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Women and Anger

Women have a lot to be angry about. Aside from how our current political and social landscape still disadvantages women, all women inherit a long lasting legacy of the oppression and suffrage of their close female ancestors. This legacy is still intensely felt in society today, and the emotional and psychological impact still visible in most aspects of women’s lives and choices.

One area that visits my consulting room repeatedly is the difficulty most women have with expressing anger. It can be argued that many men suffer from the same problem, given how anger is frowned upon in our society generally. However, I would like to focus on the particular challenges that women have with anger.

Social expectations of how women should behave, and the qualities attributed to femininity and consequently to a women’s attractiveness is still very much alive. Being agreeable, polite, friendly, helpful, caring, kind, etc. When I was a small child, every time I got angry my mother used to say “what is this ugly face?” In short, don’t ever be angry, anger isn’t pretty and we don’t want to see it.

Angry women are still seen as hysteric and unstable. Anger in women is still blamed on hormones. To the point where it can be hard for many of us to distinguish what is a justifiable emotion and what is “just hormones”. In my opinion, everything is justifiable, because hormones interact with real life situations, therefore very little to do with our emotional landscape can be attributed to hormones alone.

Many women seem to feel the need to apologise for who they are and therefore for how they feel. The problem with this is that our emotions are vital in navigating our inner world and validating our responses to external and internal events. Continually apologising our emotions away leads to erasing vital aspects of who we are. The consequence is usually anxiety and/or depression (the doctor will prescribe a pill, but never ask whether you are not feeling your feelings).

I see women break down in tears in favour of expressing anger. Not that tears are bad. Tears are important – if crying isn’t a more acceptable substitute for something else. A collapse in tears will more likely invite sympathy, even if it feels shameful. Anger can leave others startled and unable to respond – usually you won’t get much sympathy. Of course, other people have the opposite problem – it’s much harder for them to cry than to be angry. I’m not sure which is the hardest to overcome.

Some of the fears linked to expressing anger come from not wanting to displease, alienate and frighten others. Avoidance of direct conflict is endemic. Usually the fear isn’t linked to how others will respond, but of what will be unleashed within. We feel afraid of letting out all that has been tightly kept within. I have often heard women express a fear of going mad, of not being able to “put the lid back on”, of losing control, of becoming permanently angry. All negative attributes historically associated with women.

The main cause of ongoing psychological suffering is not being able to feel and express one’s emotions, and not the other way around. Whether it is grief, disgust, shame, anger or anything that you have been told not to feel. Psychotherapy aims to help you get in touch with your feelings and express them without feeling overwhelmed by them. This can take time and patience. Getting acquainted with our emotional landscape is what makes us feel alive. Being able to express that to others in helpful ways is what makes us feel connected, to ourselves and others.

Anger when expressed in healthy ways can be refreshing, helps us set boundaries and say ‘no’ to what causes us harm. Others may not like it, but part of being brave enough to say what must be said, is trusting that others will not only survive it, but that what they feel and think isn’t your responsibility but theirs.

Sam Jahara is a UKCP Registered Psychotherapist and clinical Supervisor. She works with individuals in Hove and Lewes.

Further reading by Sam Jahara

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Football, psychotherapy and engaging with male clients

I recently read that an English professional football team has a resident psychotherapist. Whilst the connection between clinical psychology and sporting outcomes is well established, having a team psychotherapist is something new. The therapist explained that they’re there to support the players, coaches and a team of staff through the emotional highs and lows of the professional game. Scoring goals isn’t the sole focus of the role, but it’s hoped that a happy and supported team will be more likely to score.

I read this not from a football supporter’s perspective, but from that of a therapist who is always mindful of how we engage with clients, especially men. There is no secret that men are less likely than women to engage with psychological services. Men are also more likely to hold gender based beliefs as to why they shouldn’t be sensitive to their own mental health.

The football team therapist spoke of how the engagement with players was less formal that traditional psychotherapy and could be anything from a few minutes chat to a longer session. It seems that being understanding and sensitive to the schedules of the players and being flexible around this, worked best for all parties.

Debating changing styles of therapy is a whole other discussion but it does make me question how greater engagement with men might be based on challenging concepts of masculinity whilst not taking men out of their own understood gender roles. In effect to reframe masculinity in a way that still feels masculine.

As a trainee therapist being in your own therapy is a requirement. The experience of being a client is something that shapes how we are as practitioners. The understanding of what it’s like to explore your own mind and how you can gain a deeper understanding of yourself can feel like a huge luxury. It can also feel like the most anxiety inducing and impossible task when you feel your own vulnerability in the face of another. As a trainee male practitioner this was the moment when I began to understand that I held many gendered views of what men did and didn’t do and how could I shift my perceptions without losing my own sense of my gender.

As therapists we are well aware of the challenges when clients begin to explore and think about their feelings. Knowing how that can feel for us we can empathise and think with them. When this is seen through a series of deeply held beliefs around gendered roles it can feel impossible. Here a myriad of gendered terms about ‘men not crying’ and being a ‘strong, silent type’ spring to mind. Is it any wonder that men can struggle to acknowledge, let alone engage with thoughts about mental health when there is so much messaging that it isn’t ‘masculine’?

Reading about a football club with a psychotherapist felt very positive. It wasn’t only an interesting article, but it very gently reminds us that attitudes towards men’s mental health, are changing. If the knowledge that a football team are supported and as a result successful by being sensitive to their own mental health it sends a subtle, yet positive, message. This can only be a good thing for helping men to think that being aware of their own mental health is not challenging their sense of their own masculinity, it is merely offering a different perspective.

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove and Lewes.

To enquire about psychotherapy sessions with David , please contact him here, or to view our full clinical team, please click here.

