Mark Vahrmeyer Blogs - Brighton and Hove Psychotherapy

Is starting psychotherapy a good New Year’s resolution?

August 4, 2025 by BHP Leave a Comment

Dissociative identity disorder: A rare trauma response, not a social trend

In recent years, Dissociative Identity Disorder (DID) has become a trending topic on social media, particularly on platforms like TikTok. Short-form videos often depict individuals rapidly switching between so-called “alters,” complete with visual and behavioural cues. The implication—sometimes explicit, often subtle—is that these portrayals are representative of DID.

They are not.

Clinically, DID remains one of the rarest and most severe psychological responses to trauma. Its presence in the consulting room is exceptional. And when it does appear, it is neither sensational nor theatrical.

It is often profoundly confusing for the patient and represents a significant challenge to diagnose—let alone to work with therapeutically.

What is DID?

DID does not arise in response to ordinary life stress or general childhood adversity. It is a response to extreme, prolonged, and frequently unspeakable trauma—often chronic sexual abuse—occurring in early childhood, at a time when the child’s sense of self is still forming. The psyche, overwhelmed by terror and deprived of adequate relational support, fragments as a means of survival.

This fragmentation is not a performance but an act of psychic necessity. The various identities—commonly referred to as “alters”—emerge as distinct parts of the self, each holding pieces of memory, emotion, or experience that could not otherwise be processed. These parts are not necessarily “visible” in the way TikTok trends would have us believe.

Many individuals with DID are unaware of their condition until much later in life. The disorder is more often characterised by dissociative amnesia, identity confusion, and significant functional impairment than by the overt behavioural switches popular culture associates with it.

The risks of glorification

When a complex and rare condition like DID is popularised through social media, the risk is twofold. First, individuals living with the condition may feel misunderstood, invalidated, or even disbelieved. Second, such portrayals may encourage vulnerable young people to self-diagnose or mimic symptoms without understanding the gravity of what they are engaging with.

This trend trivialises and caricatures both the disorder and those who live with it.

The clinical reality of DID

In the therapy room, DID is rarely, if ever, flamboyant. It does not look like costume changes or shifting accents on cue. It looks like deep disorientation. It looks like unbearable silence and fractured memory. It looks like a long, painstaking process of building safety, recognising fragmentation, and slowly working toward integration—often over many years.

The goal is not to spotlight “alters,” if indeed the patient experiences themselves in this way, but to support the whole person in reclaiming continuity, safety, and coherence.

A note on curiosity and clinical competence

It is natural to be curious—dissociation is a fascinating and complex area of the psyche. But curiosity must be paired with caution. When complex trauma responses are reduced to trends, we risk distorting the public’s understanding of profound psychological suffering.

Most clinicians will never encounter a case of DID in their careers. It is arguably the most extreme trauma response the mind can manifest to protect itself from annihilation and psychosis. For those who do encounter it, the condition may be missed—misunderstood as something less serious—without the aid of specialist supervision.
DID is not entertainment. It is the psyche’s last defence against obliteration. It demands our respect—not our spectacle.

Further reading by Mark Vahrmeyer

Can AI offer therapy?

Why staying in your chair is the key to being a good psychotherapist

Is starting psychotherapy a good New Year’s resolution?

Twixtmas – surviving that dreaded time between Christmas and New Year

How to minimise Christmas stress if you are hosting

May 26, 2025 by BHP Leave a Comment

Can AI offer therapy?

There is currently a great deal of noise and speculation about whether artificial intelligence (AI) can provide therapy. There are strong advocates on both sides of the argument, and evidence would suggest that, at least to some degree, AI can provide what some describe as ‘therapy’.

The NHS, in part driven by its chronic funding crisis, is using ‘chatbots’—a form of AI—to interact with patients. In principle, there seems to be no immediate harm in this, provided that data from patient interactions with chatbots remains wholly anonymous.

It also appears that some individuals find AI chatbots helpful in the context of their mental health. I am not in a position to dispute this. If such interactions offer some benefit, then—again in principle—I see no objection.

However, I believe that focusing on whether AI can offer therapy is the wrong question. This places undue emphasis on AI as a system, rather than addressing the far more important and nuanced issue of what actually constitutes therapy—more specifically, psychotherapy.

What is therapy?

‘Therapy’ is a nebulous, catch-all term. It describes something believed to be helpful to one’s mental health—a term which itself has, in recent years, been diluted and now often incorporates emotional, and even physical, wellbeing.

When members of the public describe something or someone as ‘therapeutic’, or beneficial to their mental health, they are usually speaking subjectively—referring to something that helps them feel better, whether temporarily or over the longer-term.

