and wonders why B can’t see this. She’s worried now that he’s become silent.

A says he’s remembering last week an argument with his son who was angry he was always on his back. He realises he can be like his father at times.

D points out how C herself had jumped in to defend A. C wonders about it in terms of her own father who she felt was bullied by her mother. C says she envies how B seems to be able to say what she thinks. She always feels she needs to protect the other person.

A recognises he can be disapproving sometimes in the group and in his family. But he has never thought of himself as vulnerable. He feels moved by C’s protection, but it also feels new and strange to him.

In this vignette you can hopefully see the analogy of the hall of mirrors at play. The group members are constantly reacting to each other. The more the group allows openness and spontaneity the more can be revealed.

For example, the members reveal two different aspects of A seen by B and C. A is familiar with one but unaware or in denial of the other. He is moved when his vulnerability is seen but also disconcerted. B and C while having genuine but different responses to A also then recognise the parts of themselves or not that they are seeing in him – and for C what she also sees in B.

Responses to Mirroring

Mirror reactions can reveal ‘truths’ which may then be responded to by the individual in a range of ways. Mirroring in group therapy often operates at a complex and spontaneous level and can go on consciously and unconsciously, verbally and non-verbally. This experience is then hopefully utilised therapeutically by the group and the group therapist.

In my constructed vignette, the group members’ observations and responses are conscious and easy to verbalise. They are all able to make use of their responses to each other and the discussion is constructive and productive. It’s perhaps easy to see how their insights could lead to further therapeutic explorations in relation to past and current relationships. In a live group session however, responses to feedback can be more varied and complex.

“affect, understanding or intuition seen in or associated with others, can reveal truths about the self that may be welcomed, opposed, taken flight from or attacked.

Schlapobersky p 255 From the Couch to the Circle: Group Analytic Psychotherapy in Practice

Some ‘truths’ are deeply unconscious and like in the case of A can feel disconcerting when exposed. Others are harder in other ways to receive and may take time to be utilised, if ever.

Conclusion

The process of mirroring is only one aspect of what goes on in groups. However, it plays a key role in the group therapeutic experience. Many people seem to find group therapy particularly helpful for their confidence and sense of identity. While this will be down to many factors, mirroring between group members plays an essential part, helping the individual develop a sense and understanding of who they are.

 

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

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

What is it like being in a Psychotherapy Group? Case study – Joe

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

What is loneliness?

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The Unconscious Mind

How do we bring to mind what is unconscious? Is it important to make this journey? These two questions are central to the therapeutic process of psychological therapy. When we are young we depend on our primary carer’s usually our parents, to hold and contain our emotional needs.

In childhood, none of us have a mature mind to guide us we rely on adults, siblings or our extended social network to help us grow into mature people. Siblings play an important role in our social development our place in the pecking order can determine how we deal later on with competition, rivalry our reaction to authority, etc. This effect can impact on us throughout our lives. Bringing to the conscious mind these experiences can help with regulation of our emotional responses as adults.

Our unconscious can exercise its influence on us leading to destructive patterns in our relationships with family, friends and work colleagues. This is often the primary motivation for people to seek out psychotherapy.

When we are grown up the experiences of childhood can exhort their influence on us leaving us bewildered at our difficulty in managing our emotional responses in everyday situations. It is as if a shadow is caste over us, we are driven by something beyond our control to act out.

Feelings, emotions and experiences from childhood or the accumulation of a long period of small daily undermining by family dynamics or bullying at school can lead to trauma. When we are traumatised, either by an event or the cumulative effect of oppression, our only escape is to detach. This may result in retreating into a fantasy world or addiction, compulsive behaviour or other psychological defenses in order to survive.

The work with the therapist or group on the unconscious allows us to revisit this hidden material. To experience in a safe environment the painful and disturbing events that triggered a defensive psychological response.

This blog to asks more questions than gives you answers. Its aim is to offer you whatever your age, ethnicity or orientation to consider looking at your own journey with greater understanding. You can follow-up this blog by watching a utube webinar “Three Ways of Connecting With Our Unconscious Mind” by Kirsten Heynisch’s, Clinical Psychologist’s description of accessing the unconscious and working with it. This can inform your work with the process of change in Individual or Group Psychoanalytic Psychotherapy.

 

To enquire about group sessions with Thea Beach, please contact her here, or to view our full clinical team, please click here.

 

Dorothea Beech is a Group Analyst with many years experience working in the UK and overseas.  She worked as A Group Analyst in South Africa as a Lecturer at Cape Town UCT and at Kwa Zulu Natal University in Durban, lecturing on a Masters Program in Group Work.  Her MA in Applied research was on Eating disorders. Her interests are in cultural diversity and trans-generational influences on the individual.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

Groups for Mental Health

Group Psychotherapy in a post ‘Pandemic World’

Termination and endings in Psychotherapy

What is Social Unconsciousness?