 

Further reading by David Work –

When Home and Work merge

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Am I cracking up or is it my hormones? Pre-menstrual Dysphoric Disorder and the importance of tracking symptoms

It is not comfortable being told that you are feeling the way you do because of your hormones. This kind of biological reductionism is not helpful to any gender but the extremely severe symptoms of Pre-menstrual Dysphoric Disorder are completely aligned to the menstrual cycle. They manifest during the week before menstruation and end when or shortly after the start of menstruation. Like a switch going on and off.

There are a wide range of physical symptoms some not usually recognised as linked to pre-menstruation – changes in vision, heart palpitations, numbness and easy bruising – along with those that are familiar. In this post, I am concerned with the psychological symptoms.

The ones we might expect like irritability, confusion and weeping to excessive anxiety, deep depression and suicidal thoughts and feelings. It is the severity of these psychological symptoms, far more severe than normal pre-menstrual symptoms that make PMDD so disturbing and destructive.

Women suffering with PMDD can find themselves unable to cope with everyday life in the week or so leading up to their period. Ordinary tasks at home or at work can be insurmountable. Getting out of bed to dress and wash is impossible. The ‘personality changes’ put relationships under enormous duress. The sudden change in symptoms at the onset of a period is a relief but much of the next three weeks will be spent in repairing and picking up the pieces. It is not surprising that women can feel they are cracking up.

Unfortunately, many women are undiagnosed, incorrectly diagnosed and they can feel as if they are regularly in torment for a long time until their PMDD is recognised and treated. An example of misdiagnosis is a diagnosis of bipolar disorder. This is because the cyclical nature of mood swings is a feature of both conditions but it fails to recognise the correlation between emotional lability and the menstrual cycle. The predictability of the changes in thoughts and feelings is a key feature of PMDD and this raises the importance of tracking symptoms. Tracking symptoms provide information over time that may reveal a pattern, in this case, the menstrual cycle. Informed diagnosis leads to appropriate treatment, this means a woman will be treated for a severe problem with her endocrine system rather than a psychiatric illness. Sometimes it is your hormones.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

The medical definition of sexual dysfunction in women is hypoactive sexual desire disorder (HSDD) that is low or no libido. Like men, women’s desire for sex is effected by all sorts of factors such as relationship issues, bereavement, physical illness and the side effects of medication, job loss or work stress, depression and anxiety, recreational drugs, hormonal changes through aging and pregnancy, child birth, miscarriage.

There are conditions such as vaginismus where penetration is too painful for women to have sex but for the moment I want to look at chemical attempts to address women’s loss of sexual desire.

Unlike Viagra which treats the mechanics of erectile dysfunction, new pharmaceutical treatments in the US that aim to improve women’s sexual problems act on the brain rather than the genitals because blood flow has nothing to do with sexual function in women. At the moment there are no licensed treatments for women’s sexual dysfunction in the UK, but two in US are available for pre-menopausal women, these are Flibanserin (Addyi) and Bremelanotide (Vyleesi). They work by enhancing the neurotransmitters in the brain that support sexual arousal, reducing inhibition and encouraging sexual excitement.

These medications demand some commitment from users. Filbanserin is taken orally every evening whether you plan to have sex or not and Bremelanotide is injected into the thigh or stomach about 45 minutes before sex, no more than once every 24 hours or 8 times in a month. There are side effects such as tiredness, nausea, headache, dizziness dry mouth and these medications should not be taken with alcohol or grapefruit juice, as this may lower blood pressure to a risky level.

HSDD treatments do not claim to make sex any better rather they claim to promote an increase in women’s desire to have sex. The research determines a positive result as a limited increase in sexual activity measured as one more sexually significant event per month.

I have looked at the anecdotal experience of US women posting online. HSDD medication is extremely expensive costing several hundreds of dollars and the jury is out on its efficacy. Many women commented on the side effects, for some there was no improvement and/or the side effects were intolerable but others were extremely grateful for the difference it had made to their sex lives.

In the UK Prelox, a herbal supplement, is marketed as improving sexual function for late reproductive and post-menopausal women. There were no adverse effects during the trials but there it was noted that any improvements maybe due to a placebo effect.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

New Year’s Resolutions – why change might be so difficult

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Popping a bluey – young men and Viagra

Following on from my earlier blog about the physiological effects of Viagra, in this blog I am going to discuss some of the psychological and social issues that make young men pop a blue pill.

There is common notion that young men are constantly getting erections and always up for having sex. Various sources indicate the reality is different. Peggy Orensteins’s recent book ‘Boys and Sex’ cites a General Social Survey study showing young men between 18 and 29 are having less sex. This is indicated by the increase in the number of men who declare themselves abstinent, which rose from 10% in 2008 to 28% in 2019.

Orensteins’s conversations with young men reveal the extent of their performance anxiety. They fear that girls would be more knowledgeable and experienced and in contrast they will be unsatisfactory sexual partners. They are anxious that any inadequacy, such as not being able to undo a bra strap or coming too quickly will be broadcast to their peer group on social media and result in humiliation. They are also concerned that girls will take it personally if they can’t get an erection. Young men seem to feel that they are responsible for the success of a sexual encounter.

At the same time online pornography has set up unrealistic expectations about opportunity, performance and satisfaction. The Reward Foundation is an educational charity that focuses on the internet, love, sex and relationships; they have found a correlation between erectile dysfunction in young men and an increase in access to internet porn. Whether or not young men actually believe that the sexual relationships and encounters they view on screen are ‘real’, these representations have an impact. As a young presenter on VICE online magazine said, “In my head I’m thinking that girls will be expecting me to fuck them like a porn star.”

First dates or sexual encounters can be extremely anxious events. Dating apps like Tinder and Grinder make it easy to move on to a new sexual partner if the sex does not meet expectations the first time. This may increase pressure on men to have a prolonged erection or several erections and Viagra can be an ‘insurance policy’ or a ‘booster shot’ to ensure a good performance the first time they have sex with a new partner. If the relationship continues they may continue to take Viagra to maintain their performance and hide the fact that they took it in the first place.

