Attachment Archives | Brighton and Hove Psychotherapy

July 16, 2018 by Brighton & Hove Psychotherapy Leave a Comment

What does Integration mean in Psychotherapy?

Psychotherapy is many things, but on a fundamental level it is about the integration of split-off parts of ourselves.

This cannot be achieved without the integration of psyche and soma (body), which is the function of the mind. We need the mind of another to grow a mind and this is what happens in the relationship children have with their parents, if all goes well. Emotional and psychological integration cannot happen outside of the context of a secure object relationship and it is this that is the function of psychotherapy.

Far too many ‘modalities’ of psychotherapy operate in ‘silos’, possibly reflecting the medical approach to the body and mind. This makes them limiting and we end up with ‘infighting’ around “my modality is better than yours”, or “this modality is NICE approved whereas that one isn’t”…. All of this in unhelpful to clients and to the profession. Without an integrated approach to helping clients to grow and use their minds to form a relationship with their whole being, little change is likely.

Going back to psychoanalysis

The old analysts, from Freud through Winnicott, understood integration and Winnicott wrote extensively about the ‘Mind Object’: where a mind becomes an external ‘object relationship’ for the patient/client, to compensate for a lack of secure primary object, but then persecutes the individual for having an emotional world (as it cannot process and contain emotion).

In the absence of a ‘good enough’ parent, the child projects his or her mind out of the body and uses it to navigate the world, however, this is a precocious mind that cannot help the client process emotion and attacks the client for their emotions.

The function of a mind is to make sense of the psyche and soma and be an ally to the individual. Integration in psychotherapy involves the client/patient growing a mind; learning to navigate their feelings and making sense of their thoughts, all whilst accepting reality and being in relationship to others. To do this requires and integration of approaches, not least Object Relations (psychoanalysis), Attachment Theory, Neuroscience, Embodiment and Existential Givens, all held within a relational therapeutic context.

Integration vs eclecticism

Being a potent psychotherapist means therefore being able to adapt our language and thoughts processes to those of the client in order to help them grow their mind and discover how they become integrated. It relies on the ability to move between languages (therapeutic, class, gender, culture, religious/spiritual) as well as being able to move between the client’s experience and our own. This is the true meaning of integration and the difference between integration and eclecticism.

Mark Vahrmeyer is a UKCP-registered integrative psychotherapist working in private practice in Hove and Lewes. He is integrates psychotherapeutic approaches with neuroscience and the body in his work.

March 13, 2018 by Brighton & Hove Psychotherapy Leave a Comment

Lady Bird: a Psychotherapist’s Perspective on Key Themes

Ladybird

Warning – This article contains spoilers for anyone who has not seen the movie Lady Bird.

A critical success, this film about a mother and daughter relationship falls into the ‘coming of age’ genre, however it is also so much more than this in considering the systemic and unconscious processes at work that make this film both poignant and painful to watch.

There are many key themes present relating to those clients bring to psychotherapy, however I would like to pick out a couple that stood out for me which are perhaps better posed as questions we can imagine that Lady Bird (Christine), the protagonist, is grappling with unconsciously:

What is my desire?

How do I leave my family?

These two questions are in reality interconnected, as it is through desire that we leave the family. However, in a family where the roles are blurred, and for a young woman whose desire has always had to be curtailed to cope with her mother’s envy, the two questions are complex and the unconscious conflict immense.

From the opening scenes, we see a mother who struggles to see her daughter as separate to her. She clearly loves her, but also invests her own unfulfilled desires in her daughter. This is suffocating for Lady Bird, to the extent that in an early scene, she flings herself from the car to escape the literal confines of being with her mother: existence is impossible with her mother and hurling herself from a moving vehicle is less a thought-out action of leaving, than a murderous gesture – self destructive to her and to her mother.

As the film unfolds, the usual twists and turns of teenage experience are interspaced and amplified by the complexities of Lady Bird’s family. Her father is impotent – he loses his job and cannot separate mother and daughter. However, what he does know is that Lady Bird must leave, and he facilitates this through making financial arrangements for her university education, without involving his wife to whom he seems to be unable to stand up against (or to come alongside). This arrangement is pragmatically what Lady Bird needs, however, psychically it further undermines her autonomy and blurs any clarity of who she is in the family and who she is in relation to her mother.

An Envious Mother

Lady Bird understands, like so many of us who have had envious mothers, that she needs to ‘split off’ (disavow) her desire and get it met secretly, if at all. Or she can turn it into something destructive. Both choices aim to protect her relationship with her mother.

She gets in with the exciting, but bad crowd and swaps her boyfriend (who it turns out is gay) for an aloof boy who, like his friends, is nihilistic in his outlook on life. Neither her gay boyfriend nor her disinterested one will help her leave her family, as neither contain her true desire. Here Lady Bird seems to be asking herself less about her own desire and more about that of others: who am I for others and what do they want from me? A question she asks herself repeatedly in the relationship to her mother.

