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As I Walked Out One Evening

Some years ago, I was given a card that quoted the second and third verse of Auden’s poem, ‘As I walked out one evening’. It was wonderful, the idea that someone could be loved until two continents met across the Pacific Ocean. What a romantic notion.

For many of us, when we fall in love we feel outside the ordinary world, a kind of intensity and madness that takes us beyond the limitations of everyday life. Auden illustrates this feeling at the beginning of the poem, The lover says that they will love the other until impossible things come to pass, ‘till the ocean is folded and hung up to dry’, that is they will love the beloved forever.

As I walked out one evening,
Walking down Bristol Street,
The crowds upon the pavement
Were fields of harvest wheat.

And down by the brimming river
I heard a lover sing
Under an arch of the railway:
‘Love has no ending.

I’ll love you, dear, I’ll love you
Till China and Africa meet
And the river jumps they over the mountain
And the salmon sing in the street

I’ll love you till the ocean
Is folded and hung up to dry
And the seven stars go squawking
Like geese about the sky.

‘The years shall run like rabbits,
 For in my arms I hold
The Flower of the Ages,
 And the first love of the world.’

(verses 1-5)

The idea of a never-ending romantic love is a seductive narrative and I believe a pernicious one. This is because it implies that the power of romantic love, i.e. being in love, is enough to overcome the vicissitudes and transitions of human life. But these are inevitable because we live in time and in space.

In order to fall in love we have to avert our eyes from the ordinariness of the other, to believe they’re special and by being loved by them we are too. Time passes and the ordinary person emerges; time passes and what first attracted us is now irritating; time passes and what matters to us has changed and we don’t share the same interests; time passes and our bodies have grown older and less attractive; time passes and we become forgetful, frail and fearful; time passes, perhaps we become ill and eventually we die.

What happens to being in love? Auden’s poem continues with a warning that love cannot overcome time. Time is watching us from the darkness, perhaps occasionally we are aware that our relationship has a time limit, but often ‘In headaches and in worry, Vaguely life leaks away,’. In the poem there are warnings about the lover’s relationship, the glacier knocking in the cupboard, the desert sighing in the bed and the cracks in the teacups.

But all the clocks in the city
Began to whirr and chime:
“O let not Time deceive you,
You cannot conquer Time.

‘In the burrows of the Nightmare
Where Justice naked is,
Time watches from the shadow
And coughs when you would kiss.
‘In headaches and in worry
Vaguely life leaks away,
And Time will have his fancy
To-morrow or to-day.
‘Into many a green valley
Drifts the appalling snow;
Time breaks the threaded dances
And the diver’s brilliant bow.
‘O plunge your hands in water,
Plunge them in up to the wrist;
Stare, stare in the basin
And wonder what you’ve missed.
The glacier knocks on the cupboard,
The desert sighs in the bed,
And the crack in the tea-cup opens
A lane to the land of the dead.

(verses 6-12)

Couples come to therapy full of regret and resentment and tell me it’s been like this for years. They recognise there were signs that they needed to pay attention to their love and changes in their relationship and these opportunities were missed. I suggest that some of this is because people want what they had at the beginning, I want to it to go back to how it used to be. To recognise change in a relationship can mean mourning the loss of those early feelings of being in love, that intoxicating pinnacle of romance.

Part of the work of couple therapy is to be able to remember and respect those initial feelings and to find a more fluid and changing narrative about romantic love. One that recognises that time passes and we cannot, we just cannot, stay the same.

Where the beggars raffle the banknotes,
And the Giant is enchanting to Jack,
And the Lily-white Boy is a Roarer,
And Jill goes down on her back.

O look, look in the mirror,
O look in your distress;
Life remains a blessing
Although you cannot bless.

O stand, stand at the window
As the tears scald and start;
You shall love your crooked neighbour
With your crooked heart.

It was late, late in the evening,
The lovers they were gone;
The clocks had ceased their chiming,
And the deep river ran on.

(verses 13-16)

Apologies for any misinterpretations of Auden’s poem.

 

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 –

Thinking about the menopause in energetic terms

Poetry: A space to ponder

Relax: Watching people using their hands

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 symptoms

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What does Couple Counselling do?

At a fundamental level, couple counselling provides an opportunity for a couple to explore their relationship with a therapist who facilitates the exploration. Couples have said to me that they really value the dedicated time, space and support to talk about feelings and difficulties that don’t feel safe to share with each other elsewhere. What else couple counselling does is more provisional and it’s perhaps helpful to think about what couple counselling can do?

First of all, I’d like to make it clear what, in my opinion, couple counselling doesn’t do. Couple counselling is not about the counsellor determining whether a couple should split up or stay together. Nor is it about the counsellor telling either individual how to behave or taking sides. (There are exceptions to this if one of the partners is coercive or violent.) The more behavioural approaches to couple counselling often provide communication exercises and homework between sessions, humanistic and psychodynamic approaches tend not to do this.