So what’s the problem with young men using Viagra to perform better? If young men believe that the standardised notion of good sex is a good performance as Orenstein’s study suggested, we can see that taking Viagra would be a way to avoid some of the stress about being a good performer. Unfortunately this can create a psychological dependency making it more and more difficult to stop taking Viagra and harder to open up the subject with a partner. Like any kind of emotional withholding keeping Viagra a secret is likely to be a negative factor in a sexual relationship.

Good sex can be whatever is good for each couple and is far more nuanced and complex than a good performance. In a relationship of mutual consent sex can bring physical and emotional intimacy but sex does not always go smoothly, misunderstandings and disappointments happen. Exploring sexual dissatisfaction and difficulties makes people feel extremely vulnerable. By using Viagra to focus on performance, young men are avoiding the opportunity to speak honestly about what they expect and want from sex as well as finding out what pleases their partners. Trusting each other and exploring differences and desires together can build a stronger relationship as well as a more satisfying sex life.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Relationships, networks and connections

How many of us are seldom more than an arms length from our mobile phone? Our bags, clothing, even our sports wear is designed with special pockets for its’ safe keeping. For most of us it has infiltrated every sphere of  life, a constant companion. Staying connected has never been so easy. Mobiles are for people (like us) on the move – always contactable – but never confined. As long as we are never too far from a power source and a signal we can bridge the gap between together and apart. It is a familiar modern experience to encounter, in a public space, a café, a bus, a pedestrian walkway, others, eyes down ensconced in their device. For many of us it feels jarring, not least because we know that we are not immune to the same behaviour. We no longer seek the eyes as a point of entry into the world of another.

Virtual proximity

Ours is a time when proximity no longer requires physical closeness just as physical closeness no longer determines proximity. Virtual proximity renders human connection simultaneously more frequent and more shallow, more intense and more brief. Getting in touch is no obstacle to staying apart. Notions of community have shifted with the tides of of socio political, economic and technological time. So too has our relationship to home. We now slip into our separate houses, more often our separate room’s bypassing the shared spaces, seeking ‘our own space’. The virtual ‘network’ is now the place we gather, the new village square, the new community, residing behind each closed door. We are lonelier than ever… more connected than ever.

Reflection

This is not a a condemnation of technology or technological innovation, how ignorant and foolish that would be. Rather it is an expression of concern about a gradual erosion of social and relational skills, of face to face, up front and personal human interaction. The more our attentions are absorbed in a virtual kind of proximity do we risk losing these skills ? Might we fail to learn them in the first place or reject them all together. Are we choosing to replace intimate proximal partnerships with virtual networks – and where may it lead us?

Quantity v quality

The language of ‘connections’ subtly usurps the language of ‘relationships’. Connections are ‘virtual relations’ entered and exited at the press of a button. In a virtual network connecting and disconnecting share the same status, are made on demand and broken at will. In a virtual network we are free to roam as we please and to terminate those connections which no longer interest or satisfy us. The old fashioned networks of ‘kinship’ and ‘partnership’ and ‘committed relationship’ are far more slow moving, clunky and messy than their virtual counterparts and certainly far more difficult to exit. Turnover is the cardinal measure of success in the consumer world. Consumer life favours lightness and speed. Variety and novelty are valued over durability. Commitment and sharing in this context lose their meaning and our appetites for interpersonal risk taking (relating) decline.

There is no doubt that in infinite ways technology improves and enhances our lives as individuals and communities. It is true too that wherever there is something gained there is inevitably something lost. So let us all remember to keep the bonds of human connection alive. Look up, make eye contact, maybe smile or say hello to the next person we stand next to in a queue or a lift. Face time for real! Let’s switch off our devices from time to time and not automatically grant them space at our tables when we commune with real life friends and family. And let’s leave them outside the bedroom door at the end of the day and reclaim that space for rest, restoration and good old human connection.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin –

Paying attention to stress

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Termination and endings in Psychotherapy

We have just celebrated the ending of the year, welcoming in a New Year. It provides a shared / collective opportunity to reflect on the past, think ahead to the future. Likewise, psychotherapy invites us to think about the past, how it contributes to who we are, what is important to us, how the past can provide an understanding of previously unconscious material that has been repressed in order for us to reconcile the past and choose what is taken into the future.

This segmentation of time helps to contain a complex worldview. I suggest the break or holiday from psychotherapy offers us a chance to reflect on how we manage our internal world in the absence of the secure base represented by the clinical setting. The break provides an opportunity to see how we feel without the weekly hour or hour and a half in the session or group.

How important are endings in psychotherapy?

The therapeutic alliance between the therapist and the client provides a safe, secure and consistent base for attachment to a reliable figure for working through trauma. Childhood experiences of adult caregivers, depicted most vividly in fairytales of giants and powerful forces that impact on our emotional security; in adulthood leave traces of emotional trauma that can distort our judgment of reality haunting us as adults. Trauma inhibits the development of neurological pathways that lead to self-regulation of emotional states. Attachment styles will influence how we react to stresses in the environment, the challenge of psychotherapy is to find a way of reaching our fears and understanding how these shape our lives. The biological changes in the brain required to establish new pathways takes time and can leave us feeling confused and bewildered.

Neuroscience has given us a greater understanding of the effects of child hood trauma’s and a method of working that bring about changes in how we process feelings and thoughts.

Through our interactions in the therapeutic setting, either individual or group, enables us to experience /observe our defenses at work in a safe and containing space/ in the individual session or through the group matrix of interactions. This results in a re-working of the internal working model originally created to cope with trauma to enable change to occur. We begin to integrate more adaptive responses to our emotions and feelings. To gain mastery over long held ways of relating, the internalized working model that shaped our attachment style is revised.

