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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  Many believe we have ‘evolved’ beyond his ‘outdated’ theories and indeed, there are views and  theories of his that are no longer literally relevant.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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The Problem with Change

When people come into therapy it is usually with the wish or hope for something to change. If not, they want help with adapting or stabilising following a major change.

It is a paradox that change is such a constant in our lives. As we age our bodies inevitably change and if nothing else this makes living itself a profoundly transitional experience.

Changes in our lives can come in many forms. For example, there are key developmental milestones at various life stages – adolescence and mid-life are perhaps the most discussed of these.

Significant events in life can also impact and bring about profound change in ourselves. These changes always involve beginnings and losses and can lead to crisis. Crisis too can bring about change. Even positive changes – like getting married or starting a new job for example – are often cited as highly stressful, so societally we very much recognise the equation of change and crisis.

Psychotherapy and psychoanalysis have had huge influences in how we might understand changes and crises in life stages and events.

For example, Elliott Jaques, a Canadian psychoanalyst, coined the term ‘midlife crisis’ in his 1965 paper (1). Jaques wrote about how this crisis repeats earlier intense transitions from adolescence and infancy and explored what he saw as a tendency for the individual to lose or discover creativity as a response to this life-stage.

And it is largely due to Winnicott’s seminal work (2) that we understand the level of intense feelings that typifies adolescent transitions, when the young person is caught in a fraught conflict between childhood and adulthood.
In psychotherapy we think about therapeutic change, meaning an internal change for the better. I think most people come into therapy welcoming this idea of inner change and certainly those who are assessed as being suitable for psychotherapy will partly be so on the basis that they recognise the need for some internal change.

Initially in therapy, changes are often experienced as positive. Being heard and supported and gaining insight generally increases confidence and a sense of self. At the same time people can find quite that more negative feelings towards themselves seem less extreme. These changes are important and real. However, deeper changes that take place in therapy, in my experience, are not always so welcomed. This is partly because of the disruptive nature of change and its relationship to crisis.

Undergoing the kinds of powerful changes that therapy can offer can feel destabilising and bewildering. As mentioned earlier, change always involves loss of some kind. What might need to be given up may be experienced – consciously or more often unconsciously – as vital to the person’s sense of self. Even unwanted aspects to one’s psyche and behaviour are still familiar and what is known is experienced as safe, even when it is also recognised as harmful and self-limiting.

While we might recognise the likelihood, even perhaps inevitability of crisis in change, experiencing this in therapy can, for some people, feel understandably counter-intuitive.

Many people who come through therapy find a way of tolerating and working through these unsettling if not disturbing experiences of therapeutic change. But some become too frightened or overwhelmed and may then leave suddenly.

In my experience, those who stay are able, with the support and help of the therapist, to recalibrate and restabilise – much as after major life stages and events. As things settle, they can then experience and enjoy the positive benefits of the internal work and changes they have undertaken. However, inevitably and necessarily, in time the problematic process of change will be repeated.

 

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?

 

References – 

Death and the Mid-Life Crisis. Elliott Jaques, 1965
Contemporary Concepts of Adolescent Development and their Implications for Higher Education, from Playing and Reality. Winnicott, 1971

Online Therapy for Bereavement

Grieving is an emotional, psychological and physical response to losing someone we’re close to. It can be an unsettling experience and many people feel as though something is wrong or missing from their life. Elizabeth Kubler-Ross’ Five Stages of Grief outline the core emotions as denial, anger, bargaining, depression and acceptance. But there are countless other emotions you may feel as a result of losing someone, which can make it confusing to comprehend. Online bereavement therapy is a popular way to help you deal with loss.

What is Online Bereavement Therapy?

Online bereavement therapy can be beneficial in helping you cope with your loss and come to accept what has happened. You’ll speak with a trained counsellor who has experience in helping people grieve and the issues that surround bereavement.

Since grief is often accompanied by feelings that are similar to depression, it can be all too easy to rely on anti-depressants to heal you. But this can often mask the impact of grief and delay the grieving process, causing more harm than good.

Online therapy will enable you to work through what has happened and come to terms with it. A counsellor can also help you understand that grieving is not a neat process and even after you’ve accepted your loss, you may still have difficult periods occur in the future. Your therapy may last several months or even longer – it all depends on the individual and how they process such events.

