Brighton and Hove Psychotherapy

Online Therapy
01273 921 355

by Leave a Comment

What is it like being in a Psychotherapy Group? Case study – Joe

In my experience, when exploring joining a therapy group, people often ask what it will be like. I thought it might be helpful to write a fictional narrative to give a flavour of the therapeutic experience of being in a group. This ‘case’ is not based on a real individual although some of the conflicts and difficulties will undoubtedly feel familiar to many. To keep this blog as a short read, I have simplified the details, and have focussed on just one aspect of a person’s history, difficulties, and group experience.

Joe

Joe would always say his childhood was fine. Nothing bad or traumatic happened. No real problems. As an adult, however, Joe felt increasingly alienated in his life and relationships.  In particular, he had struggled to maintain long-term relationships, which was causing him pain, disappointment and worry about the future. 

After his last relationship ended in a familiar way, Joe came into therapy with a sense of loneliness and emptiness. Through discussing this with the therapist, Joe came to feel that a group might be helpful for his difficulties.

Early stages

Once in the group, Joe found that by listening to the way others talked about their experiences, and hearing their feedback to his own, he could start to formulate some different perspectives on himself. 

Particularly new for Joe, was an insight into the ways he had felt neglected as a child. Joe began to connect old memories and recall new ones which gave a picture of a lonely child overlooked by two busy and distracted parents. It was a shock to recall this vulnerable and neglected younger self.

Joe was immediately struck by the supportive and open atmosphere in the group. At first, he found the curiosity and empathy that other group members showed towards him strange. Over time the other members pointed out how often he dismissed his emotional experiences, and the ways that he avoided being taken care of in the group.  Joe realised this was the first time in his life where he felt his emotional needs might be important. 

New Insights

Accepting that his early experiences might have been difficult and impactful was the first step for Joe. He began to realise how he had developed an emotional independence as a means of survival and had therefore set out to deny the needy part of himself. Keeping his needs at bay also required creating a distance between himself and others. Joe was desperately fearful of this defensive system falling apart, and of being thrown back into the loneliness of his childhood. 

A few months in to being in the group, Joe had an important insight that his relationships often began to fall apart around the same time that he started to feel an emotional commitment. Joe’s break-through was heightened by being able to link this to what he was discovering about himself and the feedback he was getting about the way he pushed people away in the group.

As time went on, Joe was able to open-up more in the group. He explored the patterns of relationships failing and was also able to learn from others who also reflected on their own historical and current relationship struggles, as well as developments and successes. 

Making External Changes

After about 18 months Joe was feeling settled in the group. He had started a new relationship, and with the support of the group was more conscious of what was getting stirred up in him and mindful of his impulses to escape the intimacy this person offered him. 

Crisis

The group had helped Joe get in touch with the painful experiences of his childhood that he had tried to deny and avoid. He found himself increasingly in touch with emotional needs that he had not had sufficiently met as a child. This made it harder to tolerate the times in the group where he felt unheard or overlooked. The more Joe opened himself up to his need, the more he felt wounded and frustrated when it was not met. 

Joe announced very suddenly that he was going to leave the group. The group members questioned the timing of this decision and Joe agreed to give it more time and thought.

The group and therapist helped Joe to think about the parallels with the times in his life where he tended to finish a relationship just as it was beginning to be. Joe realised that the frustration and upset he had been feeling in the group was bound up with intimacy. He started to see that leaving at this point was another way of avoiding the frustrations of having intimate relationships. Being able to make a link between what was happening to him in the group and his pattern of relationships helped Joe to properly understand himself on a profound and deeper level. 

3 years on, Joe is still in the group. Last week the other members and therapist were delighted when he told them he and his partner have decided to get married. 

Discussion

Joe benefitted enormously from the therapy group from the outset and had been able to make significant progress and changes in his life, However it was when his ‘problem’ manifested in such a live way in the group that something was able to transform on a deeper level. Joe’s frustration with the group was a turning point in his therapy as he had to confront pain reminiscent of his childhood and see how his habitual strategies of ‘ending’ relationships was a way of avoiding the reality of intimacy. 