I think a key element of what couple counselling can do, is to give a couple the opportunity to see their relationship from a more objective position, to help a couple step away and see themselves as if looking in from the outside. People are often familiar with repeating patterns in the interactions with their partners. They know which situations end in a row or sulking or tears – “you always …,” “you never …” but they can’t necessarily recognise the dynamic that underpins the patterns. How they both act in a way that means these situations keep playing out in the same way again and again. They know that over time painful feelings have built up, such as hurt and resentment, frustration and fear, disdain and humiliation. These feelings can reach a point where one or both partners question whether they can carry on living like this or would it be better to break up. Then they come to couple counselling.

A couple counsellor can notice and comment on what they see being enacted between the partners in the session. They and the couple can think about how this dynamic can play out in the relationship and the way it impacts how they feel about each other. This close attention from the therapist can make couple counselling challenging, each partner becomes aware that their behaviour is coming under scrutiny. They may be fearful of owning their own behaviour and ashamed about revealing aspects of themselves, aspects that may be protecting them and hiding feelings of weakness, vulnerability or lack of self-worth that probably originate from their past.

A therapist can encourage both partners to be more compassionate with themselves and each other, to let go of the feeling that their partner is a potential threat and they need to defend themselves. A couple can then begin to see their partner as someone who is on their side, who is on the same team but perhaps brings a different perspective.

Hopefully a couple can recognise the dance between them and acknowledge the relationship they have created together is a shared responsibility, both the positive and negative parts. This means that the project of creating a more satisfying relationship, or a constructive separation, can also be shared and is perhaps more possible than they imagined at their first counselling session.

 

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 –

Thinking about the menopause in energetic terms

Poetry: A space to ponder

Relax: Watching people using their hands

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 symptoms

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Thinking about the menopause in energetic terms

I often have women clients who are going through the peri-menopause or who are post-menopause and I am curious about how I might better support them therapeutically. I want to share some thoughts from a recent talk by Joanna Groves where she invited us to think about the peri- and post-menopause in more practical and energetic terms. The menopause is defined by 12 months without menstruation; on average this happens at 51 years old. The peri-menopause, the period when the sex hormones are reducing, can start from the late thirties to mid-forties and the symptoms can last for 4 or more years after the menopause.

Groves asked us to pay attention to the pressure of trying to maintain ‘normal’ life during a time of physiological and psychological change and to take seriously the stress this places on women’s physical and mental health. She outlines the physiological and psychological changes that occur during the peri-and post-menopause. There are common physiological symptoms including heart palpitations, sweating, sleep problems and fatigue, these are often accompanied by other changes such as food intolerances and sensitivity to alcohol. Along with anxiety and depression there are other psychological symptoms such as memory and concentration problems, confusion and a loss of confidence and self-esteem. The pressure to maintain work, family responsibilities and a relationship and manage everyday crises can become overwhelming, like trying to stop a burst pipe with a teacup and one hand tied behind your back.

The ‘fight, flight or freeze’ response is caused by Cortisol, the stress hormone. Cortisol is produced and managed by the adrenal glands and is a survival response, an alarm reaction to threat or danger. In contemporary life we’re not at risk from predators but we need cortisol to help us deal with an emergency or carry on under pressure. Cortisol helps us keep going partly by repressing non-essential functions such as digestion and the immune and reproductive systems. When the crisis is over or the pressure reduces cortisol levels drop and the body returns to equilibrium. But what if the pressure is continuous and we are in constant crisis? Eventually the adrenals become exhausted and we become energetically depleted, this can result in anxiety, depression, headaches, difficulties sleeping, digestive problems and burn out.

If all that wasn’t enough to contend with. Groves suggests that during the peri-and post-menopause as our emotional resilience reduces; we no longer have the energy to keep difficult emotional experiences supressed. Buried feelings of grief, loss and shame can re-emerge and memories of trauma can resurface. Long established relationships are examined and sometimes break up. What felt safe and secure no longer feels so and this can feel like a kind of madness.

Groves’ advice is to acknowledge that this time is a process of transition that will eventually lead to a new stage of life, a kind of post-menopausal rebirth with renewed energy. She highlights ways to reduce stress and conserve resources during this transition.

One key message from Groves is that ‘energy follows attention’ i.e. what we focus on consumes or generates energy. She invites us to reflect on this through several different aspects:

  • The importance of getting enough rest and sleep, this might mean delegating some responsibilities, reducing working hours and includes sensory rest such as time without a phone.
  • The physical benefits of movement and keeping mobile through activities like walking, stretching, swimming and gardening; movement creates energy.
  • Gut health and nutrition are two aspects that may need adapting, for example reducing the consumption of sugar and alcohol.
  • Relationships and friendships, it helps to prioritise friendships that sustain and nourish and to limit those that are draining. Family and romantic relationships can come under scrutiny and may be revived or changed irrevocably.
  • Finally Groves emphasises (self) compassion, this might include physical and/or holistic treatments, new creative experiences, practices such as meditation and psychotherapeutic support.