We all benefit from activities and relationships that support, calm, or stimulate us — depending on the context. This is a reflection of both individuality and temperament. Examples might include cold-water swimming, yoga, reading, eating nutritious food, or indeed seeing a psychotherapist. These may all be helpful, but they are not interchangeable. They are not all ‘therapy’, in the clinical sense of the term.

What is psychotherapy?

I have written extensively on this subject, but to summarise:

Psychotherapy, like counselling, emerged from the tradition of psychoanalysis. While counselling and psychotherapy may look similar on the surface—two people talking in a room—the depth, training, and psychological work involved are fundamentally different.

In the UK, psychotherapy training typically takes 4–5 years at postgraduate level. It includes intensive assessment, a psychiatric placement, an ongoing personal therapy requirement, and at least 450 hours of supervised clinical practice. Counselling training is significantly shorter and less rigorous in all aspects.

UKCP and BPC-registered psychotherapists are trained to work at depth and to formulate—psychological diagnosis — based on the patient’s inner world and relational patterns. Counsellors are not trained to formulate.

Psychotherapy is an intimate and sustained relational process in which the clinician uses their mind and emotional presence to understand the patient’s unconscious processes.

The aim is to work through relational disturbances—most often rooted in early development—and to support the patient in grieving and integrating these experiences.

Psychotherapy helps patients disentangle themselves from the repeating patterns of their past so that they may live more freely and authentically in the present.

One could argue that psychotherapy involves a process of “re-parenting” the unconscious—a concept encapsulated in Freud’s idea of therapy being a “cure through love”.

Why can therapy only be provided by a human?

At its very core, psychotherapy is a human-to-human experience. It is a living, breathing relationship between two people—one of whom offers their presence, mind, and emotional attunement in service of the other.

We connect in relationships through a complex process that involves both our cognitive and emotional faculties.

What is a mind?

In psychotherapy, the mind refers not to the brain as an anatomical structure, but to the capacity to make sense of one’s own thoughts and feelings — and, crucially, to hold and make sense of another’s experience. The mind is what allows us to reflect, to empathise, and to regulate emotion.

What is an emotion?

An emotion is a physiological response to internal or external stimuli. It seeks to be communicated, first to ourselves, then to others. When we label our emotions using language, we call them feelings. Emotions originate in the body and without a body, there can be no emotional experience.

Why AI can never offer psychotherapy?

Psychotherapy can only occur between two (or more) human beings. It requires the full, embodied experience of another person in order to take place. The therapist must bring their humanness to the process—not only their intellect, but their feelings, their capacity to be impacted, and their ability to remain separate, yet deeply connected.

AI does not possess a mind. It simulates a mind.

AI does not feel emotion. It mimics emotional understanding.

AI is not embodied. It cannot reflect or hold another’s experience because it has no experience of its own, as it has no body.

If AI could truly offer psychotherapy, then AI could also raise children. The implication is chilling: we would, in effect, lose the essence of what it means to be human.

Can AI be helpful to mental health?

As I stated earlier, AI may well have a role to play in the broader realm of mental health—particularly as defined in its current, diluted cultural form. I meditate daily and do so for emotional and physiological benefit. Meditation may well quieten the mind, but it cannot grow one. Meditation is therefore not psychotherapy but may be a useful adjunct.

Minds are only grown in human-to-human relationships

This begins in-utero and throughout infancy—in the mother-infant dyad—where the child’s mind is shaped through emotional connection with a caregiving other. When that process is disrupted or fails, psychotherapy is the only viable path to develop a reflective, relational mind in adulthood. It is, in that way, profoundly unique.

Further reading by Mark Vahrmeyer

Why staying in your chair is the key to being a good psychotherapist

Is starting psychotherapy a good New Year’s resolution?

Twixtmas – surviving that dreaded time between Christmas and New Year

How to minimise Christmas stress if you are hosting

March 31, 2025 by BHP 1 Comment

Why staying in your chair is the key to being a good psychotherapist

When working with trainees and supervisees, I frequently refer to the need for a psychotherapist to ‘stay in their chair’. Let me explain.

Psychotherapy is a relationship. It is a very intimate and unique relationship between the clinician and their patient, which is principally about the needs of the patient. This, however, does not mean that the psychotherapist acquiesces to every whim or request a patient may have. On the contrary.

The key to any successful relationship, whether a friendship, a romantic relationship or a parent-child relationship, is that there are clear boundaries. Often, if not always, when a patient comes into therapy it is because they have grown up in an environment where the boundaries were poor, inappropriate or non-existent. In other words, they grew up with relational deficiencies.