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

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

What is loneliness?

Facebooktwitter

by Leave a Comment

“Should I stay, or should I go?” What does easing the lockdown mean to you?

I have found the Clash’s song of this title playing over in my mind when thinking about the current easing of the social lock down in the UK. It seems to me that we all, to some degree or another, now face a dilemma whether to stay or go.

Straight away, it is important to acknowledge the relationship of this dilemma to levels of freedom and privilege. It is true that some people have little or no choice about whether to go back into their workplace.  We all face very differing health concerns, with those in the ‘extremely vulnerable clinical group’ likely to feel greatest levels of concern and anxiety about going outside.  There has also been concerning, though unsurprising, expositions of inequalities in terms of health risks, with poorer and BAME people having greater chances of fatality.

However, in my experience these will not prevent them from experiencing similar kinds of conflicts at this time. It is a reality that a great many of us will, to some degree or another, be starting to wonder about how or when or whether we return to ‘normal’.

I have been wondering myself about this dilemma but I am also interested in how it might tap into broader questions about how we think about ourselves in relationship to our worlds – both outside and inside.

There is no doubt this has been a strange and disturbing time and of course we are no way through it. The sudden exponential growth of the virus and pandemic was frightening, and many felt traumatised by the level of crisis and what felt like an intense threat to our mortality. The war metaphors and imagery referenced by our government, while perhaps intended to help rally a ‘blitz spirit’, in all likelihood, simply added to the terror already felt by many.

The orders to lock down came as a relief for many people. We had permission to retreat and protect ourselves against what had suddenly become a hostile world. This was and is a necessary response but one that also exacerbated the fear of the outside world engendered by the virus and the rhetoric used about it.

We all responded differently to the retreat and this of course varied at different times. There are those who found and continue to find the lock down liberating, others who found and find it oppressive.  Of course, we are also living in different circumstances which add or detract from the benefits of the protection it offers. For example, it has been widely reported that incidents of domestic violence and abuse have increased during this period. Many were able to work easily from home, many were not and there was, and is still, differences between the level of risk for those going into work. And many have lost work or continue to face this as an increasing prospect.

External factors aside, our relationship to the pandemic and the lock down response will also key into aspects of our own internal worlds. A reluctance to move out of lock down could arise for those of us who tend to use retreat as a defence. It makes sense that the bubble offered by the lock down could tap into and heighten historical ways of managing difficult realities through strategies of self-seclusion. At the same time, those of us who have particularly found the lack of purpose and activity in the lock down difficult may have developed defences around keeping busy as a means of warding away difficult or painful feelings.  This could lead to a manic response to the easing of restrictions – perhaps a rushing quickly back into the world and ‘normality’.

Of course, both states may be at play in us at different times, but I am wondering about our overall tendencies that will shape how we are likely to interpret, and respond to, this shift in government advice.

Reflecting on my starting title, I wonder now about the aptness of the Clash song. It seems the transition from lock down to ‘normality’ (whatever that means) is not going to be as either/or as staying or leaving a relationship. It looks likely anyway that we are going to experience further Covid outbreaks with many expert views suggesting the current easing as premature and a second wave imminent.  We can therefore most probably anticipate more lock downs, perhaps even soon.

So, it feels more appropriate to think about a dialectic in/out situation we find ourselves facing requiring complex navigations. How we proceed and find our way through these difficult and disturbing times and those ahead, will be dictated by many external factors but also our own internal worlds and their responses, conscious and unconscious, to the different experiences of this pandemic.

 

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

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2e

Facebooktwitter

by Leave a Comment

Silences in Therapy

Silences are an inevitable and potentially helpful part of the therapeutic process. However, a number of people I see as a therapist express a feeling that they are not getting something right when a silence arises in our work together. The psychotherapy world (in particular the psychoanalytic and group analytic fields) has also had some difficulties historically with accepting the value of silence.

