In second of two video interviews, Paul Salvage discusses who may benefit from psychoanalytic psychotherapy and explains how it has evolved since the days of Freud. Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.
“Watch your plants and see what they’re telling you” (Ollie Walker, Hosta grower, Gardeners’ World, BBC2, 14.6.19).
Ollie Walker has fallen in love with the diversity of Hostas and delights in watching them grow. This is some dedicated watching: the nursery he works at stock over 800 varieties. Noticing small changes in thousands of plants, he knows exactly which nutrients are needed for the healthiest growth.
Many babies are fortunate enough to be watched with arguably much greater devotion than this. For starters, the care-giver: cared-for ratio is much better – 1:1 attention at least. The sense of wonder surrounding a new-born breeds connectedness which begins relationship. It gives the baby an experience of felt safety, of being held psychologically as well as physically. This is just as well. We now know that early attachment relationships are a foundation for all forms of later development. As Winnicott said, “there is no such thing as a baby.” [i] Infants cannot exist independent of someone to look after them.
An attuned care-giver is open to a baby’s non-verbal communication -her cry, gaze, gesture, smell, touch or muscle tone – and finds meaning there. “Good enough” parents provide consistent, appropriate care and interaction enough of the time. Inevitable mis-attunements are further food for curiosity, opportunities for adjustment and repair which strengthen attachment and resilience. Toddlers and children of all ages, continue to require the mind of a benignly curious adult to scaffold development. Behaviour is a window to a child’s inner world of thoughts, feelings and body states.
All children, at one time or other, behave in ways which cannot be dealt with easily or quickly and might be perplexing, concerning, maddening or all three. Those children growing up in environments where their needs are not sufficiently met or where they are unsafe will be more likely to do this. We may find that even our best intentions and the most tried and tested behaviour management strategies are not effective. This is often because they have not evolved from a relational understanding of the child’s needs and what is being communicated through the behaviour.
Staying curious can be hard if there is pressure from friends or family to quickly stamp out unwanted behaviour. Or we may be driven by a need to make something better and hurry to provide instruction, fix a problem or eradicate pain without first considering what the matter might be. These can also be the behaviours which trigger our own vulnerabilities.
In addition to highlighting aspects of our own internal make-up, intense emotional experiences inside of us can be an effective clue as to what children themselves are feeling. This is central to Wilfred Bion’s development of Melanie Klein’s theory of Projective Identification.[ii] Bion proposed that not only can unwanted feelings be projected into another person, who then feels those feelings, but that this process serves the purpose of communication. For example, a looked after child who sabotages her own birthday meal after a lovely family day out may cause a foster carer to feel rejected and resentful. This could be thought about as the child (unconsciously) letting her carer know about both early experiences of rejection and how hard it is to believe in her own capacity or deservedness to sustain states of joy in the present.
For children with experience of trauma, challenging behaviour and Projective Identification may be the only means they have of telling the emotional story of what has happened to them. It can seem counter-intuitive, but we need to welcome this and, alongside setting appropriate boundaries, seek to find meaning in it.
Symbolism in the child’s play and other activity can be very revealing about a child’s inner world and language itself can be thought about beyond its literal meaning. For example, a child who repeatedly says she is hungry, when we know she has recently eaten, may be letting us know she is hungry for connection, as opposed to food.
It is the wondering process here which is as or more important than the resulting care itself. Through close observation and knowledge of the child and attention to his/her own emotional response to what is happening, a care-giver takes in the communication of discomfort, frustration, distress, fear and so on, reflects on it, digests it, and feeds it back in a more manageable form, often through words, as well as through tone/ gaze/ affect/ posture/ actions. Correspondingly, the child feels accepted, held and understood and receives a message that his/her care-giver is able and willing to be alongside and help manage emotional pain.
This is what Bion called “containment”, the parent as “container” the child as “contained” – in my view, one of the greatest gifts we can give to the younger generation. Through repeated experiences of this kind, children develop their own capacity to think about and process feelings.