What part then do breaks and endings play in this process? Jeremy Holmes suggests that different attachment styles require different approaches to endings. (See paper European Psychotherapy on termination of psychotherapy /psychoanalysis)

I suggest that some knowledge of the theory is useful to clients like a comforting diagnosis helps people feel more in control. It is what mindfulness can do for all of us used in the service of our need for regulation during times of heightened arousal / stress.

Whenever we make an attachment be it to a therapist, a working environment or an intimate relationship we are faced with separation. This is why falling is love is so disorientating; the object of our love leaves us fearing loss, jealousy, envy etc. etc. If our love is reciprocated then we are both preoccupied with one another. It becomes a joke when the love struck people are in a group of friends and only have eyes for each other.

So attachment and separation are present and unavoidable; we are social beings who seek closeness and intimacy throughout our lives. (The exception is when we are preparing for the end of life.)

Ending a relationship or needing to adjust to changes in others in our lives such as our children going from being a child to an adult requires an ability to face the often painful and difficult process of change.

Breaks in therapy offer an opportunity to try out our internalized therapeutic capacity for self-regulation. Ending therapy or a good ending requires work on understanding the capacity we have to deal with life outside of the safety and security of the therapeutic alliance.

 

Thea Beech is a UKCP registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst.  Her work in psychodynamic psychotherapy spans 20 years in the NHS and for the last 10 years overseas in South Africa.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

What is a Psychotherapy Group?

Group Psychotherapy: The Octopus and the Group – what do they have in common?

Face to Face and Online Therapy Help Available Now

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Viagra: Some ups and downs of the little blue pill

The arrival of Viagra (sildenafil citrate) came on the market in 1998 as the first drug to treat impotence. Impotence is the consistent inability among men to achieve and sustain an erection sufficient for sexual intercourse and/or to achieve ejaculation. Like the contraceptive pill in the 1960s it was greeted as a life changer giving men a chance to enjoy more and better sex when they wanted it. Of course it was never going to be that easy and the complications would take a while to emerge. In this blog I will share some thoughts on impotence and Viagra mainly in physiological terms; I will explore further psychological and relational aspects in later blogs.

There are other drugs for erectile dysfunction such as Cialis and Levitra as well as generic versions for example Kamagra. For simplicity I will use the term Viagra to refer to all the different versions.

Key findings from a 2018 survey of 2000 men, carried out by Atomik Research and sponsored by Co-Op Pharmacy, showed 43% of men between 18-60 were suffering from impotence and only 28% of those surveyed had discussed it with a GP. These are worrying figures and we can see why Viagra has been such a success story. Millions of men have taken Viagra apparently without any major incident or serious drawbacks. Although given the reluctance of men to talk to their GPs about sexual problems there may significant numbers who are suffering side effects that impair their sex lives.

Impotence is caused by reduced blood flow to the penis and Viagra works by increasing blood flow. A study of 23,000 men, cited by Pfizer the pharmaceutical company that manufactures Viagra in 2019, claims that 72% – 85% of men taking Viagra (the differences relate to the dosage 25 mg, 50mg and 100 mg) achieved erections hard enough for sex compared to 50% of those men on a placebo. This looks encouraging.

It can take around 15 minutes to one hour for Viagra to bring about an erection suitable for intercourse. On average these effects last 2-3 hours, may be up to 4-5 hours depending on your body’s metabolism. Viagra can help maintain an erection after ejaculation and can reduce the time it takes to achieve another erection following ejaculation. Some men say it can be more difficult to orgasm with Viagra, which may or may not be an advantage for their partners. Pfizer advise Viagra only works when you are sexually aroused, it does not make you feel aroused or cause instant hard-ons. In theory you will not be left with an unwanted erection if you are no longer horny.

A higher dose does not necessarily mean a better hard-on but it is likely to produce more side effects. These can include headaches, flushes, indigestion, abnormal vision, stuffy or runny nose, muscle pain, nausea and dizziness. There are also negative interactions with prescription drugs, over the counter medications and natural supplements. Viagra does not work well following a fatty meal or alcohol, which is tough for those who like to wine and dine as a prelude to sex.

There are men who do not have erectile problems who use Viagra to improve their sexual performance. However the recreational use of Viagra can be dangerous, especially if combined with other recreational drugs as in chem sex; this is an issue because chems can make it difficult to achieve and sustain an erection. Taking Viagra at the same time as recreational drugs such as chems, ecstasy, cocaine, crystal meth, poppers, and speed can produce a range of side effects including serious risks of a fatal drop in blood pressure and/or additional pressure on the heart. There are instances of men taking large doses of Viagra and enduring erections that last many hours. These are often painful and if not treated can damage the penis. In 2013 a Columbian man took a large dose and ended up with an inflamed and gangrenous penis that had to be amputated.

We have to recognise the benefits for men who can buy Viagra without a prescription, however apart from the recreational risks outlined above there are concerns about self-mediation and missing the signs of serious illness. High blood pressure and diabetes are two conditions that diminish the blood flow and therefore impotence can be a symptom. In the US diabetes is the most common cause of erectile dysfunction and impotence can be the first sign of heart disease especially in young men. If left unchecked these conditions can have long term and tragic results.

Viagra has undoubtedly helped many men and couples regain a sex life or find sex more satisfying, however this little blue pill is not always an effective treatment for erectile difficulties. Men who cannot tolerate side effects or for whom Viagra is not medically advised may want to explore other ways of enjoying sex if they are and their partners are able to talk about it. Viagra often reduces spontaneity and mean partners have to plan when to have sex, which again requires talking about it. Openly discussing the impact of impotence on a relationship is not easy; sometimes the conversation never happens. This is where counselling and psychotherapy can help by offering a safe space to have these conversations as individual or as a couple.

