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Loss

You can hold yourself back from the sufferings of the world, that is something you are free to do and it accords with your nature, but perhaps this very holding back is the one suffering you could avoid.” ? Franz Kafka

In this blog, I wanted to write about Loss and try and explain a bit about what the hell we are supposed to do with it! I think loss is perhaps one of the things that I find it hard to think isn’t a feature of almost every encounter I experience as a Psychotherapist, and perhaps as a human, it is a pervasive part of being human, a painful part but a part none the less.

I encounter loss in the therapeutic encounter in a huge range of experiences, from the sudden tragic losses due to bereavement; due to the more ambiguous everyday losses of identity due to the on going vicissitudes of life and changing circumstances. These include the loss of who we are when our situations change, the loss of childhood experienced by parents and their children, due to adolescence, the loss of a much loved work identity in retirement and of course the frequent and painful losses when relationship change or end. So what do we do when, as a colleague poignantly put it, “ the glue dissolves”.

During my training, and in the literature, there is much talk of processing these losses, the need to mourn etc. and about what can happen when these things get stuck, but what do  these things actually mean?“

I think a lot of what I’m doing as a therapist is trying to reflect mentally through my experience and the sharing of my experience of being with someone, a mirror to them so they can come to understand what it is they are doing. Often in grief, there is pain and this pain has to be managed, feelings have to be managed. I will seek through this reflective process to help clients understand what they are doing to manage their grief, not to judge it as good or bad but simply to bring some awareness to it, so it can be thought about. Often, through this exploration of these important-survival strategies, and over time, the experience of grief often so raw and frightening can start to be experienced, to allow it bit by bit to be felt, the good and bad of what has been lost to be experienced and allowed to pass, or at least survived. Sometimes a loss has to examined from many different angles, many times over. Loss is painful and hard to stay with.

Darian Leader in his excellent book, The New Black, revisits Freud’s concepts of Mourning and Melancholia, to explore a more nuanced experience of loss and argues that, modern society has created a pressure to package and treat loss and that this has created a simplistic definition that can be biologically defined and then treated by adjusting the chemicals within the brain via medication. This has led to the many complex and often unconscious causes of depression being narrowed and linked to biological markers that can be targeted via drugs. That’s not to say drugs can’t be helpful, they can be, but they rarely resolve the underlying causes.

Leader while praising Freud’s new thinking about depression, argues that he misses a vital element of mourning, its communal aspect and looks at various cultures and the way in which they share the process of mourning.

For me I am struck by the Musician Nick Cave and his wife; Susie’s, much documented loss of one of their twin boys, aged 15. Nick Cave, has since that loss and after a period of retreat, sought to engage with his audience and to open himself to the experience of loss, he writes a webpage called the Red letter diaries, has gone on speaking tours and often engages and shares in the stories of loss with his audience. He cites this as an essential part of what has helped him survive this tragedy. As he says there are an awful lot of mourners out there.

Both Cave and Leader cite the Buddhist story of a Mother who loses her baby and has the dead baby  strapped to her chest, a monk says that she must find some mustard seeds from a house that has experienced no loss and as she goes from house to house in search of these, never finding a house that has experienced no loss, but as she comes into the contact with the various losses of each house and in the sharing of their grief’s she is eventually able to lay her baby to rest.

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconsious

A Nation Divided

Adolescence: the trials and tribulations

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

The start of a new year feels like a good time to make resolutions to change your life. Cut down on drinking, learn something new, be more efficient, be kinder, be more sociable or get fit.

Gym memberships regularly peak in January, increasing by 10%-20% but how many of those new memberships are used? According to research by Fridge Raiders, published in the Daily Mail in March 2019, 23% of Britons have gym memberships but only 12% use them often. They estimate that more than 4 billion pounds a year is wasted on unused gym memberships.

The reasons given for the 50 percent who did not attend regularly or at all, were to do with feeling self-conscious or intimidated, thinking that everyone was watching, finding repetitive activity boring and not knowing how to use the gym equipment. These could be valid reasons but Robert Kegan and Lisa Laskow Lahey think it goes deeper. They ask why do we stick with the status quo when we are unhappy or unwell and know that change will make us feel better or even make us live longer? Kegan and Lahey have been researching the resistance to change for many years. In their book Immunity to Change (2009) they discovered that strongly held values, often unconscious, prevented both collective and individual change.