In addition to patience, true curiosity requires flexible thinking, open to the myriad nuances of human behaviour. The same actions can have different meanings for different children or even for the same child, such as a troubled 7 year-old boy who would regularly take himself into the corner during a PE lesson and sit with his head in his lap. Over time, staff learned that he would do this both when he was hyper-aroused (worked up) and needed space away from others to calm down and when he was hypo-aroused (switched off) and in need of company and livening up.
In psychotherapy with children (and in therapeutic parenting work) we are often dealing with issues which have felt too difficult to think about and make sense of. The therapist’s task is to engage, observe, listen to, accept, be curious about and sit alongside a child, gently helping to make thinkable the unthinkable. This takes time. Emotional defences are there for a reason and require sensitive handling.
Holding steadfast to curiosity is one of our soundest investments with children. If we can start to wonder about a child’s behaviour, we stand a much greater chance of coming up with an effective way to meet his/ her needs. As Gerda Hanko (Educational Psychotherapist) and others have said: “Don’t just do something, stand there!”
Michael Reeves is a Psychotherapist working with children and young people aged 4-18 and/or their parents/carers. He is available as a clinical supervisor for training or practising therapists and counsellors, whose work is primarily focused on children/ families/ parents. He is available at our Lewes Practice.
Further reading by Michael Reeves –
[i] Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship. Int. J. Psycho-Anal., 41:585-595.
[ii] Bion, W.R. (1962b). Learning from Experience. London: Heinemann
As much as we might fight it, our own experiences of being parented, create within us blueprints or ‘internal working models’ of what it is to be a parent. These models only become fully activated when we become parents ourselves, and often take us by surprise. For instance, we may find ourselves ‘turning into’ our parents in ways we hadn’t intended. Similarly, memories from our past can be unexpectedly invoked in us when our own children reach the same age.
Selma Fraiberg (1987) emotively referred to this phenomenon as “ghosts in the nursery” – the idea that without conscious effort to alter entrenched family patterns, family life can essentially become a ‘rehearsal’ for the next generation. More commonly, we refer to this phenomenon as the enactment of ‘family scripts’. John Byng-Hall (1985) proposed three ways in which these family scripts may manifest –
- REPLICATIVE SCRIPTS:
These scripts are a direct replication of the parenting that we received ourselves. They can include replication of positive scripts (e.g. family rituals, ways of nurturing children, ways of enforcing boundaries, certain sayings, etc.). They can also include replicating negative (unresolved) scripts, which may be consciously replicated (e.g. “smacking never did me any harm”) or unconsciously replicated (e.g. needing to hide one’s sad or angry feelings from a parent can make it harder for these children to later recognise or respond to these feelings in their own children).
- CORRECTIVE SCRIPTS:
These family scripts are a conscious decision to offer our children a different experience of being parented to what we received ourselves. The danger for this type of script, however, is that because they are driven from an emotional response to our past, there is a risk that we will go too far the other way (e.g. feeling hard done by as an older child, so favouring our own eldest child).
- IMPROVISED SCRIPTS:
These family scripts relate to the ability to flexibly and creatively amalgamate what we most value from our own experiences of being parented, with what we now value and learn from new relationships, education, culture, etc. We generally consider that the most resilient and healthy families adopt this form of script.
Difficulties can arise when damaging or unhealthy replicative family scripts cannot be consciously thought about by parents. In extreme cases, these can negatively impact upon a parent’s relationship with their child and therefore, their child’s subsequent emotional well-being. For the most part, however, activation of family scripts is normal, inevitable, and actually helps children to become embedded within the familial and social context to which they belong. Indeed, almost all the parents that I meet in my work (myself included), offer a fascinating mix of all three of the above scripts to their children.
Byng-Hall, J. (1985). The family script: A useful bridge between theory and practice. Journal of Family Therapy, 7, 301-305
Fraiberg, S., Adelson, E. & Shapiro, V. (1980). Ghosts in the nursery: A psychoanalytic approach to the problem of impaired infant-mother relationships. Journal of the American Academy of Child Psychiatry, 14, 3.
Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes Practice.
Further reading by Dr Laura Tinkl –
This blog follows on from my previous blog – Existential Therapy. This is how I have interpreted some vital notions connected to existential therapies.
Existential therapy is a diverse approach which is used to understand and clarify a client’s problems and possibilities for living their existence. Below are some more of the vital principles (as I see them) typically considered by existential therapists. I would like to make clear that what I have written is not exhaustive, conclusive or necessarily a general order of things.
1) A belief in the relational nature of being as a central aspect of existence .
This suggests two things to me. That we are always in relationship with the world, and how we relate to it is often fundamental in how we are and what we become. It is interesting to note that in therapy the relationship has been continually found to be the key to efficacy whatever the approach.
In contrast to the relational sense of existence some existential philosophers have asserted we are ultimately alone in our existence. For instance, Kierkegaard emphasised the individuality of being human, describing human existence as a solitary affair.
Wherever one falls on this spectrum the discussion of how one is relating to their world can be a fruitful enterprise in existential therapy.
2) Seeking to understand a client’s subjectively lived experience and how it is taking place within a framework of temporality (past, present and future), tensions and contradictions. 
For me this means the intention is to understand that human existence is full of paradoxes. The aim is to clarify a client’s life as they have lived it, support them to reflect on what has happened and allow them to determine how they would like to live in the future in line with their values.
For instance, if a client comes to see me I am not going to attempt to fit them into any theory or model. I am also not going to tell them what to do. I do hope to hold an openness to each client’s way of being-in-the-world and support them to get clarity on what is going well and what needs to be changed. I may employ an exploration of philosophy and other wisdoms as well as psychological theory to support a client’s inquiry, but I will always lean towards emphasising a client’s lived experience as key to the investigation rather than any theoretical understanding.
This leads me to another understanding that frames existential therapy.
3) A consideration and discovery of a client’s freedom and responsibility
For me this element is summed up nicely by Nietzsche’s words “Follow not me, but you”. 
When he said this I think he was responding to people’s attempts to pinpoint his ideas into an all-encompassing approach to life. For me, it feels like a relevant description of every individual’s existential responsibility.
An existential therapeutic perspective typically strives for the clients to take responsibility for their lives and see their very existence, their being-ness, as the source of their potential as well as an opportunity to confront their limitations. This possibility of being also upholds a fluid sense that we are always becoming and not a static substance. It invites a platform from which clients might begin to take responsibility for their existence and what they value. In this movement we may begin to reveal, understand and clarify their choices and actions. This takes courage though. It takes courage to birth and live out one’s potential, especially in the face of adversity and limitation.
This links into another significant understanding or theme underpinning existential therapy: ‘being towards death’. Please also read my blog on Existential Therapy and Death Anxiety.
Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals. Susanna is available at our Brighton and Hove Practice and Lewes Practice.
Further reading by Susanna Petitpierre –
 Spinelli, E. (2007) Practising Existential Psychotherapy. The Relational world. London: Sage
 van Deurzen, E. (1998) Paradox and Passion in Psychotherapy: an Existential Approach to Therapy and Counselling. Chichester: Wiley.
 May, R., (1958) Origins of the existential movement. in Existence. (Eds: Rollo May, Ernest Angel & Henri, F Ellenberg) Rowman and Littlefield Publishers: USA. p. 31
 van Deurzen, E. (1998) Paradox and Passion in Psychotherapy: an Existential Approach to Therapy and Counselling. Chichester: Wiley.
A question that is often asked of us whether or not psychotherapy, and indeed counselling or clinical psychology, can ever be claimed as a legitimate business expense?
What are business expenses?
Business expenses are classified as allowable expenses which constitute the running costs of your business. These will, obviously, vary from business to business. The question of whether psychotherapy is a legitimate business expense therefore applies to people who are self-employed, ranging from freelance workers through to business owners (although for limited companies slightly different rules apply).