References-

https://www.atomikresearch.co.uk/case-studies-archive/co-op-pharmacy-erectile-dysfunction-pr-survey/

http://www.tradesexualhealth.com/sexual-health/sex-drugs/viagra.html

TRADE – Free, confidential health advice, information, services and support for the lesbian, gay, bisexual and trans communities of Leicester, Leicestershire and Rutland.

https://www.viagra.com/learning/is-it-right-for-me

Pfizer, 2019

https://www.usrf.org/index.shtml

Urological Science Research Foundation

https://www.independent.co.uk/news/world/americas/man-s-penis-amputated-after-viagra-overdose-8835146.html

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further Reading by Angela Rogers –

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

The Contemporary Consulting Room

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Is Love a Tameable Force?

Death like birth is a one off life event. We cannot learn through our experience of either to “get it right” next time. Love on the other hand (or the act of ‘falling in love’) is an event amenable to repetition. As such it is also available for re-definition by the forces of culture – political, philosophical and economic.

We no longer imagine or indeed contract for that (romantic) notion of love “till death do us part.” A vision in part predicated on (now outdated) kin-ship structures. These days it seems we care less to tie ourselves into lifetime contracts, or at least not without the freedom to change provider.

Love in a consumer age

One factor involved in the consideration of any investment is the risk attached. The ‘hookup’ model of relationship is a way of keeping (emotional) risk to a minimum. Its strategic focus is on convenience and short term satisfaction. It requires a particular vigilance to any (unruly) emotional undercurrents, with cost/benefit analysis consistently calculated and reviewed. When the initial (emotional ) investment is small there is protection against future insecurity in what can be a highly volatile market.

In his book, ‘The Art of Loving’, Erich Fromm describes how satisfaction in love cannot be attained “…without true humility, courage, faith and discipline” a vision at odds with the consumer age. Now the structures and forces of the market place promise something different. We can barely move for ‘expert’ relationship advice and books, articles and podcasts abound to coach us in the practice of relationship consciousness. In the online marketplace, the otherwise busy consumer may choose from an extensive menu of mouthwatering relational options. Available with an ease of access (and exit) and an abundance of choice, previously unknown. The new ideal of instant satisfaction takes the wait out of wanting with all risk insurance and money back guarantees there to catch us if we fall.

Love and uncertainty (uncomfortable bedfellows)

Love though is an unruly force and resists attempts at mastery or design. Love finds its own meaning in a continual state of becoming. Its creative forces are fraught with risk and like any creative force, we may never be sure where it will end. When we ‘fall’ in love, we enter into a great unknown, we  feel untethered from our usual moorings and suddenly vulnerable in the force field of another’s freedom. Indeed, love navigates a fine line between security and freedom and is threatened by both. ‘Too much security’ may feel like fusion or possession, stifling the creative urge. ‘Too much freedom’ (and a deficit of security) may lead to an overwhelming and agoraphobic sense of uncertainty.

There is then an inescapable duality in love and any attempt to surmount it ends only in its destruction. This paradox lies at the heart of loving. Eros forever haunted by Thanatos like an iron hand clad in a velvet glove.

Love seduces and emboldens us (at least in its opening gambit) to dive into the uncharted waters of ‘otherness’ and engage with the unknown. Love as an antidote to death soothes the ever present human dilemma of separateness. The blessing and the curse of individuality makes a mockery of us and all lovers seek to foreclose the space that separates them from their beloved. It is though in this very act that the death knell to love is sounded. Whatever else love might be a commitment to it inevitably involves the certainty of uncertainty.

To love is to risk and there is no algorithm to square that particular existential circle. The last word on love may perhaps always be best left to the poets.

Source – Erich Fromm, The Art of Loving(1957; Thomson’s, 1995)

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin –

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Emotionally Focused Therapy: For Couples in Distress

Emotionally Focused Therapy (EFT) is a short-term evidence-backed therapy with a high success rate in supporting clients to move through difficulties in their relationship. This includes one or both partners who have experienced early trauma. It is shown to to be an extremely effective way of helping distressed couples strengthen their attachment bond, particularly where one or both partners have experienced early trauma.

As a couple in distress you might feel you’ve reached the end of the line, or you are struggling to get past your partner’s infidelity. Perhaps you can’t seem to get your point across without a descent into conflict.  When this becomes a habitual pattern it becomes destructive, affecting how safe you feel which can erode intimacy, desire and emotional connection.

Emotional, or attachment bonds in our relationships are physiological and therefore potent.  Neuroscience is uncovering how important these attachment bonds are to our sense of safety: distance and separation is perceived as threatening and we go into fight-or-flight mode to get what we need.  This emulates our early life experience when we relied on caregivers to survive.  It might not feel like it but arguments are often a way to draw our partner closer when we feel they are not attuned to us.

Modern couples are subject to different stressors than previous generations. Socio-cultural shifts means we have higher expectations that both partners provide for all our emotional needs  as well as the financial and practical elements. Children may or may not be part of the way we configure our relationship.  Paradoxically we also expect to maintain excitement and passion throughout as we strive to emulate the sexually exciting worlds of the movies.  Yet though we know there’s a dissonance between fantasy and reality, disappointment follows and we may wonder if there’s someone better out there.  EFT considers the wider context that affects relationships, looking at the systems  around the couple that influences their relationship.

How does it work?

Our emotions play a key part in making decisions and in signalling to others our desires, feelings and intentions. Paying attention to our emotions can support us to gauge a situation and act in a way that benefits us and others.

One of the strengths of EFT is that it places emphasis on the negative cycle of conflict couples get pulled into rather than apportioning blame to either person.  The therapist works in collaboration with both partners to identify this dance of ‘pursue-withdraw’ or ‘criticise-defend’ as the couple interact in the room. This here and now focus illustrates the triggers, escalation points and underlying feelings that erode attachment bonds but often remain unspoken.