At the same time as outlining these practical approaches, Groves acknowledges that in a culture driven by productivity and achievement attempts to cut down responsibilities and become less productive may feel like ‘weakness’ or ‘failure’. Women in my practice have asked – if I can’t do what I used to do what am I good for – and said – I feel worthless like there is no place for me.

On a more positive note Groves identifies a paradigm shift around the menopause. It is not just women that go through this transition but those who accompany them, friends, colleagues, parents and especially partners and children. Hopefully by welcoming a wider range of experiences including accounts from transgender women we might develop ways to support and improve life transitions for us all. Meanwhile, as therapists we can offer a conversation to help understand and contextualise what is happening to those who find themselves at the centre of this particular life transition.

 

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 –

Poetry: A space to ponder

Relax: Watching people using their hands

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 symptoms

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

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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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Relax: Watching people using their hands

Stuck at home I don’t always want to chat with friends and family or listen to any more news, podcasts or watch TV drama or read a book. Yet I want to be taken out of myself. I want to be elsewhere and with my own thoughts at the same time.

Being engaged in an activity that uses our hands is recognised as having therapeutic benefits. During the privations of Covid-19 lockdowns making and baking have become popular. You can find numerous examples of famous faces presenting the results on social media. For example, the Olympic diver Tom Daley says he took up knitting to help him relax and he has knitted clothes for his husband and child. Finding no knitting patterns for men’s swimwear he adapted a pattern for bikini bottoms and produced a pair of crocheted speedos for himself.

There is also a therapeutic effect when we watch someone else using their hands. Think about the close-ups on hands in cooking programmes. Might this satisfaction in watching be something to do with mirror neurones. Discovered in the 1990s, mirror neurones fire in the brain of observers whilst watching or listening to another person performing an activity. The neurones that fire in the brain of the person performing the activity are mirrored in the observer. That is, the same neurones fire in the brain of the observer. It seems we can experience what another is experiencing at the same time. This has led to research investigating the role of mirror neurones in how empathy operates and how we learn.

Whilst watching the gardener raking the Zen garden in this video clip, I find I can sense his body movements, almost feel the weight of the rake and the resistance and flow of the gravel. And then I watch it again. I can be there in that garden and at the same time sitting at home relaxing into my own thoughts and imagination.

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 sysmptons

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?

Viagra: Some ups and downs of the little blue pill

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

Schools will soon have menopause on the curriculum. Largely due to the efforts of psychotherapist Diane Danzebrink and her #MakeMenopauseMatter campaign. In 2019 Education Secretary Damian Hinds confirmed menopause will
become part of the Sex and Relationships curriculum for teenagers in the UK in Autumn 2020 alongside periods and pregnancy.

With the recognition that menopause needs to be better understood in the broader context of sex and relationships perhaps now we can begin to talk about men’s experience of changes in their hormones. Testosterone is the main sex
hormone (androgen) in men and the symptoms that men can experience as a result of reduced testosterone are called andropause. The hormone testosterone plays a role in the production of sperm, in the drive to have sex, in building muscle and bone mass, in the way fat is deposited around the body, in the facial and body hair patterns found in males and their deeper voices.

Men will experience hormonal changes as they age, levels of testosterone will start to decline from around 30 at approximately 10% every decade. It is important to note that testosterone reduction can also be affected by other
factors such as injury, cancer treatments, medication and chronic conditions including diabetes, obesity, kidney and liver disease. Symptoms include a lower sex drive, loss of body muscle and an increase in body fat, decrease in bone
density, fatigue, insomnia and difficulty attaining and maintaining erections*.

From research by the Centre for Men’s Health Clinic in Manchester, looking at men over 50 in the UK, Dr Malcolm Carruthers says: “Of the ten thousand men surveyed actually 80 per cent had moderate or high levels of symptoms suggesting they had testosterone deficiency. This shows that its not the rare condition that some doctors claim but actually its very common and almost totally untreated.”

Symptoms described by two patients attending the clinic and suffering from low testosterone, defined as Testosterone Deficiency Syndrome, share features with women’s accounts of menopause.

“Well I was 55 or there abouts and I was getting perspiration in my shirt and was getting really wet, I’m talking serious perspiration, tiredness and I had a lot of muscle aches particularly in my legs”.

“I was a fishing skipper for 23 years and was the type of person that woke up in the morning and rolled out of bed and was on the job, something to do” …  Then when I reached the age of 55 I began to feel that I was flagging and I got all sorts of strange to me symptoms, aches, pains, horrendous sweats and uncontrollable temper.”

What about the mental and emotional aspects of andropause? We need to acknowledge and better understand andropause and the impact on men and their lives and relationships. Symptoms of andropause include mood swings,
irritability, low-self esteem, memory and concentration problems and depression. These are familiar menopausal symptoms for women, however it may be harder for men to acknowledge these symptoms and to ask for help
because they are associated with female menopause.