How Can Bereavement Therapy Help Me?

Some people find comfort in talking about how they feel, while others may find it difficult to talk about their emotions and withdraw from those around them. Grieving is incredibly tough, but you don’t need to feel as though you’re on your own. Offloading your worries and feelings onto someone else can be beneficial and help you work through the stages of grief.

Online bereavement therapy can help you during this mourning process – you’ll have the support of a trained professional and everything you discuss with them will remain completely confidential. It can help to discuss your loss and identify the emotions you’re feeling, whether it’s sadness, anger, guilt or helplessness.

Your counsellor can also help you in learning to live without the person you’ve lost, something that can be daunting. With the support of a counsellor, you’ll soon realise just how common and natural your responses to grief are which can make these emotions easier to deal with.

If you want to talk to our team, contact us today or take a look at our practitioners.

All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.


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Why do ex-boarders find intimate relationships difficult?

What is the purpose of intimate relationships?

This is a question I often ask couples who come to see me for couples therapy. Most cannot answer the question beyond the superficial. However, it is an important question to ponder: relationships are not easy for the most well-adjusted of us and so there has to be a fundamental reason why we (generally) choose to pair bond (be in a committed intimate and romantic relationship with one other person).

I believe that we choose to pair bond as on an unconscious level it is the closest that we can come as adult humans to replicating the ideal) experience of childhood where we had a parent who was there for us, who would listen to us and who, most importantly, would help us make sense of our feelings so that we knew we were not alone. This is essentially what strong functional couples do – they listen to each other and try and work out what feeling their partner is trying to convey to them. The general term for this is empathy.

I therefore believe that this explains what we all want and why we all go into relationships. And also why so many of us keep on trying to find ‘the right person’ even after so many disappointments.

What happens to boarders?
Ex-boarders also harbour hope of a good relationship, however, may be at odds in identifying one. The attachment damage they have sustained and the abandonment (couched in privilege) that they have experienced, leaves them unconsciously yearning for that idealised mother who will be there unconditionally for them. Of course, what they eventually find in any relationship with another adult is that they are not in an unconditional relationship (no such thing exists) and then they withdraw to avoid being hurt or disappointed.

What does it look like?
We are all different and so are ex-boarders, however, many have some traits in common which I shall list:

Ex-boarders tend to-

  • Withdraw emotionally from relationships in order to keep themselves safe and default to their indolence survival strategy;
  • Struggle to make sense of what their emotions are telling them and lack the ability to navigate them without becoming overwhelmed: ex-boarders are good under pressure until they are not;
  • Have an over-reliance on logic and rationality to make sense of the world – this does not work when confronted with a partner who is trying to share their emotions;
  • Regulate (read manage) their emotions by controlling their external world – exercise, career success, sex, alcohol, drugs etc. Some may be less harmful than others but all show an inanity to be in contact with their inner world;
  • Live a pseudo-life where they can never really allow themselves to feel alive as that can only happen through bringing themselves fully into relationships and navigating their needs through communicating boundaries.

What can be done?
The effects that the abandonment a child suffers from being sent to boarding school can be enormously significant. Often ex-boarders will only resent for therapy when they have ‘hit a wall’ in some way.

Psychotherapy can help and indeed is the only way to remap the brain and help ex-boarders come to life. As the damage is relational, the only remedy is a therapeutic relationship where the cut-off feelings of loss, abandonment and emptiness can be retrieved and experienced in the safety of a psychotherapeutic frame.

 

The term ‘Boarding School Syndrome’ was coined by Jungian analyst Professor Joy Schaverian around a decade ago. Since then, it has gained significant traction as a model for explaining the experiences and symptoms of adults who were sent away to boarding school as children.  Please refer to Mark’s previous blog.

 

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 ready by Mark Vahrmeyer –

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

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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What is ‘Blocked Care’ as it applies to parenting?

The phenomenon of parental ‘blocked care’ is a term coined by Clinical Psychologists Dan Hughes and Jonathon Baylin and Psychiatrist Dan Siegal. It represents a central feature of the Dyadic Developmental Psychotherapy (DDP) approach to treating children and young people with a history of developmental trauma and attachment disruption.