The therapist supports the couple to listen effectively, witness and ultimately validate the other person’s underlying feelings, emotions and desires.  Partners learn to express feelings from a place of vulnerability and ask for what they want and need from each other.

The ultimate aim of EFT is to reduce conflict and  restore a sense of safety, connection and  intimacy.  Whatever the outcome you will learn new skills of communication, increase compassion for each other and re-establish trust and safety.  It isn’t always an easy journey but you will learn a lot about each other and yourself in the process that will help you make clear decisions about your relationship.

If you would like to try out EFT please get in touch.

 

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.

 

Resources –

Susan M. Johnson (2019) Attachment in action — changing the face of 21st century couple therapy  www.Sciencedirect.com

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The language of love: how couples communicate

When working with couples I am often struck by how much they love each other!

This may sound surprising – by definition the couples I see in my practice have come to me because their relationship is in trouble.  However I rarely see couples who say they no longer love each other. In my experience the problem isn’t that love is no longer there, rather it is that the individuals no longer feel loved by each other.  

By the time couples come to see me one or both of them have been feeling unloved for quite some time.  This comes across in many different ways but often the individuals are hurt and angry. This is easy to understand.  One of our basic human emotional needs is to feel loved. As human beings when we are deprived of a primary emotional need we feel psychological pain which leads to feelings of anger and sadness. 

The emphasis here is on the word feel.  It is not enough to know that our partner loves us, we need to feel that love.  The difficulty is that what makes one person feel loved is often different to what makes their partner feel loved.  If couples are to develop and maintain long lasting intimate relationships they need to know what they need in order to feel loved and also what the desires and needs of their partners are so that they are communicating their feelings in a way their partner can understand on a deep emotional level.

According to Gary Chapman we communicate our love in 5 Love Languages.  They are:

  • Words of Affirmation
  • Quality Time
  • Receiving Gifts
  • Acts of Service 
  • Physical Touch (including sex)

However, we do not understand all 5 Love Languages in the same way.  For example an individual in couples therapy ‘A’ might express frustration that they are being accused of being unloving even though they are always telling their partner ‘B’ how much they love them – Words of Affirmation. The problem is that ‘B’s love language is Quality Time so although she is hearing the words they are not translating into the feeling of being loved.  The chances are that B in turn is using the ‘wrong’ language to express their love for A.

The situation is further complicated by the fact that very often individuals don’t actually know what makes them feel loved.  They might assume that they feel loved when their partner does nice things for them (Acts of Service) but what can emerge in therapy is that actually what makes them feel loved is being physically touched.  

Once couples have discovered what makes their partner feel loved they can then make the choice to actively love their partner in the language their partner understands emotionally.  This is necessarily an oversimplification but once individuals are giving and receiving more of what they need to feel loved by each other some of the feelings of hurt and anger dissipate leaving a healthier emotional climate in which to work on other aspects of their relationship.

 

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.

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Men, Sex and Aging in Relationships

I have previously written about women and the menopause, I am now turning my attention to men, sex and aging in a heterosexual context.

Research indicates sexual activity declines with age however as we see older people being portrayed as healthy, attractive and vigorous, we are more likely to acknowledge this age group as sexually attractive and therefore potentially sexually active.

In psychosexual terms feeling healthy, feeling good about your body and being reasonably fit are factors in feeling sexually attractive and of course these are likely to make a partner more responsive. Whilst the recognition of desire, lust and libido in the later stages of life must be a positive shift it may hide some of the struggles that older men are facing in the bedroom.

There are inevitable physiological effects of age on erectile function. Age UK says that 40% of men over 60 experience erectile problems. Erectile tissue becomes less elastic over time, testosterone levels are reduced, blood flow to the penis decreases. Apart from achieving an erection, difficulties in maintaining it, ejaculating too quickly or not being able to climax at all are common problems.

Sexual problems are frequent amongst older adults. In one study about 25% of older adults with a sexual problem said they avoided sex as a consequence. There are links between poor health and lack of sexual activity. In the same study the most common reason cited for a lack of sexual activity was the man’s ill health. Examples included drinking alcohol to excess, smoking, stress and a lack of exercise and conditions like high blood pressure, type 2 diabetes and heart disease.

Sexual problems are infrequently discussed with doctors and communication about sexual problems can be poor. Apart from the fact that sexual problems may be symptoms of an underlying physical condition, undiagnosed and undiscussed sexual problems may lead to depression and social withdrawal.

The kinds of problems that do not get discussed include concerns about medication for other conditions that impair men’s sexual performance, as well as drugs to improve sexual performance that have unpleasant side effects such as headaches and indigestion. Men might choose to stop taking medication if they feel they will have better sex without it and they may give up taking medication to improve their sex lives if they cannot tolerate the side effects.

In 2015 prostate cancer accounted for 13% of all cancers in the UK. The survival rate has been improving over the last 40 years but survivors can be left with lasting changes to their sense of themselves as sexual beings. One of the treatments is hormone therapy, which effects the production of testosterone and reduces the desire to have sex. Men put on weight more easily and can develop man boobs and they may find themselves crying more often. It is no wonder that a man might ask himself, “Am I still a man?”

In a relationship the impact of an older man’s difficulties on achieving and sustaining an erection will depend on their partner’s own experience of sex and aging. A man with a younger partner may feel he is letting his partner down. A couple may feel safer distancing themselves from each other and avoiding even affectionate physical contact in case it leads to unsuccessful sex. Men with partners no longer interested in sex may feel shameful about masturbating using pornography or fantasising about other women.

We do not readily talk about sex, it makes us feel very vulnerable. Seeking support and sharing feelings in counselling and psychotherapy can be a step to rebuilding a sense of self and sexual confidence and the start to thinking about new ways of relating.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with  individuals and couples in Hove.

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Are criticism and anger good or bad for a happy relationship?

Studies of happy marriages find that anger and criticism are expressed rather than repressed. However the way that they are expressed matters.

