They are used to a solution-focused approach and can want quick answers from me.
I feel rushed and pulled to meet them in their anxious place – to offer solutions, set goals, etc. I can easily see the how therapy session could quickly turn into a business meeting.
I take a breath, check in with myself and see how I am feeling (pushed, rushed, slightly anxious to give solutions).
I pause and offer the following:
“It seems you want me to give you more work in addition to what you already have. This seems to be exactly what is stressing you out. What would it be like for us to slow down and focus on your experience right now?”
We both look at one another for a moment and there is a sense of confusion: “I’m not sure what I’m supposed to DO.”
The DO bit is of importance here. Everything seems to be about doing in this person’s life. I imagine most of us can relate to this way of being.
This is because many of us have not learnt to pay attention to our experience. As children we are taught to do well, achieve, win, etc. in order to be loved and recognized. However, real recognition comes from validation of experience. This means paying attention to feelings, thoughts and responses,
Through a focus on doing and achieving, we loose connection to our bodies and our feelings. This means we end up a little bit like performance machines, ticking lists and meeting deadlines. In this process we tend to forget who we are, why we do what we do and how we feel about it.
One of the goals of therapy is to facilitate this process of coming back to oneself and understanding what drives us for good or bad. We then look at what behaviours and ways of being serve you and which really don’t.
If we could take a child’s logic and apply it to the arena of psychological injury we may be better equipped to deal with the emotional pain and suffering that is an inescapable part of being human.
None of us is immune to heart ache. We are relational beings and cannot help but be touched by the emotional connections and disconnections we have with others. We have clear methods and maps for understanding and navigating physical pain and disease. Physical injury is generally quite easy to identify. It is harder for us to acknowledge psychological dis- ease, even when ignoring it can drastically impact our lives.
Loneliness and self esteem
Loneliness is a case in hand. Research indicates a detrimental impact on health in the experience of chronic loneliness. It can elevate blood pressure and suppress immunity rendering people more vulnerable to disease. Indeed it has been estimated that that the likelihood of premature death may be increased by as much as 14% for those in the grip of chronic loneliness.
The experience of loneliness is subjective. We can feel lonely in the midst of a crowd, lonely in the context of our marriages and our families. When we feel lonely, we feel emotionally or socially disconnected from those around us. More often in this age of technological connectivity we may even feel a certain taboo about admitting our experience.
The disconnection we feel serves to alter our perceptions and our thinking about ourselves and those around us. It may lead us to believe that others care less about us than they actually do. When we think this way we are less likely to reach out. The stakes in so doing can seem high and we risk the additional pain of rejection. When our self- esteem is low, we are more vulnerable to stress and anxiety and when this is the case we are more likely to experience rejection, failure and loneliness as evidence of our inadequacies and shortcomings.
When we ruminate we chew over, again and again, replaying upsetting or unpleasant events, we become slaves to our thoughts and our feelings and feel powerless to change. When trapped in this negative cycle we put ourselves at risk of developing depression and anxiety or of developing other unhealthy habits with food and alcohol for example. We harm ourselves.
Our thoughts and feelings are not always the reliable arbiters of reality we imagine them to be. More often the critic within will speak with the voice of an absolute authority whilst delivering the worst kind of propaganda. Rarely does our critical voice have something genuinely new to tell us.
Confusion and suffering may indeed be our birthright, but wisdom and well-being may also be available. When we recognise and attend to emotional injury and struggle, (by reaching out and finding out) we become pro-active, as opposed to reactive. Catching our unhealthy and unhelpful psychological habits puts us in with a chance of changing them.
Psychological health and resilience is the reward.
In this trio of blogs, three of our therapists – a psychologist and two psychotherapists – of differing modalities will be sharing their views on how to work with a fictitious client. The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.
The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.
He comes from an upper-middle class background where there was a family culture of not talking about feelings and difficulties. He was sent to boarding school ages 6 – 13. He is eldest of 3 children and his parents divorced when he was 13. There’s has been other traumatic childhood incidents that he is yet to disclose.
He presents well dressed, competent, practical and wants quick solutions. He is very busy and wants to know what therapy can do for him and how long it will take
A transactional analysis / psychodynamic approach
I’m interested in James’s past, present and hopes for the future. Also relevant here is James’s attitude towards emotions. What has he learnt from his parents or caregivers about the role of feelings and emotions? Here, clearly there is a culture of not talking about feelings. I would imagine there was little encouragement for James to develop a relationship with his inner-world, given academic achievement was the main focus and what James would have been rewarded for.
In boarding school there is usually a culture of suppression of emotions, including suppressing the distress of leaving home at such an early age. The developmental stage of 6-13 years is also relevant. It is a transitional period for both girls and boys linked with identity development and moving from dependence to independence. Without a ‘secure base’ (parental presence, support and encouragement), this is likely to be compromised.
Starting a new relationship can trigger feelings around early bonding and attachment. Inner conflicts to do with dependence versus independence will likely resurface, causing anxiety about the future of their relationship.
The divorce of his parents at age 13, followed by years in boarding school would have invariably shaken his world. Early separation from parents is traumatic for children, and so is divorce. We don’t know yet about the other traumatic events of his childhood, which will no doubt emerge as the therapy progresses.
I would be led by the person’s telling of their story. The process of telling one’s story and being heard by a present and supportive other can be transformative in itself. This might be an alien concept to James and something that he may find both pleasant and strange.
Wanting quick solutions is part of the driven environment of his family, profession and background. A therapist who is willing to be both understand and challenge his worldview, whilst exploring healthier ways to relate to himself is needed here.
Working relationally in the ‘here-and-now’
I would encourage James to begin paying attention to his experience, rather than on the demands he is likely to impose on himself and others. I imagine that James has never been allowed to experience his feelings and receive comfort and support when distressed, sad, angry, etc.
The above are just initial thoughts based on a limited amount of information given about a fictitious client. Although the information presented here will be familiar to quite a few readers.
In therapy, client and therapist will work together in defining their therapeutic work. This usually happens in a spirit of collaboration and mutuality which, albeit challenging, can also be an enjoyable and incredibly rewarding experience.
Sam Jahara is a UKCP Registered Psychotherapist and Certified Transactional Analyst with a special interest in cross-cultural and intergenerational influences. She works from our Lewes and Hove practices and sees individuals and couples as well as offering clinical supervision.
Panic attacks can be terrifying. When experiencing a panic attack we feel out of control and at the mercy of what is happening in our bodies. We are overwhelmed and unable to ‘think our way out’ of what is happening to us; indeed, it is not uncommon to imagine that we may be dying.
As an integrative psychotherapist I have written extensively about the importance of integrating the body into psychotherapeutic work. The fundamental reason for this is because all of our emotions originate in the body and need to be felt in the body. We then use a thinking mind to make sense of what we are feeling. However, if we become overwhelmed we may experience a panic attack which is when the body has physiologically gone into a ‘fight – flight’ response to a perceived threat. Often, the threat is not actually life threatening – it may not even be ‘real’ in the sense that it is a repeat of trauma.
Panic attacks can be controlled. But only through the body. I have produced an embodied guide that literally walks you through becoming aware of a panic attack and managing it. This guide has been produced as a series of interviews and VLOGS into the topic of psychotherapy generally. So, please check out the interview and we would welcome any feedback or suggestions for future VLOGS.
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.