Research into the areas of attachment, trauma and neurobiological development, are teaching us that children’s brains are shaped on a neurological level by their earliest caregiving experiences. 

We now even know that an infant’s brain is primed, even in utero, to adapt to the type of care that it anticipates receiving from its primary caregivers in order to maximise its chances of survival. 

The Five Care Systems in parents

What is perhaps less known however, is that parents’ brains are also neurologically influenced by their experience of caring for their child – that the relationship is symbiotic. When things are going well, we now understand that five main areas or ‘care systems’ in the parental brain are optimally functioning. These are:

  1. The Approach System: The system that enables us to fall in love with our children, to crave to be with them and to become completely absorbed in them. This system is associated with the release of oxytocin (colloquially known as the ‘love hormone’).
  2. The Reward System: The system that enables mutual delight and attunement when a parent interacts with their child. This system is associated with the release of dopamine (the ‘addictive hormone’).
  3. The Child Reading System: The system that enables parents to positively interpret our child’s behaviours and motivations and to remain interested in their unique qualities.
  4. The Meaning-Making System: The system that enables parents to think positively and meaningfully about their relationship with their child.
  5. The Executive System: The system that enables us to physically care for our children.

For some parent-child dyads however, things do not go so well and these care systems do not operate optimally. For example, some parents may face unmanageable levels of stress whilst caring for their infants, which may be exacerbated by their own poorly developed care and emotional-regulation systems. 

Others may be offering reparative foster parenting to children who, owing to previous experiences of abusive or neglectful parenting, now fear, mistrust and reject the care they are being offered, which can be extremely painful for their new carers to bear.

The real risk when things go wrong however, is that parents may enter (chronic or acute) periods of ‘blocked care’. When this happens, the first four systems listed above start to shut down. The parent no longer experiences joy or fulfilment of being with their child. They do not get the rushes of oxytocin and dopamine that other parents get, and they do not seek to be with their child.

These parents also become much more likely to interpret their child’s behaviours and motivations from a negative perspective (e.g. “he is manipulating me” or “she is a spiteful child”) as well as their own relationship with the child (e.g. “I am a rubbish parent”).

In psysiological terms a stressed out parent is operating in ‘survival mode’. They are no longer able to remain open and engaged to the child’s emotional and developmental needs and are simply coping. 

Without external support, the final care system – the executive system –  may also start to shut down. This is the point when we start to see abusive or neglectful parenting emerge where parents are physically unable to care for their child or children.

The growing evidence-base for blocked care highlights the crucial need for psycho-education, as well as early and non-judgmental support to parents and carers who are most vulnerable to it.

 References:

Hughes, D. & Baylin, J. (2012). Brain-Based Parenting: The Neuroscience of caregiving for healthy attachment. Norton

Hughes, D. & Baylin, J. (2016). The Neurobiology of Attachment-Focused Therapy: Enhancing Connection & Trust in the Treatment of Children & Adolescents. Norton

Siegal, D. & Hartzell, M. (2003). Parenting from the Inside Out. Tarcher/Penguin

 

Please follow the links to find out more about about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

Face to Face and Online Therapy Help Available Now

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How are you going to Spend Your Emotional Currency in 2019?

Perhaps it seems odd to you to even think of emotions having an intrinsic value, isn’t it all rather cold and controlling.  However, alongside purchasing a house, a car or other valuable object our relationships will need energy and investment of time to make them work well.  

So in the next twelve months, wherever you are in the partnership process, there will be things to consider that will require the investment of emotional energy. If you are single you maybe considering looking for a partner or hoping love comes along, whichever way you approach this, a life-long partner will be one of the most important emotional investments you make. 

Although many of us go about this in a haphazard way, without giving sufficient thought to what we need to make a commitment to another person. Often we are under pressure from parents or peer group and the ever-present biological clock to get on and find someone or consolidate an existing relationship.

Some of us who are members of a religion will have priests or clergy to go to for advice and preparation before entering into a full commitment.  However, this usually occurs after the couple have met and decided to enter into a long-term relationship.  At this point the intention has been shared with family and friends, when it is more difficult withdraw, if the preparation phase uncovers areas of incompatibility in the relationship.