Most of us are uncomfortable with expressing anger and being critical. Anger and criticism generate rejection and everyone hates rejection. More often than not criticizing and complaining create a climate of negative energy before they create positive energy.

Why does criticism feel like attack?

Historically criticism could lead to ostracism that may in turn lead to death. To ostracise someone meant to not speak with them, trade, or engage with them in any way. Being the subject of criticism therefore could threaten one’s livelihood and reputation as well as that of one’s family. Our genetic heritage made it functional to kill the criticiser before the criticiser killed us.

Female vs Male anger

In a study on sex differences, when observers were told that the infant they were observing was a boy they were more likely to interpret “his” emotional expression as anger; observers told the identical infant was a girl were more likely to interpret “her” emotional expression as fear.

When we interpret a woman’s emotion as fear the instinct is to protect, when the same emotion expressed in a man is interpreted as anger the instinct is to fight or flee.

It may be that a double standard has lodged itself in our mindset and translates into our feelings about how to criticize a man vs. a woman. It is more often the case that a man’s criticism of a woman is met with disapproval whilst a woman’s criticism of a man is approved of and approximated with empowerment.

Most men have learnt to express anger and criticism toward other men, but have been socialised to protect women, to argue outside the home (with men) not inside the home (with women). Withdrawal is not the way men do battle with men. It is the way they do battle with women.

Genetic heritage

For millions of years, women have biologically selected men who were heroes. The word “hero” derives from the Greek “serow” from which we get our words for “servant” “slave” and “protector.” Servants and slaves were not expected to express feelings but to repress them, just like heroes.

Our genetic heritage, the socialisation process that led women to marrying killer/provider men and men marrying beautiful women, thus selecting genes from which the next generation of children were born is still with us.

With all this genetic and social baggage in tow, is it possible to create a safe environment in which to both give and receive criticism without fear of annihilation? Couples are often afraid to understand their partner’s point of view for fear it will diminish or discount their own and demand too much by way of compromise. This is understandable in an evolutionary context where survival was more dependant on combat than compassion.

Moving forward

Perhaps it is useful to understand relational dynamics as an art, to be engaged with and navigated without blame or shame. Especially so at a time when our relationships have become the organising principle of our lives and the couple the chief organising unit.

This is easy to say, but if communicating effectively were easy, we’d already be doing it! In my next blog I shall be considering what relationship tools, language and intelligence might look and sound like, such that anger and criticism may be expressed and received in ways that promotes relational growth.

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice from Hove.

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50 years on, how free are we from homophobia?

This year has marked the 50th anniversary of the (partial) decriminalisation of male homosexuality in the UK. This has been responded to with a slew of television and radio programmes exploring current and past personal and political experiences of LGBT individuals and communities in the UK and elsewhere. This output has been matched by a large number of broadsheet and online articles on this subject. Some of these commentaries have pointed out how in our celebration of social progress we shouldn’t overlook the social and state owned prejudices that have caused much harm and damage to LGBT people.

For those interested and sensitive to these matters, it is perhaps clear that trans-phobia is still very much alive in our society. However, increased acceptance of homosexuality could give an impression that homophobia may no longer be an issue for people with same-sex identities and orientations in the UK.

This blog focuses on the continual difficulties for specifically LGB identified people due to past and continued impact of homophobia. Prejudices have become more submerged and hidden. There is now an added challenge for therapists to continue to recognise how these might be interplaying and undermining their LGB clients’ social and internal worlds.

Homophobia today

While open hatred towards lesbians and gay men is now less widespread, as a recent BBC documentary testified, it still exists.

Violent attacks aside, people in same sex relationships will still scan their environment before doing something as natural as holding hands in public. In many parts of the UK, being affectionate in this way with a same sex partner is still not deemed either comfortable or even safe enough. In other parts of the world, being openly gay is still very problematic. In some places, it is criminalised and extremely dangerous.

Homophobia refers to hateful (and possibly fearful) feelings towards people with homosexual orientation. When we talk about homophobia, we perhaps think about it being overt. However, this kind of social discrimination operates on many levels. More subtle, and sometimes unconscious, expressions and feelings of homophobia can be harder to tackle, understand, and talk about.

Despite social and legal progress, people with homosexual identities and orientations continue to feel excluded, marginalised, and unseen in this society because relationships are still regarded in the mainstream as heterosexual. How this continues to operate on a social level is complex and often unconscious. This mechanism is known as ‘heteronormativity’, meaning the norm is assumed to be heterosexual.

These social processes are similar to ways in which other groups can be discriminated against, for example on the basis of gender, ethnicity, disability, etc. These prejudices operate in such a socially ingrained way that they are mostly only visible to those in the minority group (and not always to them.) This makes it very hard to challenge or change them.

Internalised homophobia

Broadly speaking, internalised homophobia refers to homosexual self-hatred in relation to sexual orientation. These feelings have been absorbed, like everybody else’s, by living in a homophobic, heteronormative world.

Many LGB people still struggle with overt negative feelings towards their sexual orientation. These feelings might be particularly heightened prior to or grappling with ‘coming out.’ However, feelings of self-hatred, self-disgust, inadequacy and low self-esteem in relation to sexuality can surface at any time in the lives of those with same-sex desires or identities.

Like homophobia, internalised homophobia often seems to be discussed in terms of overt feelings. It is important that we are able to think about these internal processes on a more complex level to understand the less visible ways in which they may continue to undermine the well-being and confidence of gay and bisexual people. LGB individuals living in our current society may well find themselves struggling with less conscious sources of self-hatred that they may not recognise as having any link to homophobia.