A few years ago, I wrote about silence in relation to group analysis (Barnes, 2015) I felt compelled to do this as I had been working with a psychotherapy group that was gripped for some time by long, crippling silences. These silences affected the whole group and were intensely paralysing – for the group members and for me. I found it hard to help the group but also wasn’t helped myself by the general absence of clinical literature on this subject.

In my paper I made a case for the value and role of silence in therapy and specifically therapy groups. I explored how silence is a part of speech and that all speaking relies on pauses and breaks for our communications to make sense (this is, perhaps, most obviously understood in music). These rhythms and patterns in our communications are particularly important and central to the processes of therapy.

By just seeing silences as unhelpful we lose the opportunity to be curious about the different kinds of silences and what they might mean.  Below are some of the kinds of silences that can come up in the therapy relationship.

  • A common silence in therapy arises when both therapist and patient, or members of a therapy group, pull away from verbal interaction and retreat into a more internal space. Often, in my experience, this is when a discussion then moves onto a deeper level.
  • Sometimes silences are used to protect from scrutiny. Using silence as a defense can be bound up with early experiences of intrusion or a difficulty in asserting one’s self in interpersonal relations – the only protection then is to withdraw.
  • Then there is the paralysed silence, like the one that seemed to incapacitate my group for so long. People often say they can’t think in this kind of silence. When we’ve explored it more it seems they feel increasingly self-conscious in the silence and under pressure to break it – like it’s all too much responsibility. This seems to me bound up with shame.
  • But sometimes words just fail and just don’t feel enough. Silence can be used to convey this. Or to show a respect for the enormity of what is being felt.

In thinking about silence and speaking it’s also important to bear in mind the thoughts of French psychoanalyst Andre Green who pointed out how “behind the noise of words speech can be silent” (Green 1972). At times we talk in order to silence something uncomfortable, or just too painful.

Holding a silence can be a way – perhaps sometimes the only way – of staying with what feels difficult and communicating this.

References –

Barnes 2015 ‘Speaking with Silence. An Exploration of Silence and its Relationship to Speech in Analytic Groups’, Group Analysis, Vol 48 number 1

Green 1972’ On Private Madness,’ reprint Hogarth Press 1986

 

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

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

What is loneliness?

50 years on, how free are we from homophobia?

If you don’t like groups, could it be time to join one?

Facebooktwitter

by Leave a Comment

How important are our Groups?

“Each individual – itself an artificial though plausible abstraction – is basically and centrally determined, inevitably, by the world in which he lives, by the community, the group, of which he forms a part.”  Foulkes, S.H. (1948, p 10, Introduction to Group Analytic Psychotherapy, Karnac)

The above quote is from Sigmund Foulkes who was the founder of Group Analysis, a widely disseminated group psychotherapy approach used in this country and internationally.  It might seem an extreme position to suggest that the individual is not real, but an ‘abstraction’. So, what does this mean?

Partly, it means we are all part of a complex network of human relationships. Our identities are formed in and through these relationships. Even when we are alone, we are relating to others in our minds.

More radically, it means that our context (i.e. culture, society, networks, relationships) creates us. This process involves our earliest experiences of our social world which we internalise unconsciously from birth through our key relationships and groups. This continues throughout our lives as we are always relating in and to our networks, existing as they are, outside and inside us.

So, the groups that you will have lived in, and continue to live in, will be inseparable to who you are.

On a broad level your ‘group’ will include your community, your country, your ethnic and cultural group – past and present. But on a more personal level your groups include: your original family (including wider family and past generations); current family relationships; friendships – child and adult, past and present; past and current romantic and sexual relationships; other relationships and networks in schools, colleges, communities, neighbourhoods, clubs, societies; workplace; support or therapy groups. The list could go on.