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Some existential musings from the sea

“Why do we like the frantic, the unmastered?” Asks Virginia Woolf,  in her diaries. This is a question I also return to time and time again as I look out to sea. Feeling the disquiet holds an edge of excitement for me, there is a thrill to its wild and unknown nature.
For me there is something quite awesome about being made to feel small, insignificant, vulnerable.
Something playfully cherishing about being sprayed by the sea and even more so when seeing the other’s surprise as they are splashed by the sea spray as they walk along the promenade.
Even more touching is when I am in the sea, bobbing around, apparently trusting its capacity to hold me, softly caressing my form, knowing its strength could take me over, its sometimes silent, sometimes roaring power could take away any sense of control I may feel I have, at any time.
For me that makes me feel free. For others I am aware that feels like the opposite of freedom. Perhaps it is the sense of disquiet that is not thrilling for the other. Of course that is completely understandable and perhaps very sensible.
The sea, our relationship, has taught me a lot.  Not just what was said above. Many other beautiful things too, some known, some still unknown.
It has deepened my capacity to feel, to reach into sensations, when to let go and when to push forwards. It has taught me how not to take things personally,  how to play and take risks, how to feel and experience joy, it has taught me, or at least invited me to be open even in the unknown and when I think I might be unsafe; not to judge or believe every thought that emerges from the reckless mind. It has taught me there is much I don’t know and that it is ok not to know. It has taught me lessons about connection,  intimacy and friendship.
It has inspired me, filled me with awe. It has provided beautiful gifts, delightful and magnificent gifts.   Whether seeing elusive pods of dolphins in the early dawn, as I witness the wonder of the full moon and the rising sun in unison.  Or the simple drama of playful young seagulls dipping and diving into the waters. It has yielded me a space to dive deeply into the unknown, into pleasure, and held me patiently on its voluptuous and flowing surface as I come up for air, breathing, resting and trusting.
And when its roaring form prevents me from entering its embrace it still teaches me much. It teaches me about patience, power, movement and change,  and it quietly, continually gives me permission to become. It invites me once more to come into contact with and enjoy the unmastered within me.
Even if one only feels a slight desire to see the sea, and not even consider entering it, there are many gifts to receive, lessons to learn. But if that desire increases I recommend dipping a humble toe into that vastness, you never know what might happen.

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

 

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

 

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Intimacy: pillars and obstacles

Our capacity for intimacy as adults is widely understood to be shaped by our early relational experiences. Theorists from diverse orientations emphasise the link between early attachment patterns and subsequent adult love relationships. When our formative experience is one of loving reciprocity with our caregivers, our abilities to give and receive love freely and fully later in life are enhanced. Children who experience themselves as loved and valued in the context of a harmonious parent/child dyad are more likely to develop a secure sense of self and will have a more robust relationship to (their own and others) autonomy and dependence.

We all struggle to find a balance between a need to be a part of something greater than ourselves and a need to be apart from – to be separate. Some of us will navigate the continuum between proximity and distance with fluidity and ease. Others will experience greater comfort at one end of the continuum or another. For all of us our capacity to experience intimacy will reflect in some measure our abilities to risk closeness and separateness. 

Separateness

The growing infant internalises their primary care giver(s) through the process of separation-individuation. A parent’s recognition and validation of the baby’s unique self will initially be expressed in the child’s specific preferences for being held, soothed and fed. The feedback loop between child and caregiver as the child seeks to explore the world beyond (m)other is critical. When attuned, the child will learn that separation is both pleasurable and manageable  and that it will not entail the loss of the love object. The process of separation-individuation is repeated throughout the life cycle, in adolescence, in marriage and in parenthood. At each stage there is an  opportunity to rework or repeat old patterns and to adopt either old or new solutions. 

Mutuality

To give, to receive and to share in the spirit of joint reciprocal endeavour is the cornerstone of mutuality, another pillar of successful intimacy. Once again it is understood that the capacity for mutuality is rooted in our early experiences with a “good enough” caregiver. The infant develops trust and confidence through interactive engagement with an attentive other. Through this exchange expectations of safety, effectiveness and pleasure are cultivated or impaired. 

Successful intimacy requires the capacity to regress and be dependent, and in an adult partnership, for each individual to be able to tolerate these states in both themselves and the other. This requires a secure sense of individuation on both sides so that closeness is not experienced as an engulfing fusion and a threat to a cohesive sense of self, and separation is not experienced as a catastrophic rejection or abandonment. 

Empathy

Feeling what another person feels whilst maintaining psychological separateness is the essence of empathy. It involves the capacity to immerse oneself in the emotional life of another, temporarily leaving one’s own world without experiencing a loss of self. As such it is fraught with difficulty and risk for the individual who is not securely individuated. Empathy is a two way process in which each partner must have an investment in both understanding and being understood. Early developmental deficits or excesses will inevitably interfere with our capacity for empathy and mature intimacy in our adult pairings.

Viable Intimacy

Intimacy can evoke fear ( conscious or unconscious) in any relationship. Fear of loss or merger, fear of shame, fear of attack or of one’s own aggressive impulse, fear of disappointment and fear of needing. The path to intimacy is complicated and fraught with risk, never more so when we bring our unattended psychic wounds to our adult partnerships in hope of healing. For intimacy to be viable  it will probably help to have an idea of our appetites for closeness and distance. Armed with this self understanding and willing to understand the appetites of our partners we will be better positioned to navigate and negotiate this most foundational relational terrain.

 

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 – 

Love and Family

Understanding sexual fantasy

Fear and hope in the time of Covid

Relationships, networks and connections

Paying attention to stress

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