I have wondered, through working with couples, whether this should be done earlier in the relationship as soon as couples find they are talking about their future together.

Falling in love is an intense emotional, biological and physical experience, at times expressed as akin to madness.  Delightful though this period of time is, it does hinder good decision-making.

Couples will come after a crisis, wanting help to mend a relationship after an event or betrayal has injured the mutual trust in the relationship.  Or they come when a life event, such as the birth of the first child, loss of a job, children leaving home, retirement, illness or bereavement.  All of these events put demands on the relationship, and people handle them in different ways.  It helps to have a supportive family or friendship network around to contain and hold the couple as they navigate their way through these life-changing processes. All require the expenditure of emotional energy to maintain the relationship on an even keel.

So ideally we could envision a couple coming to relationship counselling before they finally decide this is the person they feel able and want to make this commitment to for the rest of their lives.

Dorothea Beech is a UKCP-registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst providing long and short-term psychotherapy to both couples and groups in Hove and Lewes.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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How Psychotherapy Taught me to Live Life

This piece is written by a ‘fictional’ client who is a composite of three real-life clients who have shared their experience of psychotherapy with me.  Some details have been changed to ensure confidentiality, however, the thoughts feeling and experiences expressed are those of three very real clients:

When I came to psychotherapy I did not even really know what it was.  I knew I needed something because I knew I was struggling but whether that something was counselling, psychotherapy or what I simply had no idea.

As well as not having much of an idea about what to expect from my psychotherapy, I also had no idea about how long it would take.  And I was impatient!  It is therefore with a surprise that I look back upon my two-year journey of weekly one-to-one psychotherapy with some degree of awe with regards to how little I really understood what I needed and for how long; from my initial impatience, a sense of appreciation and security developed from knowing that on Tuesdays, at 5pm, I would be seeing my psychotherapist.

Where I say that psychotherapy taught me how to live life, I mean this in the sense of courageously living rather than existing.

Prior to psychotherapy I approached life and relationships from a default fear position.  Not that I knew that at the time – the way I was all seemed perfectly normal to me.  Normal is, after all what we are familiar with.

However, part of me also know that I felt unfulfilled and lacking in purpose and meaning.  Meaning in terms of my own desires and meaning in terms of what relationships could offer me.

It has been through a slow process of learning to be in relationship with my psychotherapist that I have slowly learnt to have a healthy relationship with myself.  Through being held in mind, I have learnt to hold myself on mind.  And through trusting that the relationship with my psychotherapist was and is genuine, I have come to accept that just perhaps, relationships with others have something to offer me.

I am now two years into my ‘ongoing’ psychotherapy relationship.  It has been hard, frustrating, frightening, constructive, containing and life enhancing all in equal measure.  The only commitment: we both show up each week for the session.

How have I changed

Most of all I have let go of the past.  My experiences still happened, of course.  There is no magic to undo that.  However I have accepted that I can still have a life without having gotten what I needed as a child.  And through this have come to accept that I can treat myself differently to how I experienced my parents treating me.

My relationship with myself

‘Has psychotherapy made you happy?’, people I know sometimes ask me.  No.  But then happiness is not the purpose of life.  I do, however, at times feel content and even happy.  More importantly, I am able to feel the full range of human emotions without running away from them.  I can navigate my emotional world using my mind in a way I simply could not before psychotherapy and instead would use all sorts of distractions to avoid feeling.

My relationship to others

I have far deeper and more authentic relationships with others – something I now realise I avoided in the past for fear of them really seeing me and then rejecting me.

Relationships have become important to me and I am far more able to tolerate difference in those around me – to accept that they have different minds.

In summary

Put simply, my life now has substance.  I know more about who I am, who I have been and how I spent much of my life hiding from myself and others because of not feeling accepted; I now have compassion for this part of me.

Mark is an integrative psychotherapist primarily informed by attachment theory and object relations psychotherapy.  He works relationally and sees individuals and couples in Hove and Lewes.

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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.

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Lady Bird: a Psychotherapist’s Perspective on Key Themes

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.

 

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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.

Further reading on this subject:

How does counselling or psychotherapy work?

What is transference?

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Grief – how to grieve?