 

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

 

Further reading by Angela Rogers –

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?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

 

References –
Diane Danzebrink
https://twitter.com/hashtag/makemenopause

Centre for Men’s Health Clinic
Associated Press Television 11.3.2011
https://youtu.be/33aCzR4U9l4

*See an earlier blog about men’s use of Viagra here.

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

It is not comfortable being told that you are feeling the way you do because of your hormones. This kind of biological reductionism is not helpful to any gender but the extremely severe symptoms of Pre-menstrual Dysphoric Disorder are completely aligned to the menstrual cycle. They manifest during the week before menstruation and end when or shortly after the start of menstruation. Like a switch going on and off.

There are a wide range of physical symptoms some not usually recognised as linked to pre-menstruation – changes in vision, heart palpitations, numbness and easy bruising – along with those that are familiar. In this post, I am concerned with the psychological symptoms.

The ones we might expect like irritability, confusion and weeping to excessive anxiety, deep depression and suicidal thoughts and feelings. It is the severity of these psychological symptoms, far more severe than normal pre-menstrual symptoms that make PMDD so disturbing and destructive.

Women suffering with PMDD can find themselves unable to cope with everyday life in the week or so leading up to their period. Ordinary tasks at home or at work can be insurmountable. Getting out of bed to dress and wash is impossible. The ‘personality changes’ put relationships under enormous duress. The sudden change in symptoms at the onset of a period is a relief but much of the next three weeks will be spent in repairing and picking up the pieces. It is not surprising that women can feel they are cracking up.

Unfortunately, many women are undiagnosed, incorrectly diagnosed and they can feel as if they are regularly in torment for a long time until their PMDD is recognised and treated. An example of misdiagnosis is a diagnosis of bipolar disorder. This is because the cyclical nature of mood swings is a feature of both conditions but it fails to recognise the correlation between emotional lability and the menstrual cycle. The predictability of the changes in thoughts and feelings is a key feature of PMDD and this raises the importance of tracking symptoms. Tracking symptoms provide information over time that may reveal a pattern, in this case, the menstrual cycle. Informed diagnosis leads to appropriate treatment, this means a woman will be treated for a severe problem with her endocrine system rather than a psychiatric illness. Sometimes it is your hormones.

 

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

 

Further reading by Angela Rogers –

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?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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

The medical definition of sexual dysfunction in women is hypoactive sexual desire disorder (HSDD) that is low or no libido. Like men, women’s desire for sex is effected by all sorts of factors such as relationship issues, bereavement, physical illness and the side effects of medication, job loss or work stress, depression and anxiety, recreational drugs, hormonal changes through aging and pregnancy, child birth, miscarriage.

There are conditions such as vaginismus where penetration is too painful for women to have sex but for the moment I want to look at chemical attempts to address women’s loss of sexual desire.

Unlike Viagra which treats the mechanics of erectile dysfunction, new pharmaceutical treatments in the US that aim to improve women’s sexual problems act on the brain rather than the genitals because blood flow has nothing to do with sexual function in women. At the moment there are no licensed treatments for women’s sexual dysfunction in the UK, but two in US are available for pre-menopausal women, these are Flibanserin (Addyi) and Bremelanotide (Vyleesi). They work by enhancing the neurotransmitters in the brain that support sexual arousal, reducing inhibition and encouraging sexual excitement.

These medications demand some commitment from users. Filbanserin is taken orally every evening whether you plan to have sex or not and Bremelanotide is injected into the thigh or stomach about 45 minutes before sex, no more than once every 24 hours or 8 times in a month. There are side effects such as tiredness, nausea, headache, dizziness dry mouth and these medications should not be taken with alcohol or grapefruit juice, as this may lower blood pressure to a risky level.

HSDD treatments do not claim to make sex any better rather they claim to promote an increase in women’s desire to have sex. The research determines a positive result as a limited increase in sexual activity measured as one more sexually significant event per month.

I have looked at the anecdotal experience of US women posting online. HSDD medication is extremely expensive costing several hundreds of dollars and the jury is out on its efficacy. Many women commented on the side effects, for some there was no improvement and/or the side effects were intolerable but others were extremely grateful for the difference it had made to their sex lives.

In the UK Prelox, a herbal supplement, is marketed as improving sexual function for late reproductive and post-menopausal women. There were no adverse effects during the trials but there it was noted that any improvements maybe due to a placebo effect.

 

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

 

Further reading by Angela Rogers –

New Year’s Resolutions – why change might be so difficult

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Popping a bluey – young men and Viagra

Following on from my earlier blog about the physiological effects of Viagra, in this blog I am going to discuss some of the psychological and social issues that make young men pop a blue pill.

There is common notion that young men are constantly getting erections and always up for having sex. Various sources indicate the reality is different. Peggy Orensteins’s recent book ‘Boys and Sex’ cites a General Social Survey study showing young men between 18 and 29 are having less sex. This is indicated by the increase in the number of men who declare themselves abstinent, which rose from 10% in 2008 to 28% in 2019.