Owning her Desire

There are two scenes in the film which fill us with hope for Lady Bird: the first when she owns her wish to go to the school prom and be with her old friends, thereby stepping away from her less nihilistic friends who are ‘too cool’ for school, but who in reality actually have no idea about what they want, other than to rebel.

The second scene of hope is at the end of the film where Lady Bird is at an unnamed university in New York. Lady Bird’s father has slipped a pile of discarded attempts at a letter her mother tried to write to her into her suitcase which she finds. This is significant as Lady Bird’s father is finally able to help mother and daughter separate: he encourages his daughter to leave but provides her with the evidence her mother loves her; he assumes his rightful position as his wife’s husband by consoling her at the airport when she, as a result of her struggle to let her daughter have her own desire and individuate, misses her daughter’s departure.

To Individuate or Rebel?

Towards the finale, there is a perfectly ordinary scene with Lady Bird, at what me must assume is her first party in New York, she drinks, meets a guy and they end up at his or hers. She then becomes ill and the next scene is at a hospital where we learn she has drunk far too much. This scene is a reminder of the powerful unconscious forces at play in Lady Bird – whether she can find a way to individuate and own her desire or create distance from her internalised mother through self-destructive acts (think back to the hurling herself from the car).

Ultimately the viewer is left with hope as she seems to have enough psychic distance to claim her birth name – Christine – and to find ways to be like her parents (visiting a local church), without having to be defined by being them, or not being them.

Christine makes a call home to speak to her mother but she gets the answerphone. The message here? That her mother and family can survive her going and that they can too move on with their lives. She is free.

Sam Jahara is a UKCP registered psychotherapist, certified transactional analyst and clinical supervisor. She works with clients and supervisees in Hove and Lewes.

Image copyright: A24

December 4, 2017 by Brighton & Hove Psychotherapy Leave a Comment

Adolescent self-harm

Self-injury or self-harm is when a person deliberately hurts themselves to deal with emotional pain. Mostly, people self-harm by cutting themselves, but it can also include scratching, bruising or burning.

When your child self-harms

It is shocking to discover that your child is harming themselves. It often happens after a period of worry about your teenager that you can’t quite formulate. Most self-harming teenagers are seeking quick relief from emotional distress. Many have poor emotional coping styles, for example, getting angry, blaming and isolating themselves and engaging in substance abuse.

Some of the most common reasons teenagers give for self-harm include (Selekman, 2006) a desire to have control, to alleviate emotional pain and distress, to feel alive or to feel numb. Other common reasons given are to feel connected to friends, to stop bad thoughts, self-punishment or to hurt others.

Research has shown that many adolescents who self-harm engage in other self-harming behaviours such as bulimia, substance abuse and risky sexual behaviour.

There is a strong link between eating disorders and self-harm, and in particular, body image issues and self-harming behaviours. Recent data from GPs identified that while rates of self-harming in boys has remained the same, there has been a massive 68% rise in self-harm in girls. One possible reason for this is thought to be stresses related to the exposure to digital media.

What should you do if your child or teenager is self-harming?

Be available for support
Listen
Don’t get angry when they self-harm

Be aware about social media and peer pressure. Friends can be a support system. In some cases, groups of friends may use self-harm as a coping mechanism.

Self-harm is often a secretive behaviour and exposure may cause feelings of guilt, shame and distress. Your child may not be able to talk immediately. Your first conversation on the subject is important, as it sets the tone for future trust. Many parents urgently want to know why and what they have done wrong. Sometimes the ‘why’ is complex and there may not be a ready answer.

Self-harm is non-suicidal behaviour and it does not mean that your child has a mental illness. However, if you are worried that your child is thinking about or planning suicide, you need to get urgent medical help.

What helps?

Developing a trusting relationship with a therapist who can work with the young person, involving their family (where possible) to develop emotional resilience and coping strategies.

Angela Betteridge is a couple and family therapist working at The Barn in Lewes.

Please contact us if you would like to discuss an appointment. Angela is available to see adolescents individually or with parents /carers.

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November 27, 2017 by Brighton & Hove Psychotherapy 1 Comment

What is Psychotherapy?

In this age of jettisoning the past and continually embracing the new, the answer to the question of how psychotherapy works has remained largely unchanged since the days of Freud. Modern enquiry and comprehension brings the capacity to understand what happens in the brain as a result of effective analysis, psychotherapy, or indeed, good enough parenting.

To use an analogy, Freud worked out how to bake the cake of psychoanalysis and with it, what ingredients to use. Modern science has the capacity to empirically prove how those ingredients work through neuroscience research. In this piece, I shall concern myself solely with the main ingredients of what is needed for effective psychotherapy. Although they are but two, how they are applied marks the difference between an amateur cook and a master chef.