Grief is often referred to in the context of intense feelings experienced with the loss of a loved one. The loss we experience is often caused through death. Grief is, therefore, synonymous with bereavement.

This, however, is nowhere near the whole story. In order to know how to grieve, we need to understand grief.

When we are told that someone is grieving, we may assume they are feeling intensely sad. Although this is often true, grief is comprised of a multitude of emotions, and sadness is only one. One of the early pioneers of grief work (yes, there is such a thing), was Elizabeth Kübler-Ross. She suggested grieving was an active process that required a “working through of emotions” broken down into five core groups: denial, anger, bargaining, depression and acceptance. Sadness would fall into the ‘depression’ group in this model.

Since Kübler-Ross, plenty of other models have been proposed. All of these have added something to the field. I will not directly elaborate on these in this blog, but further information can be found on the Internet.

Grief is, therefore, an umbrella term for a whole host of emotions, and it is a verb.  It is something that we must allow ourselves to experience and actively engage with.

 Why should I grieve?

Emotions exist within us, whether we consciously acknowledge them or not.  Where we are unable to feel them (through repression, which is always unconscious) these emotions will often express themselves as a conversion reaction. They will be expressed through the body such as in aches and pains. They may be expressed through even more obscure symptoms, such as a loss of physical movement.

Where we are aware that we are feeling grief, but actively suppress the feeling, emotions are likely to manifest as anxiety or depressive symptoms, which can persist for years.

Thus, there is no escaping it, grief must be felt and ridden out, like a storm. To complicate things further, it is not a linear process. We might have felt anger (perhaps with our loved one for leaving us) and moved onto bargaining (“If only I had done more for them…”) However, this does not mean that we will not return to anger again. And again…

We must grieve because we need to acknowledge what we feel.  If we do not (because we can’t or won’t) things get complicated.

How do I grieve?

Grieving (in the context of bereavement) used to be a socially prescribed activity which was both acknowledged by the wider community and defined as a process. Those who were bereaved would often wear symbols of their grief – black clothes or a black armband. Within their community, it was acknowledged that they would be grieving for a set period of time, often a year. This practice has largely been lost in northern Europe. However, in southern Europe, it remains common in more traditional communities to see widows wearing black for the remainder of their lives.

Religion

Love it or hate it, the one thing religion gave (or gives) us is a powerful story of what happens after we die.  From the Vikings with Valhalla to the Christians and Heaven, the concept of an afterlife can bring great solace to loved ones who are left behind.  The loss of socially prescribed ways of mourning, combined with a loss of religious beliefs, has made grieving more difficult.

Meaning making

A universal task in coming to terms with grief is to find some sense of meaning within it, and to weave this together into a narrative. We are no longer provided with cultural narratives in the way that we once were. This then becomes something that we need to do ourselves.

Why is grief hard for some people?

When I embarked on my own professional psychotherapy career, working directly with dying patients and their relatives, I imagined that the loss of the deceased would be felt most acutely where relationships had been close, connected and happy. However, the inverse was true. Where relationships had been difficult, strained, or even devoid of contact for long periods of time, the bereaved would often struggle to process the loss far more. This occurred particularly where the relationship was between a parent and their (adult) child.

The reason for this lies in attachment and in how we learn, through attachment, to feel.  For those of us lucky enough to grow up in homes where there is no abuse or neglect, and no unexpected losses, we find it relatively easy to move in and out of relationship – to say ‘hello’ and ‘goodbye’. With the security of the relationship comes an ability to feel emotions and make sense of what is being felt. Thus, the process of grieving, whilst hard, is something that can be actively undertaken.

In some parent/child relationships, the child has been significantly disappointed by the parent in the past. Parental neglect and/or abuse can lead to an accumulation of unacknowledged earlier losses in the relationship. In these cases, the final physical loss of the parent can make it very hard to come to terms with the enormity of all the losses that person represents. The loss is not only of the relationship and person, but also of hope. If the relationship between parent and child was strained or difficult, it is likely the bereaved will be poor at navigating his or her emotional states. This makes grieving terrifying, at best, or unthinkable, at worst.

Grieving is normal

As a clinician, I get a lot of fulfilment in helping clients to grieve. It is different from any other presenting issue they bring to me. Grief is the universal leveller. We will all experience it at some point in our lives. The way out and through grief is always the same – we have to feel the full range of emotions that our grief brings up.