This level of internalised homophobia is very difficult to tackle, as it seems likely that it begins early in childhood. In contemporary psychoanalytic thinking about sexuality, theories have emerged that support the idea that our sexualities begin to shape and orientate very early on in our lives (Lemma, Lynch 2015). In this context, it is suggested that responses from parents will heavily influence how all individuals feel about their expressions of sexuality at a young age. These parental attitudes may well be unconscious and shaped by prevailing social prejudices which again can be covert.

Impact and trauma

For some journalists writing on this subject in recent months, the damage has already been done. While things have improved in this country, past state and social attacks through criminalisation, arrests, unequal legal rights, stigmatisation and verbal and physical abuse have left individuals and communities hurt, angry and traumatised. In this way, we might think about the post-traumatic distress that some LGB people may still be struggling with.

Even without these traumatic after-shocks of the past, the negative impact of being gay in a modern society which still consciously or unconsciously operates as if everybody is straight should not be underestimated. Living in a world that marginalises or ignores who you are and who you love can be stressful and tap into earlier experiences of feeling unseen and overlooked.

While ‘coming out’ is less obviously problematic for gay people than it used to be, the experience of many working in specialist services is that it continues to be a struggle for many. Acceptance of one’s self may or may not be echoed by acceptance of friends and family. Cultural and religious differences may also continue to make this more of an ordeal for some than others.

We also certainly know that young people who identify as gay continue to be a highly vulnerable group in relation to homophobic bullying. This can lead to an increased risk of  self-harm, suicide, and the misuse of drugs and alcohol.

LGB people who have accepted their sexual orientation and worked through overt negative feelings are not invulnerable to social forces of internalised homophobia working unconsciously. These internalised feelings can exacerbate and complicate other difficulties such as shame, anxiety, anger, problems around sexual drives and body image. It is widely thought that homophobia can also play an important part in difficulties for same-sex couples.

Therapists working with homophobia

It seems to me in these more liberal and sexually fluid times, therapists need to be even more alert to the ways prejudices and other repressive forces continue to undermine our LGB clients. Homophobia and hetero-normativity operate on multiple levels in our societies. The internalisation of past and current social scapegoating, marginalisation and hatred can be emotionally problematic for even the most confident individual.

An increasing number of lesbians and gay men who come for therapy these days do not regard their sexual identity or orientation as a major problem. However, it is important that we bear in mind the social context in which they are experiencing the difficulties they do bring. These social mechanisms need to be understood as operating both externally and internally and on complex and often unconscious levels. While they may not need to be the focus of therapeutic work, there are likely to be areas where their influence will need to be recognised and actively engaged with.

Many lesbians and gay men continue to feel caution about the potential sensitivity and understanding of therapists towards sexual difference when seeking psychotherapy. Of course, any therapist seeing clients with same-sex desires and identities needs to be very aware of the ways in which homophobia might operate within themselves – whatever their sexual orientation.

In my view, affirming and supporting an LGB client’s sexual identity is essential but insufficient without being also vigilant to the hidden and sophisticated ways that homophobic processes, outside and within the individual, might work to exacerbate or create obstacles to their emotional development and wellbeing.

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

Reference: Sexualities. Eds  Lemma, Lynch 2015

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Suicide: A Largely Male Solution

In February of this year, The Guardian newspaper published two articles on the dramatic rise in male suicide figures in the UK over the past 30 years.  I should imagine that this makes sad and disturbing reading for many, but it particularly spoke to me as I am a man.  And a psychotherapist.

The statistics are grim: suicide is the leading cause of death amongst males between 20 and 34 years of age; male suicide rates that in 1981 made up 63% of all such deaths, now account for 78% across the UK; and whilst female suicide rates have halved since 1981, male rates have increased.

As a relatively young male psychotherapist in private practice I work with a fair few men who pluck up the courage and present for therapy.  The numbers are more or less evenly split between male and female clients, yet I find that there are some fundamental differences between the two genders.  Men tend to present for therapy when they are in a pretty deep crisis – often a relationship will be on the rocks, a career will be hanging in the balance or an addiction has brought them to their knees.  Or they have been sent to therapy by a well-wishing friend or an exasperated spouse or partner.  Either way, coming to therapy for men can often be something that they undertake when all other options have been exhausted.  And it can feel deeply shameful.

Working with clients from diverse backgrounds and cultures, it would also seem that men from British backgrounds, or culturally influenced by Britain, such as Australia, can find coming to talk to someone about their problems tantamount to betrayal of their gender.  Men in the UK are still culturally expected to ‘suck it up’, get on with it, provide for the family and not have feelings.

But as well as the cultural and social influencers on men, the therapy profession also has a role to play in how it has failed to reach men over the past 30 years.  Most therapists are women.  That is not to say women cannot work with men – on the contrary – but for some men it does seem to create a further barrier to entry.  Furthermore, the language of counselling and psychotherapy is often centred around feelings and many men in crisis have spent a lifetime escaping their feelings to the extent that they are not really sure what feelings are and whether or not they have them.  By this I am not suggesting that men are emotionally stunted, however, therapy can and should be tailored to help people process loss and trauma in other ways than through the ubiquitously common question ‘so, how does that make you feel?’.  Body-work, functional psychotherapy, sensing, posture work, and meditation are all routes that I have found successful in enabling men to return to their bodies and thus their felt experience.

Going into a process of psychotherapy is hard for everyone, but especially so for a man who carries round a belief that he needs to manage alone.  It is a courageous choice and one that can make a life or death difference to men who feel desperate.  But, in order for this to happen, psychotherapy needs to lose its stigma – men need to know that whilst a safe environment, psychotherapy can bring them alive and make life rich and meaningful.  And a rich and meaningful life is one peppered with disappointments, pain, loss, grief and every other human emotion possible.  Rather than being the shameful choice, it is the courageous one – the warrior’s choice.

 Mark Vahrmeyer

 References:

 Number of suicides in UK increases, with male rate highest since 2001

Britain’s male suicide rate is a national tragedy

Image credit: Mark Vahrmeyer

 

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