Orensteins’s conversations with young men reveal the extent of their performance anxiety. They fear that girls would be more knowledgeable and experienced and in contrast they will be unsatisfactory sexual partners. They are anxious that any inadequacy, such as not being able to undo a bra strap or coming too quickly will be broadcast to their peer group on social media and result in humiliation. They are also concerned that girls will take it personally if they can’t get an erection. Young men seem to feel that they are responsible for the success of a sexual encounter.

At the same time online pornography has set up unrealistic expectations about opportunity, performance and satisfaction. The Reward Foundation is an educational charity that focuses on the internet, love, sex and relationships; they have found a correlation between erectile dysfunction in young men and an increase in access to internet porn. Whether or not young men actually believe that the sexual relationships and encounters they view on screen are ‘real’, these representations have an impact. As a young presenter on VICE online magazine said, “In my head I’m thinking that girls will be expecting me to fuck them like a porn star.”

First dates or sexual encounters can be extremely anxious events. Dating apps like Tinder and Grinder make it easy to move on to a new sexual partner if the sex does not meet expectations the first time. This may increase pressure on men to have a prolonged erection or several erections and Viagra can be an ‘insurance policy’ or a ‘booster shot’ to ensure a good performance the first time they have sex with a new partner. If the relationship continues they may continue to take Viagra to maintain their performance and hide the fact that they took it in the first place.

So what’s the problem with young men using Viagra to perform better? If young men believe that the standardised notion of good sex is a good performance as Orenstein’s study suggested, we can see that taking Viagra would be a way to avoid some of the stress about being a good performer. Unfortunately this can create a psychological dependency making it more and more difficult to stop taking Viagra and harder to open up the subject with a partner. Like any kind of emotional withholding keeping Viagra a secret is likely to be a negative factor in a sexual relationship.

Good sex can be whatever is good for each couple and is far more nuanced and complex than a good performance. In a relationship of mutual consent sex can bring physical and emotional intimacy but sex does not always go smoothly, misunderstandings and disappointments happen. Exploring sexual dissatisfaction and difficulties makes people feel extremely vulnerable. By using Viagra to focus on performance, young men are avoiding the opportunity to speak honestly about what they expect and want from sex as well as finding out what pleases their partners. Trusting each other and exploring differences and desires together can build a stronger relationship as well as a more satisfying sex life.

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

 

Further reading by Angela Rogers –

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

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

Face to Face and Online Therapy Help Available Now

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New Year’s Resolutions – why change might be so difficult

The start of a new year feels like a good time to make resolutions to change your life. Cut down on drinking, learn something new, be more efficient, be kinder, be more sociable or get fit.

Gym memberships regularly peak in January, increasing by 10%-20% but how many of those new memberships are used? According to research by Fridge Raiders, published in the Daily Mail in March 2019, 23% of Britons have gym memberships but only 12% use them often. They estimate that more than 4 billion pounds a year is wasted on unused gym memberships.

The reasons given for the 50 percent who did not attend regularly or at all, were to do with feeling self-conscious or intimidated, thinking that everyone was watching, finding repetitive activity boring and not knowing how to use the gym equipment. These could be valid reasons but Robert Kegan and Lisa Laskow Lahey think it goes deeper. They ask why do we stick with the status quo when we are unhappy or unwell and know that change will make us feel better or even make us live longer? Kegan and Lahey have been researching the resistance to change for many years. In their book Immunity to Change (2009) they discovered that strongly held values, often unconscious, prevented both collective and individual change.

The most quoted finding from their studies comes from interviews with patients with heart disease who were told they must change their habits around eating, drinking, smoking and exercise and take their medication otherwise they would die. Kegan and Lahey found that only one in seven was able to make the necessary changes. Making further enquiries they discovered that although patients recognised the imperative of their doctor’s advice there were deep seated beliefs that contradicted their desire to get well.

A composite example would be a man who said that cutting down on food and drink and taking medication for ‘old people’ would make him feel he was old and weak. This challenged his idea of himself as a competent man in the midst of a productive life. Beneath this was his fear of becoming incapacitated and dying that brought back memories of his father’s illness and death. At a deep level the fears that prevented him taking care of himself were the very things that were likely to happen to him if did not change his habits.

There are many other examples in their book. Another composite example would be a manager who wanted to be more collaborative and involve his team in decision-making.  Until he participated in the research he did not realise how much his fear of being a weak leader prevented him from being open to the ideas of others. This feeling stemmed from the unspoken culture of ‘you must be strong otherwise you won’t survive’ in the family he grew up in and was an integral belief about himself. When he could recognise this belief and its negative impact he was able to ask for support to change and eventually become a better and happier leader.

Kegan and Lahey’s research helps us understand why it might be so hard to change our habits to improve our lives. They offer an alternative to castigating ourselves for our indiscipline and lack of commitment and, I think, suggest that we begin by being kind to ourselves and curious.