Poor boundaries create a psychological and at times physical environment, where there ceases to be a differentiation between self and other. This is often referred to as a merger. Where children grew up with a parent or parents with poor boundaries, the experience can be hugely impactful on their psychological and emotional development and, in attachment language, leads to insecure or disorganised attachment styles. In simple terms, it makes it very difficult for these individuals, once adults, to have healthy boundaries in two-person relationships; they are either at the mercy of the other, or conversely, make everything about themselves and fail to recognise the needs of the other.

As a psychotherapist with fifteen years of experience, I have yet to meet a single patient who crossed my threshold, who did not have issues with relationships and thus had attachment damage. It’s the work.

One of the primary roles of the psychotherapeutic relationship is to have a caring, loving relationship with the patient, that is in their best interests. It therefore is boundaried by definition.

One of the tenets of working as a psychotherapist is that it is always in the best interest of the patient for the clinician to hold the boundaries. Even if the patient pushes against these – and they will. Just as it is a parent’s role to hold the boundary with their child and hold their best interests in mind, since they cannot.

So, now we are coming to the meaning of ‘stay in your chair’ which I mean both literally and figuratively. Put simply it means stay in your role and hold the boundaries, because without boundaries, the psychotherapy ends.

Patients who have not grown up with clear and supportive boundaries will unconsciously try and recreate a familiar dynamic, generally stemming from their childhood, in the psychotherapy. Us clinicians refer to this as transference, which is a form of projection from the patient onto the clinician. The difference between projection and transference is that the role of the psychotherapist is to think about and understand the projection onto them, and within this to recognise the relational blueprint of the patient and whom the psychotherapist represents for the patient. In simple terms, the patient will attempt to ‘play out’ the most influential relational patterns from their childhood with their psychotherapist. And if this is not caught and thought about, then the therapy simply becomes a repeat of the patient’s childhood experience.

Whether a patient attacks or seduces, our role is to stay in our chair – to remain consistent and constant and to hold the boundaries. Patients will invariably ‘act out’, which is to say that they will embody and play out dynamics that are counter-productive to the therapy, but familiar to them. Our role as a clinician is to survive these acting outs and to protect the therapy at all costs, Sadly, the concept of psychotherapy has become increasingly diluted in the UK, in part due to a lack of differentiation between counselling and psychotherapy and a general ‘race to the bottom’ amongst training institutions. The result is that therapists increasingly have no concept of ‘staying in their chair’ and either move towards the patient when seduced into a collusion, or back away and abandon when attacked.

Lastly, this is not to say that as psychotherapists we should accept or ‘put up with’ attacks from patients. On the contrary, the boundaries are there to protect us too, and if a patient verbally attacks and cannot return to think alongside their therapist, then they may simply be unsuitable for the work, which is also a boundaried position to hold.

Further reading by Mark Vahrmeyer –

Is starting psychotherapy a good New Year’s resolution?

Twixtmas – surviving that dreaded time between Christmas and New Year

How to minimise Christmas stress if you are hosting

Is starting psychotherapy a good New Year’s resolution?

February 3, 2025 by BHP Leave a Comment

What do dreams mean?

We all dream – whether we remember them or not. And there is plenty of fascination about dreams and what they may mean, ranging from nothing at all, to being a means and method of understanding a patient’s unconscious.

In 1899, Sigmund Freud wrote The Interpretation of Dreams outlining his theory of the unconscious and describing dreams themselves as being “the royal road to the unconscious activities of the mind’. He therefore found dreams to be hugely relevant.

Is there an unconscious?

If dreams matter, they only do so if we believe in an unconscious and, by extension, unconscious process. Which is to say we believe that we are all, to a greater or lesser extent, driven by repressed ideas; thoughts and feelings that have been repressed – pushed out of consciousness – but that nonetheless make themselves known in our behaviours.

Analytical depth psychotherapy (psychoanalysis) believes and works with the patient’s unconscious. While the means and methods of doing so may have morphed and shifted over time, us analytically trained psychotherapists believe that the unconscious holds the key to understanding a patient’s inner world.

Freud was a neuroscientist and whilst our collective understanding of the mind was limited in the late 19th century, modern neuroscience confirms that most brain processes take place without conscious awareness and that all brain regions are involved in both conscious and unconscious thought. It therefore seems irrefutable that we all have an unconscious.

Do dreams have specific meaning?

There are plenty of folk who are quick to tell us what our dreams mean based on the imagery present in them. They see the content of our dreams as containing symbolic meaning common to all of us. These are people who often do rather well from their version of ‘interpreting’ dreams, as so many of us have a fascination with dreams and wish to see them as prophetic.

Freud and all those who have trained in real psychotherapy are suspicious of this ‘one size fits all’ approach and recognise instead that whilst dreams are symbolic in nature, the symbolism is tightly connected to the individual, and their circumstances, experiences and personality.