The most quoted finding from their studies comes from interviews with patients with heart disease who were told they must change their habits around eating, drinking, smoking and exercise and take their medication otherwise they would die. Kegan and Lahey found that only one in seven was able to make the necessary changes. Making further enquiries they discovered that although patients recognised the imperative of their doctor’s advice there were deep seated beliefs that contradicted their desire to get well.

A composite example would be a man who said that cutting down on food and drink and taking medication for ‘old people’ would make him feel he was old and weak. This challenged his idea of himself as a competent man in the midst of a productive life. Beneath this was his fear of becoming incapacitated and dying that brought back memories of his father’s illness and death. At a deep level the fears that prevented him taking care of himself were the very things that were likely to happen to him if did not change his habits.

There are many other examples in their book. Another composite example would be a manager who wanted to be more collaborative and involve his team in decision-making.  Until he participated in the research he did not realise how much his fear of being a weak leader prevented him from being open to the ideas of others. This feeling stemmed from the unspoken culture of ‘you must be strong otherwise you won’t survive’ in the family he grew up in and was an integral belief about himself. When he could recognise this belief and its negative impact he was able to ask for support to change and eventually become a better and happier leader.

Kegan and Lahey’s research helps us understand why it might be so hard to change our habits to improve our lives. They offer an alternative to castigating ourselves for our indiscipline and lack of commitment and, I think, suggest that we begin by being kind to ourselves and curious.

 

References – 

https://www.dailymail.co.uk/news/article-6765171/Britons-spend-4-billion-year-unused-gym-memberships-new-survey-reveals.html

 

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

 

Further reading by Angela Rogers –

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

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A Nation divided

There has been much talk of how Brexit has divided our country, and indeed, in my own extended family I have members on both sides of the debate.

In this blog I want to write a little bit about how we as humans are divided and how Psychotherapy can ease some of the conflict contained in that. This divide, or split, can happen when we think or do things that don’t accord with what we believe to be our own beliefs. Beliefs about ourselves as doers of good, thinkers of pure thoughts etc. 

Freud describes how these splits can be repressed, by quoting Nietzsche’s phrase: –

“’I did that’ says my memory; ‘I cannot have done that’, says my pride and refuses to yield. Finally – memory gives way.’”

Splitting is not necessarily a bad thing, it is often a way to manage something that cannot be managed at the time, so, cleverly, the psyche represses it. However, this repression is never total so the thing that wasn’t able to be managed, perhaps due to it being too overwhelming at that time, seeks to come out in some other way. 

The outpouring of grief at Princess Diana’s funeral, for instance, was not only about the sad and untimely death of Diana but also presented a triggering of an outpouring repressed and split off grief in so many people and perhaps goes to show how much grief so many of us carry around. 

Another way splits can occur is when we have, as we almost always do, conflicting feelings of love and hate to those we are close to. This can sometimes create a terrible conflict, where the anger or disappointment or hurt, feels like it can’t be expressed for fear of hurting the one that is also loved and therefore potentially causing us to lose that person. 

However, the feelings are still there, so find other ways to come out; – road rage, shouting at the TV, getting into arguments at work, etc.  Most of us want to be good and can find these parts of ourselves distasteful and best not thought about. However, that has side effects, sometimes serious ones and that is when a person will sometimes seek psychotherapy. 

The psychotherapist will work to facilitate the unearthing of these conflicts in a way that is sensitive, non-shaming and understanding, in order to allow their expression and lessen their negative effects on the client’s life. 

To start with this can seem strange and almost feel like the therapist is only interested in their ‘bad bits’.  However, it is not that the therapist wants to humiliate the client, but rather to do the opposite of colluding with the sometimes-long history and input of well-meaning friends and family who have tried to make them feel better by joining in the game of pretending to look the other way. 

As Carl Jung said :-

“One does not become enlightened by imagining figures of light, but by making the darkness conscious.” 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

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Grief – how to grieve?

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

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

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

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

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

 Why should I grieve?

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

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

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

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

How do I grieve?

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

Religion

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

Meaning making

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

Why is grief hard for some people?

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

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

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

Grieving is normal

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

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

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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Depression Counselling



One way of thinking about depression is that it is a prolonged state of feeling hopeless and often lacking any desire whatsoever.  Depression can range from mild to severe and can feel debilitating even in milder forms. Whilst the causes of depression may often not be obvious, therapy works to uncover and process unacknowledged emotions that may be feeling the depression. In fact, often the depression we feel is caused by earlier losses during our life, where the feelings at the time could not be felt and therefore become stuck. To discuss your situation with one of our psychotherapists, get in touch today.