Grief is not a mental health condition, and yet many people become stuck with their grief. When this happens, the secondary symptoms can mutate into more complex conditions such as anxiety, clinical depression and panic attacks.

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.

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What is a personality?

We all use the word ‘personality’ in everyday language. We might use it to describe how we experience another person (“She has a nice personality.”) We use it to describe elements of how a person may behave, in the case of personality traits.  And sometimes we use it interchangeably with the word ‘character’ to describe somebody. But what actually is a personality, and why does it matter – particularly when it comes to psychotherapy?

As the word ‘personality’ refers to the mind of a person, and as no human has ever seen a mind, in essence, the term is an abstraction. It’s an idea, a way of understanding how we tick, not a concrete object.

The dictionary suggests that a personality is a collection of characteristics that make up somebody’s character.  What, then, is character?  According to the dictionary, it is the mental and moral qualities distinctive to a particular individual.  And character is apparently synonymous with personality!  Confused yet?

OK, so this is how we mental health professionals generally understand personality. Personality is made up of two distinct categories – temperament and character (there’s that word again).

Temperament

Temperament is considered to be the traits that we inherit from our parents – either genetically, or through other biological means.  A person’s temperament may be a higher predisposition to anxiety, a genetic predisposition to addiction, or to being quick to anger. We are either born with our temperament. or it is developed in utero or shortly thereafter.

Character

Character, in contrast to temperament, is something that emerges at a slower rate as we grow, explore our world, relate to our caregiver and mature.  For example, we learn how to relate to others (particularly in close relationships) through our own attachment story with our primary carer. This way of relating takes place over a significant period of time.

Nature vs Nurture

We can substitute ‘temperament’ for the word ‘nature’ and ‘character’ for the word ‘nurture’ to keep things simple.  While most forward-thinking counsellors or psychotherapists will acknowledge that nature and nurture both play a significant role in defining our character, the jury remains out as to exactly where the boundary lies between the two. In fact, there may be no boundary at all!  For example, it is now increasingly accepted that what matters is not so much a genetic predisposition, but epigenetics – how our genes interact with our environment.  Therefore, just because someone has a genetic predisposition towards alcoholism, if they are raised in a loving home where they can develop a strong, solid sense of identity, it is unlikely they will become a full-blown alcoholic.

Why it matters

Therefore, personality matters as it is a word that encapsulates a large part of our identity and mind.  And in mental health, it is particularly important, as when clinicians treat clients or patients, the work will be significantly different depending on whether the presenting issue is an isolated issue, such as anxiety, or whether the problem relates more to the structure of a person’s personality. Just to confuse matters further, if a client presents with anxiety and has traits or a diagnosed personality disorder, the work will be lengthy and complex.

In Lay Terms

If who we are – how we experience ourselves and relate to others – is dysfunctional, damaging or harmful, then deep psychotherapy is required to restructure the personality. As personalities have taken a long time to form, it takes time for them to change. And because personalities are made up of temperament and character – nature and nurture – how much change is possible is something the therapy will uncover. The goal of depth psychotherapy is, of course, to change the level of the personality. However, it is also about developing kindness and compassion for one’s personal limitations and accepting these so we may lead a calmer, more fulfilled life.

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.

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Child Therapy

How Can Child Psychotherapy Help my Child?

The process of meeting with a child psychotherapist can help make sense of how a child is feeling and offer support for many issues and concerns, which can include difficulties with relationships, concerns regarding school, aggression, low self-esteem or a lack of confidence, as well as more serious mental health conditions including depression, anxiety, eating disorders and self-harm. Child therapists can also support children and young people with learning difficulties and disabilities, as well as young people who are suffering the effects of neglect and abuse.

How does Child Psychotherapy Work?

Child therapists support children and young people by responding to what might be being communicated through talking, creativity, behaviour and play. Young children do not usually talk openly about their difficulties and will often communicate feelings and thoughts through play, the arts and by using the toys provided in the therapy room. Older children and young adults may also use the arts to explore how they feel or they may like to talk through experiences and any associated feelings. Over time, anxious, hurt, angry or upsetting feelings can be put into words rather than actions and the child or young person can be helped to make sense of their feelings and experiences.