Everyone you relate to in your groups are connected to and shaped by their own networks and bring those into that relationship. Thinking about ourselves as a nodal* point in these complex networks it’s possible to see just how connected we all are and that the idea that we can possibly be understood as an individual alone is, as Foulkes also said, like thinking about ‘a fish out of water’ (ibid p 14)

Often the difficulties that bring someone into psychotherapy originate with a breakdown or disturbance within their relationship/s in their early group or groups. Group analysis is so effective because it understands the central role of groups in who we are and who we can become. When someone joins a therapy group they become part of a new network which they will also help shape and be shaped by.  Group therapy reconnects people with their world of relationships and helps restore a fundamental sense of themselves and their groups.

Group Analytic Psychotherapy Groups are offered at Brighton & Hove practice. Currently, we have two once weekly groups on a Monday and Thursday evening.

*denoting a point in a network or diagram at which lines or pathways intersect or branch.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Facebooktwitter

by Leave a Comment

The Pain of Decision-Making

Our decisions navigate us through, and throughout, our lives. This blog is not intended to be a comprehensive explanation about decision making, neither is it a guide for how to make better decisions. I simply offer some thoughts about what I see as some of the reasons that decision-making can feel hard or even painful. And why some of us avoid or delay making decisions or get paralysed in the process.

Either/Or

There may be times when a decision is a stark choice between two different things. However, often what happens is we create an either/or split in our minds when making a decision, particularly when we’re anxious.

It is from Melanie Klein’s work that we get the concept of paranoid-schizoid position. This refers to a very early life stage when – as small infants – we were overwhelmed with intense anxiety and developed protective mechanisms, for e.g. splitting experiences into opposing good or bad. Klein thought that this stage never left us and in times of stress and high anxiety we tend to return to this paranoid-schizoid ‘position’. When we’re in this state of mind we return to defences such as polarising. Of course, far from helping our anxiety this kind of stark splitting generally makes decisions harder to make.

The referendum on Brexit is a good example of an either/or paranoid schizoid type of decision that was created possibly to manage, but more to avoid, complex and painful issues the UK and its government was (and of course still is) facing.

Loss

Some decisions are easier than others. Usually this is either because they don’t have a significant role in the shape of our future, or they are reversable, or repeatable. Generally, these decisions don’t put us in touch with profound feelings about loss.

Life decisions particularly stir intense feelings, and quite real experiences, of loss. Each step we take in one direction involves relinquishing those leading us in others. The older we get the more our lives narrow in direction and focus as we need to accept giving up ‘other’ options. This parallels a growing awareness of our own mortality.

How painful and paralysing the loss of ‘other’ life choices is will partly depend on our relationship with loss and whether or how we are able to tolerate the feelings stirred up by it.

Regret

Our decisions are our responsibility. We can all look back on certain choices we’ve made in our lives and wish we had taken a different option.

Bound up with our feelings about this is our relationship to regret. Regret can be a very frightening prospect for some people. This is because of the way they might punish themselves if they feel they’ve made a mistake or got something wrong.

Freud called the part of us that can be self-punishing, the Super-Ego. This is the rule-bound, conscientious part of us and is developed in the main from early experiences of authority figures, particularly parents. We will all normally experience our super-ego at times as restrictive – in a way this is its job. Ideas about

the super-ego have developed over the years to understand how persecutory it can be at certain times and for some people more than others. The degree and constancy to which we feel punished or even tormented by our super-ego will affect how frightening it can feel to us. This fear might generate such an anxiety about making mistakes that it can paralyse us from making even the smallest decisions.

Conclusion

We are making decisions all the time, often without thinking about it. Some decisions are obviously more significant than others and need to be considered carefully. This process can be painful as it means taking responsibility for our choices and sometimes accepting losses. We don’t help matters when we allow our anxiety about this to polarise our options with either/or thinking or attack ourselves with our regrets about past choices.

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Facebooktwitter

Copyright © 2020 – Brighton And Hove Psychotherapy – Privacy Policy
6 The Drive, Hove , East Sussex, BN3 3JA.