What Causes Depression?

The causes of depression are usually multiple and differ from individual to individual. Common causes include: physical illness, issues dating back to childhood, current life circumstances, hormonal imbalances, poor diet and lifestyle, misuse of alcohol and/or drugs and relationship difficulties, to name a few.

Common Signs and Symptoms

Symptoms can range from mild to severe. Some common symptoms are:

  • Tiredness
  • Withdrawal
  • Enduring and prolonged sadness
  • Feeling helpless and hopeless
  • Lack of pleasure and enjoyment
  • Loss of self-confidence and feelings of worthlessness
  • Difficulty concentrating
  • Anxiety
  • Sleeping problems
  • Loss of sex drive and or appetite.
  • Suicidal thoughts and self-harm

Psychotherapy of Depression

When working with depression, we first try and establish what may be the underlying cause of the symptoms, that clustered together, feel like depression. For example, grief, such as that experienced after a significant bereavement, can feel very much like depression and clinically meets all the symptoms. However, the big difference is that it is completely normal to feel ‘depressed’ after the loss of someone we love, whereas it is not beneficial to feel unable to engage with the world for prolonged periods of time when there is no obvious cause.

As depression counsellors our job is to gently understand the many factors in a client’s life that may be contributing to their overwhelming feelings of sadness and then to help them to find a language to understand and process the feelings from the past or present. This may also involve an enquiry into the lifestyle factors that may be impacting or making the symptoms worse, and work with the client towards change.

Frequently Asked Questions

What is depression?  Read more

    Depression is an illness. Symptoms manifest differently for different people but it is often described as being a prolonged and deep sadness that does not lift or change. Depression can also be linked to a lack of desire where we are unable to feel ‘alive’ or engaged with life and what we may want – everything feels empty and hopeless. Depression is both mental and physical with sufferers often struggling to feel energised. It is also linked to anxiety with many sufferers reporting alternate feelings of depression and anxiety.

    How do I know if I am suffering with depression?  Read moreDepression varies from person to person, however, a good starting point is to consider whether the feelings of prolonged sadness and heaviness are linked to an event or not. For example, it is common to feel feelings similar to depression when grieving, however in this context, these feelings are appropriate and not depression. We all have ‘down’ days’ however, if you are struggling to engage with life and feel hopeless and these feelings continue for some weeks then you may be struggling with depression.

    What happens in a first session?  Read moreThe first session with one of our practitioners is an opportunity for you both to work out whether you feel able to work together. Your psychotherapist or psychologist will likely ask you various questions relating to what has brought you and explain the process of therapy to you. The first session is a two-way process where you have toe opportunity to ask questions and to decide whether you feel ‘safe enough’ working with your therapist.

    How do I find a psychotherapist of psychologist I want to work with?  Read moreAt Brighton and Hove Psychotherapy, we have two practices, one in Hove and one in Lewes, where we offer a full range of psychological therapies. On our website you can view each profile of our associates and contact them directly using the form on their profile page. You can also use our handy search function to find the right practitioner for your needs. Lastly, you may also contact us by phone on 01273 921355 and our practice administrator will assist you in finding the right associate to work with you.

    How long will it take for me to see a psychologist or psychotherapist  Read more

    We aim to respond to all enquiries within 24 hours. You may either contact one of our practitioners directly via their profile page, or you can contact us directly and we will assist you in finding the right person to see as soon as possible. If the practitioner you wish to see has space then an appointment can usually be arranged within a week and sometimes much sooner.

    How can I get in touch with you?  Read moreYou can contact our practitioners directly via the contact forms on their profile pages. They will then reply to you directly.  Alternatively you can call us on 01273 921355 or fill in our general contact form and we will assist you with your enquiry.

    What age groups of clients do you work with?  Read moreWe have psychotherapists and psychologists trained to work with every age group from infants through to adults.

    Do you offer evening and/or weekend sessions?  Read moreWe offer sessions every day of the week including on Saturdays and sessions are available into the evening.

    What are your fees?  Read moreOur fees are set by each practitioner depending on the type of therapy. For individual psychotherapy or clinical psychology our fees range from £60 – £90 per session. For couple therapy our fees range from £70 – £100 per session.

    Is there parking near your Hove and Lewes practices?  Read moreBoth our Hove and Lewes practices are centrally located close to train stations, bus routes and with on-street parking.

    For more information on depression counselling across Brighton and Hove or to find out how we can help with the treatment of depression, get in touch with us today.

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


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