The therapeutic process can be short term or long term with each appointment often lasting 50 minutes. More often than not children are seen individually, however sometimes children and parents are seen together or sometimes parents or carers meet with the therapist without the child being present. Child therapists can also offer support to other professionals working with children including teachers, learning mentors, social workers, health visitors, and youth workers as their skills can help make sense of more complex behaviour, as well as offer advocacy to children facing complicated and difficult life experiences.

Child Therapists

We have a number of practitioners who are child therapists and highly experienced in working with children and teenagers. They are able to cover a range of issues.

Sharon Spindler is an experienced UKCP systemic and family psychotherapist with experience in both the NHS and with private patients. Sharon is able to work with families and children and young people up to 18 as well as adults. She has experience in dealing with anxiety issues, eating disorders, communication problems, self harm, identity issues and more.

Georgie Leake is a NVR UK accredited Advanced Level NVR Practitioner. She holds a BSc (Hons) in Psychology, a Master of Education (Special Needs and Inclusive Education), a Master of Arts in Social Sciences and QTLS. Georgie is available to provide NVR support to birth-, fostering and adoptive families. Typically her work involves consultation with parents and does not require the direct involvement of the child, though the work is flexible according to the needs of each family.

We have practices in Lewes and Hove and have clients from right across Sussex as well as London and further afield. To find out about the help Brighton & Hove Psychotherapy can offer get in touch with us today. 

All the content on this page has been reviewed and vetted by Sam Jahara Transactional Analysis Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.


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What is transference?

I am sometimes asked, “What is transference?” Some clients are strongly negative towards the idea (of how they understand) the concept. A blog seems like a good opportunity to de-mystify this term and emphasise its importance to psychotherapy and to psychodynamic and psychoanalytic counselling.

Freud Again!

The notion of transference dates back to Freud. He used the term to describe how patients (clients) will project, or quite literally, transfer their feelings from a significant childhood relationship onto their psychotherapist.

The notion of transference is not limited to the therapy relationship. It’s something that affects many of our close relationships with others, particularly our partners. For instance, we may respond with anger or frustration if we ‘hear’ our partner use a tone of voice or phrase that a parent once used with us. Conversely, we may be drawn to someone because they remind us of a family member with whom we enjoyed a close relationship.

What’s Wrong With That?

The underlying principle of transference is that it is an unconscious process and therefore, we are unaware of it. While we are engaged in unconscious processes, the conscious part of us is always playing ‘catch-up’ by inventing reasons for why we behave in a certain way or for the way we feel about another person.

In the therapeutic relationship, the client starts to transfer ideas, fantasies, and feelings onto their therapist. This occurs because the client knows relatively little about the life of their therapist. What is transferred by the client onto the therapist becomes the basis of the collaboration in understanding the client’s relational patterns, childhood traumas and unresolved conflict.

Counter-Transference

Counter-transference is the term used to describe what the therapist feels in relation to their client. It is the therapist’s part of the entanglement of the relationship. It enables the therapist to become aware of what the patient may be feeling towards them or eliciting in them. Counter-transference shows why it is so essential for psychotherapists to be well trained and to have undergone their own rigorous analysis or psychotherapy. This enables therapists to distinguish which feelings come from their own unconscious process, and which are counter-transferential.

So transference matters?

Transference is the foundation of the work in any method of psychotherapy where the unconscious forms the basis of understanding a client’s struggles.

Is transference risky, or something to be scared of?

In a word, no, providing your psychotherapist is experienced enough to work in the transference and to be aware of unconscious processes. A psychotherapy process should never be dangerous, but nor should it be too safe. It is a daring adventure into the unconscious inner world that can be painful and difficult. Ultimately, however, it carries the goal of relieving suffering and trauma.

In other words

British analyst Harry Guntrip summarised the purpose and role of transference thus:

“Transference analysis is the slow and painful experience of clearing the ground of left-overs of past experience, both in transference and in counter-transference, so that the patient and therapist can meet “mentally face to face” and know that they know each other as two human beings. This is without doubt the most important kind of relationship of which human beings are capable and is not to be confused with erotic “falling in love”.

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.

Click here to listen to our podcast on this post.

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