 

References – 

https://www.dailymail.co.uk/news/article-6765171/Britons-spend-4-billion-year-unused-gym-memberships-new-survey-reveals.html

 

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

 

Further reading by Angela Rogers –

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Viagra: Some ups and downs of the little blue pill

The arrival of Viagra (sildenafil citrate) came on the market in 1998 as the first drug to treat impotence. Impotence is the consistent inability among men to achieve and sustain an erection sufficient for sexual intercourse and/or to achieve ejaculation. Like the contraceptive pill in the 1960s it was greeted as a life changer giving men a chance to enjoy more and better sex when they wanted it. Of course it was never going to be that easy and the complications would take a while to emerge. In this blog I will share some thoughts on impotence and Viagra mainly in physiological terms; I will explore further psychological and relational aspects in later blogs.

There are other drugs for erectile dysfunction such as Cialis and Levitra as well as generic versions for example Kamagra. For simplicity I will use the term Viagra to refer to all the different versions.

Key findings from a 2018 survey of 2000 men, carried out by Atomik Research and sponsored by Co-Op Pharmacy, showed 43% of men between 18-60 were suffering from impotence and only 28% of those surveyed had discussed it with a GP. These are worrying figures and we can see why Viagra has been such a success story. Millions of men have taken Viagra apparently without any major incident or serious drawbacks. Although given the reluctance of men to talk to their GPs about sexual problems there may significant numbers who are suffering side effects that impair their sex lives.

Impotence is caused by reduced blood flow to the penis and Viagra works by increasing blood flow. A study of 23,000 men, cited by Pfizer the pharmaceutical company that manufactures Viagra in 2019, claims that 72% – 85% of men taking Viagra (the differences relate to the dosage 25 mg, 50mg and 100 mg) achieved erections hard enough for sex compared to 50% of those men on a placebo. This looks encouraging.

It can take around 15 minutes to one hour for Viagra to bring about an erection suitable for intercourse. On average these effects last 2-3 hours, may be up to 4-5 hours depending on your body’s metabolism. Viagra can help maintain an erection after ejaculation and can reduce the time it takes to achieve another erection following ejaculation. Some men say it can be more difficult to orgasm with Viagra, which may or may not be an advantage for their partners. Pfizer advise Viagra only works when you are sexually aroused, it does not make you feel aroused or cause instant hard-ons. In theory you will not be left with an unwanted erection if you are no longer horny.

A higher dose does not necessarily mean a better hard-on but it is likely to produce more side effects. These can include headaches, flushes, indigestion, abnormal vision, stuffy or runny nose, muscle pain, nausea and dizziness. There are also negative interactions with prescription drugs, over the counter medications and natural supplements. Viagra does not work well following a fatty meal or alcohol, which is tough for those who like to wine and dine as a prelude to sex.

There are men who do not have erectile problems who use Viagra to improve their sexual performance. However the recreational use of Viagra can be dangerous, especially if combined with other recreational drugs as in chem sex; this is an issue because chems can make it difficult to achieve and sustain an erection. Taking Viagra at the same time as recreational drugs such as chems, ecstasy, cocaine, crystal meth, poppers, and speed can produce a range of side effects including serious risks of a fatal drop in blood pressure and/or additional pressure on the heart. There are instances of men taking large doses of Viagra and enduring erections that last many hours. These are often painful and if not treated can damage the penis. In 2013 a Columbian man took a large dose and ended up with an inflamed and gangrenous penis that had to be amputated.

We have to recognise the benefits for men who can buy Viagra without a prescription, however apart from the recreational risks outlined above there are concerns about self-mediation and missing the signs of serious illness. High blood pressure and diabetes are two conditions that diminish the blood flow and therefore impotence can be a symptom. In the US diabetes is the most common cause of erectile dysfunction and impotence can be the first sign of heart disease especially in young men. If left unchecked these conditions can have long term and tragic results.

Viagra has undoubtedly helped many men and couples regain a sex life or find sex more satisfying, however this little blue pill is not always an effective treatment for erectile difficulties. Men who cannot tolerate side effects or for whom Viagra is not medically advised may want to explore other ways of enjoying sex if they are and their partners are able to talk about it. Viagra often reduces spontaneity and mean partners have to plan when to have sex, which again requires talking about it. Openly discussing the impact of impotence on a relationship is not easy; sometimes the conversation never happens. This is where counselling and psychotherapy can help by offering a safe space to have these conversations as individual or as a couple.

References-

https://www.atomikresearch.co.uk/case-studies-archive/co-op-pharmacy-erectile-dysfunction-pr-survey/

http://www.tradesexualhealth.com/sexual-health/sex-drugs/viagra.html

TRADE – Free, confidential health advice, information, services and support for the lesbian, gay, bisexual and trans communities of Leicester, Leicestershire and Rutland.

https://www.viagra.com/learning/is-it-right-for-me

Pfizer, 2019

https://www.usrf.org/index.shtml

Urological Science Research Foundation

https://www.independent.co.uk/news/world/americas/man-s-penis-amputated-after-viagra-overdose-8835146.html

 

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

 

Further Reading by Angela Rogers –

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

The Contemporary Consulting Room

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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A few questions to ask if you are having relationship difficulties

When do you think these difficulties started?