In 1968, Michael Balint, a psychoanalyst in Britain, wrote the following ‘recipe’ for effective analysis which holds true for counselling and psychotherapy to this day:

“Although, as a rule, it is not stated quite so implicitly, we are compelled to recognise that the two most important factors in psychoanalytic therapy are interpretations and object relationship. It should be borne in mind, however, that with the latter we are on comparatively unsafe grounds because psychoanalytic theory knows much less about it.” (p159, The Basic Fault – Therapeutic Aspects of Regression)

Balint is making two important points in this brief paragraph. Firstly, he gives us the key ingredients of what makes psychotherapy work. Secondly, he tells us that while object relationship is an essential ingredient, in 1968, psychoanalysis lacked an understanding of why that is.

A basic cake ingredient remains the same through the generations. No doubt, there are scientific reasons to explain why the chemical constituents of flour and egg make a good cake. This is also true of Balint’s main ingredients; interpretations and object relationship, or, put more simply, understanding ourselves and the importance of the therapeutic relationship.

Understanding, or, Knowing Thyself

Insight and understanding is a key tool in making changes. If clients can form a compassionate – and that word is key – understanding of how their past relationships (object relationships) and experiences have shaped them, they can develop the capacity to change. However, this possibility of change is entirely contingent on the therapeutic relationship they form with their therapist. Insight alone cannot lead to change. This is the fundamental answer as to why the many shelves of self-help books comprising an ever-increasing proportion of high street booksellers, never really lead to any change in their hopeful authors. Change requires a relationship in which loss can be worked through and trust built in a new way of relating; trust that the other person in the relationship (the psychotherapist) will not let the client down. At least not catastrophically.

Object Relationships

Why can change only take place in the capacity of a relationship? In the past, I have written blogs about the therapeutic relationship and its importance, as well as on the principles of attachment. However, to recap, psychotherapy is about re-parenting. On a fundamental level, it is about helping the client to experience a good enough relationship where they are listened to, cared about and held in mind. Through this, the client can start to develop their own mind, and over time, hold themselves in mind in ways they have not been able to do in the past.

If the therapeutic relationship is so important, why is it not enough? It can be argued that affective attunement is about offering interpretation, if interpretation is about helping a client to understand why they feel, think or behave in a certain way. Is this not, after all, what a good enough mothering relationship provides, minute by minute, hour by hour and day by day?

To contradict myself, it is also too simplistic to simply suggest that the object relationship with a psychotherapist is akin to re-parenting. It is far more disappointing and frustrating than that. It is, for the client, a coming to terms with the stark reality that they cannot and will not ever have the mothering they needed for the child they once were. It is the working through of this and then, ultimately, the abandoning of infantile objects – unconscious childhood trauma driven states of mind – for adult objects – conscious adult states of mind that can tolerate the limitations of adult life and adult relationships; a tolerance of pain and abandonment of pleasure.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

How does attachment influence parenting?

Parenting is a difficult job. Our main blueprint is our own experience of being parented. When we share parenting with our partners, two blueprints come together. This can be a point in the family life cycle which causes fractures in the couple relationship. Many couples come to family therapy at this stage and quickly realise the couple relationship, as well as the parenting relationship, is in need of some adjustment.

Authoritative parenting

Authoritative, as opposed to authoritarian, parenting is responsive to children’s age-related needs and ability. It typically has clear boundaries which are flexible and adaptive as children’s needs change.

As adults we bring our own (often quite strong) beliefs to parenting. Our beliefs are based on whether we want to replicate our own experience or do something reparative. Insecure attachment can impact on parenting and relationships in a number of ways. Adults who have felt secure in childhood are more likely to have good adult relationships. However, sometimes, a good secure couple relationship can mitigate an insecure childhood experience.

Attachment and parenting styles

There are four major recognised parenting styles:

• Authoritative -responsive, clear expectations, consistent
• Authoritarian –demanding and reactionary
• Permissive –too responsive and undemanding
• Uninvolved – unresponsive and undemanding, disinterested

Our experiences of how we were responded to when we were children impact on how we see ourselves and the expectations we have in our relationships. This is particularly true at times when we feel frightened, anxious and uncertain. These form our internal working models and can be applied to any adult relationship.

Attachment work in couple and family therapy is layered and complex. It brings together our own and our partner’s working models and seeks to understand how they impact on the couple’s relationship, parenting and other relationships, including with colleagues and friends.

If we only worked in the behavioural domain, we would be doing our clients a disservice. We need to be able to acknowledge and understand our own processes and how our life experience has influenced our internal working model. With the help of a skilled therapist working systemically, you can change patterns that aren’t working and make choices about the future.

Angela Betteridge is a couple and family therapist working at The Barn in Lewes.

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