How can psychotherapy ever be a business expense?
The answer to this is yes. For example, any counsellor, psychotherapist or clinical psychologist can legitimately claim their own personal therapy as a business expense. Not only is this appropriate as an expense, but it is arguable that all mental health clinicians should be in their own ongoing personal therapy for self-development and to ensure that they are being appropriately supported in the emotional work they do with their clients.
However, in my own practice I have many clients who claim their personal psychotherapy as a business expense and who work in completely unrelated fields ranging from property development through to creative endeavours such as musicians. So how is this justified?
What is psychotherapy?
Counselling, psychotherapy and clinical psychology all wall under the heading of ‘talk therapy’. They are concerned in similar ways with helping people to work through loss and trauma. However, both the concept of ‘talk therapy’ and the idea of ‘working through loss and trauma’ cover an enormously large remit and in many instances, this remit impacts upon our ability to work. Let’s consider an example:
Sarah, a freelance musician, has recently been offered a position playing with a major orchestra. This has come about as a result of many years of hard work and dedication; it offers the potential of being the pinnacle of her career. However, to her utter astonishment she notices that every time she joins the new orchestra for rehearsals, she experiences sleepless nights and strong symptoms of anxiety that impact on her ability to play to the best of her ability. Clearly, in this example, Sarah would both benefit from psychotherapy and it can be legitimately argued that psychotherapy for her performance anxiety is a legitimate business expense.
The reasons for Sarah’s anxiety could be numerous ranging from an unconscious fear of success rooted in her mother’s option of her, through to feelings of inadequacy and shame around ‘being seen’. However, from a business expense perspective, the causes are less important that the manifestation of Sarah’s symptoms – her anxiety is impacting on her ability to ply her trade.
Is psychotherapy only a valid business expense in times of personal crisis?
Many people initially enquire and start psychotherapy when they hit a crisis – in other words when their symptoms become debilitating, or at least too distracting to ignore any longer.
So, whilst the initial part of any psychotherapy process often overtly works with the crisis the client brings, the underlying process will be addressing deeper relational issues. It is not uncommon for clients to expect to undergo a period of psychotherapy which then turns into a deep, meaningful, intimate and ongoing relationship that continues week after week. And, in many instances, long-term ongoing psychotherapy remains a valid business expense.
Most businesses are comprised of relationships. Whether that simply means working on behalf of external clients, through to being a part of a team or leading an organisation. And as psychotherapy is a relational process of deepening ones understanding of self through the unique relationship with a psychotherapist, many clients continue to find that an ongoing process of psychotherapy becomes an asset to how they manage stress and anxiety and in turn their relationships with their colleagues.
Can couple therapy be a business expense?
Again, the answer to this depends on how the couple relationship is intertwined with the business. For couples who run a business together – often a complex and stressful experience – couple therapy or marriage counselling can be both invaluable in stabilising the relationship but also in assisting the couple in improving dialogue with each other so as to improve their working relationship. In such a context couple therapy would be a valid business expense.
What if I am not self-employed?
Business expenses apply to those who work for themselves and submit their own (or company) tax returns. So, if you are employed, clearly psychotherapy cannot be a business expense, however, this does not necessarily mean that you cannot get help or support in attending and/or paying for psychotherapy.
Private health insurance
Increasingly private health insurance is offered as a benefit to salaried workers and most private health insurance providers provide cover for psychological support from appropriately trained and registered counsellors, psychotherapists and clinical psychologists. This cover may be capped in terms of a value amount or in terms of the number of sessions, so it is worth checking with you provider to find out more.
Time off to attend psychotherapy
And lastly, where employers may not choose or be able to offer private medical coverage as a benefit, an increasing number of employers are recognising how important it is to support mental health issues. It is therefore not uncommon for employers to allow staff to attend psychotherapy during working hours (with time made up on another day) or to come to a flexible arrangement with staff, such as working from home, to enable them to attend sessions.
All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Superviser and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.