It is important to recognise when things began to change. On the other hand you might realise that to some extent it has always been like this but it is only now that you recognise that.

Think back to the time when things began to change what else was happening around that time?

Life events make different demands on different people and individuals respond differently to the same events, often we don’t realise the impact this can have on how we feel as a couple. These events might include a new baby especially a first baby; changes at work, losing a job or being promoted; a house move to an unfamiliar area; children leaving home; serious illness, caring for elderly or sick relatives or the death of a parent.

How have these events changed how you and your partner spend time together and/or communicate with each other?

Most couples, consciously or not, have regular ways that they show their care for and communicate with each other. These may part of daily life, a cup of tea in bed in the morning, a lift to the station, a chat in the bathroom. These small rituals are important in keeping the relationship ‘oiled’ and for both partners to feel reassured and affirmed.

How did you meet and get together and what was it that first attracted you to each other?

Look back to what was happening for each of you when you met and think about your expectations of each other. You might have imagined each other would bring new opportunities or offer something that was missing in the other. Maybe one of you seemed warm, expressive and sociable when the other was feeling low or lonely or maybe one of you helped the other sort out practical problems or manage a difficulty at work; perhaps you saw each other as very funny, clever or sexy. One of you might have recently been left or left a relationship and have had high hopes that this one would be very different.

 

These questions begin to reveal the underlying hopes, dreams and expectations in a relationship. These may have been unrealistic at the start, or they can become fixed and out of date. Thinking about disappointment is painful and it is easy to blame the other person for failing to live up to expectations or for changing, “You used to be thoughtful and sensitive!” “You used to care about me!” Life events make an impact and the picture keeps changing. Things that seemed important have drifted into the background, something new is brightly lit in the foreground and you can sense things emerging at the edges.

As a couple it is important to be responsive to life and what it brings for each of you, to give yourselves opportunities to reimagine what you want to create together as a couple.

 

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

Face to Face and Online Therapy Help Available Now

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The Contemporary Consulting Room

Following on from the post featuring Andrew Robinson’s photographs of the rooms at Brighton and Hove Psychotherapy, I want to think about the objects in the room in which therapy takes place.

“Both room and house are psychological diagrams that guide writers and poets in their analysis of intimacy.” (Bachelard, 1958/1994:38). This implies we have a tacit (a felt but not easy to express in words) understanding of the psychology of physical space. I suggest that the surroundings in which therapy happens are part of the therapy.

In contemporary psychotherapy there is a concern about the blurring of the boundary between the personal and professional. In the psychodynamic model if the therapist’s life comes too much into focus the client’s therapeutic potential can be compromised. It is a commonly held belief that therapy should ideally happen in a neutrally private room. However we would want to avoid any resemblance to anything cold, clinical or cell like. Freud is well known for his iconic rug covered couch and his large collection of figures that stood like a group of silent watchers in his consulting room.

A positive approach to the objects and disclosure can provide opportunities for working things through. Let’s think about books on display in the consulting room. A collection of psychotherapy books could be reassuring, showing that the therapist is well informed and takes their professional development seriously. If a client shows an interest in a particular book it can open up an area for exploration.

The impact of objects in the room can become important when a counsellor moves or there is a change in the room. Lapworth describes how when he introduced a sculpture into his consulting room, a client re-saw the room and noticed the books that had been in the room all along. When her attention was drawn to the books by the arrival of a new object, they resonated with her father and she talked about him for the first time (Lapworth, 2012:8).

Field notes the need for counsellors to take transitional objects with them, for example a rug on the floor. When she moved her consulting room a client was relieved to see the rug reappear in the new room. “We came to understand that it was symbolic of my perception of him: that I accepted him as he was; in his words ‘scruffy, imperfect, colourful and well travelled!’ ” (Field, 2007:174).

Therapists can use objects and images to support themselves in their work. A small sculpture or photograph with personal associations or special memories can help a therapist keep an open mind and feel connected with their own resources. Clients can sooth themselves through difficult times by finding reassurance when looking at familiar elements in the room.

 

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

References

Bachelard, G. (1958/1994) The Poetics of Space.

Field, R. (2007) Working from home in independent practice.

Lapworth, P. (2011) Tales from the Therapy Room.

Face to Face and Online Therapy Help Available Now

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Men, Sex and Aging in Relationships

I have previously written about women and the menopause, I am now turning my attention to men, sex and aging in a heterosexual context.

Research indicates sexual activity declines with age however as we see older people being portrayed as healthy, attractive and vigorous, we are more likely to acknowledge this age group as sexually attractive and therefore potentially sexually active.

In psychosexual terms feeling healthy, feeling good about your body and being reasonably fit are factors in feeling sexually attractive and of course these are likely to make a partner more responsive. Whilst the recognition of desire, lust and libido in the later stages of life must be a positive shift it may hide some of the struggles that older men are facing in the bedroom.

There are inevitable physiological effects of age on erectile function. Age UK says that 40% of men over 60 experience erectile problems. Erectile tissue becomes less elastic over time, testosterone levels are reduced, blood flow to the penis decreases. Apart from achieving an erection, difficulties in maintaining it, ejaculating too quickly or not being able to climax at all are common problems.

Sexual problems are frequent amongst older adults. In one study about 25% of older adults with a sexual problem said they avoided sex as a consequence. There are links between poor health and lack of sexual activity. In the same study the most common reason cited for a lack of sexual activity was the man’s ill health. Examples included drinking alcohol to excess, smoking, stress and a lack of exercise and conditions like high blood pressure, type 2 diabetes and heart disease.

Sexual problems are infrequently discussed with doctors and communication about sexual problems can be poor. Apart from the fact that sexual problems may be symptoms of an underlying physical condition, undiagnosed and undiscussed sexual problems may lead to depression and social withdrawal.

The kinds of problems that do not get discussed include concerns about medication for other conditions that impair men’s sexual performance, as well as drugs to improve sexual performance that have unpleasant side effects such as headaches and indigestion. Men might choose to stop taking medication if they feel they will have better sex without it and they may give up taking medication to improve their sex lives if they cannot tolerate the side effects.

In 2015 prostate cancer accounted for 13% of all cancers in the UK. The survival rate has been improving over the last 40 years but survivors can be left with lasting changes to their sense of themselves as sexual beings. One of the treatments is hormone therapy, which effects the production of testosterone and reduces the desire to have sex. Men put on weight more easily and can develop man boobs and they may find themselves crying more often. It is no wonder that a man might ask himself, “Am I still a man?”

In a relationship the impact of an older man’s difficulties on achieving and sustaining an erection will depend on their partner’s own experience of sex and aging. A man with a younger partner may feel he is letting his partner down. A couple may feel safer distancing themselves from each other and avoiding even affectionate physical contact in case it leads to unsuccessful sex. Men with partners no longer interested in sex may feel shameful about masturbating using pornography or fantasising about other women.

We do not readily talk about sex, it makes us feel very vulnerable. Seeking support and sharing feelings in counselling and psychotherapy can be a step to rebuilding a sense of self and sexual confidence and the start to thinking about new ways of relating.

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

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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A Couple State of Mind  

This is the first in a series of blog posts about couples therapy.  In this post I want to talk about what Mary Morgan from Tavistock Relationships calls a ‘couple state of mind’.

Why if our partner is ‘right’ for us don’t they understand us completely? There are limits to how much we can ever fully understand or know another person. As we move from away from the early stages of being in love or infatuation it can be disappointing when our partner doesn’t live up to our expectations, ‘You aren’t the person I married!” or “You’ve changed since we first met.”. What we mean is “You haven’t become the partner I imagined you would be.”

When we become a couple we are two separate people with our own ideas of what it means to be a couple and what each of us should be prepared to offer and can expect to receive. These ideas are likely to be based on how we experienced our parents’ or carers’ relating to each other, as well as the community and culture we grew up in. As a couple we will inevitably be sharing psychic space as well as physical space, the tension between wanting to be held and close and wanting our own space and freedom can be challenging.

At times, we might find our sense of our self and our reality is threatened by our partner’s version of what is happening. For example, we might feel our frequent phone calls and texts show how attentive and caring we are but our partner may feel overwhelmed and claustrophobic. One of us may feel it is important to regularly spend time apart to not become tired of each other, but this might make our partner might feel rejected and isolated. These polarised positions highlight the difficulties of holding two perspectives on what it means to be in a couple relationship.

Couples coming to therapy often do not have a sense of themselves as a couple. Thinking about what your relationship needs is not the same as thinking about what you need. This may sound obvious but it is easy to lose sight of when you are finding life is a struggle. One role for the couples therapist is to help partners contain or tolerate their differences long enough to create a shared space to think, a couple state of mind. A couple state of mind can be understood as a third perspective, a position which gives a couple a chance to step back, look at their relationship and explore what they could hope for and create together.

Couples therapy also gives each of us the chance to see our partner relating to the therapist, showing ways that two people can think together in a close and trusting way. Seeing someone as familiar as your partner connecting with another person can be surprising, they can be revealed in a different light. The therapist offers a safe and supportive environment where a couple can think together and explore a couple state of mind, to see if they can continue to develop as individuals whilst enjoying the closeness and intimacy of being a couple.

Morgan, M. (2018) A Couple State of Mind: Psychoanalysis of Couples and the Tavistock Relationships Model. London. Routledge.

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

Face to Face and Online Therapy Help Available Now

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