When working as an analyst, Freud used a method called ‘free association’ to gain an understanding of the patient’s unconscious mind, including what their dreams may mean. Rather than imposing his own view on what their dreams meant, he would instead ask a patient to share whatever associations came to mind in relation to their dreams, and from this suggest what they might mean. His approach was therefore collaborative.

What is manifest and latent content?

In depth therapy we do not take the presented content – the manifest content – literally. We see it as being coded content from the unconscious, which we refer to as latent content. The unconscious both wants and does not want to be known. It is where memories and experiences that are too painful or contradictory for the psyche are buried – repressed. And yet, repression is never perfect, and so at the same time the unconscious expresses the needs linked to this repressed material through behaviours and through dreams.

How can we know what dreams mean?

Anyone who tries to convince you that they know what your dream means based purely on the content is a charlatan. Human beings are far too complex for this and understanding a dream can only be done in understanding a person’s history and experiences, and in the context of a relationship.

Even when a psychotherapist knows you well, I would hope that they would not suggest that a dream has certain meaning without asking you what you make of it, and your associations with the symbolism. A dream can have multiple meanings and many only become clear over time.

All this said, dreams can be both hugely interesting for both the patient and analyst, in gaining deeper insight into what has been repressed and is seeking expression.

Further reading by Mark Vahrmeyer –

Twixtmas – surviving that dreaded time between Christmas and New Year

How to minimise Christmas stress if you are hosting

January 6, 2025 by BHP 2 Comments

Is starting psychotherapy a good New Year’s resolution?

Most of us make some sort of New Year’s resolution, whether overtly or covertly. The new year can feel like an opportunity to put the past behind us and to start afresh.

Whether or not we actively name and own our New Year’s resolutions, most of us can also attest to the best held intentions for change slipping away. There are plenty of good reasons why New Year’s resolutions don’t work. We are often too unspecific in what would constitute change, and it can be hard to make change on our own.

Psychotherapy is about change. However, the start of all change comes from inside. To make change, we need to understand ourselves and accept why we have made the decisions we have. Nothing is random.

Psychotherapy is first and foremost about learning to have a relationship with ourselves and to learn to hold ourselves in mind, often in ways others failed to do when we were growing up. When we hold ourselves in mind, we can objectively evaluate if something is helpful or in our best interests.

We learn to hold ourselves in mind through others holding us in mind. This is one of the main roles of a psychotherapist. Holding a client in mind is far broader and deeper than simply making notes and remembering what they told us. It is about having a relationship with them and helping them to understand their blind spots, their relational patterns to themselves and to others. Helping them work through this is the therapeutic encounter.

Psychotherapy is often hard. Keeping to a weekly day and time when we meet with our psychotherapist can feel like a slog. Unlike a New Year’s resolution, the process is held relationally. Your psychotherapist makes the time and space available to hold you in mind and expects you to show up for the weekly dialogue. Even if you do not attend, your therapist is there to hold you in mind.

Perhaps the question is not so much whether psychotherapy is a good New Year’s resolution. Rather, it may be whether you are committed to having a deeper and more meaningful relationship with yourself, and through this, learning to hold yourself better in mind. The latter will lead to long-lasting changes on a profound level which may or may not include more frequent trips to the gym!

Happy New Year from all of us at Brighton and Hove Psychotherapy.

Further Reading by Mark –

Don’t tear down psychological fences until you understand their purpose

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

December 23, 2024 by BHP Leave a Comment

Twixtmas – surviving that dreaded time between Christmas and New Year

Twixtmas, that time between Christmas and New Year seems to be a particularly difficult time for many. Why is this?

The build up to Christmas and the accompanying excitement for some, and anxiety for many, can leave us feeling depleted and down in the immediate aftermath of the big day.

Perhaps a lot of why we collectively struggle with this period of time, is that we are failing to use it in a way that is in keeping with nature and our biology. There has been a celebration around this time for much longer than the word ‘Christmas’ has existed.

Christmas falls, not coincidentally, very close to the winter solstice in the northern hemisphere. This would have been marked by people pre-dating Christianity as being the shortest day of the year and the celebration of the return of the light.

It is a time when nature goes fully into hibernation and it seems like nothing is happening in the natural world. What is actually happening is a renewal – a time of deep rest, before the return of growth and activity – the latter would have been celebrated as a fertility festival at a time we now refer to as Easter.

Therefore, rather than approaching this period of time as empty and boring, much can be gained from seeing it as a period to rest, reconnect with loved ones and recuperate before the start of the new year. It is a time when we can legitimately do very little.

After any period of excitement comes a lull and this is no different at Christmas. One cannot be experienced without the other. We can probably all relate to this with the feeling we get after a fabulous sunny holiday, only to return home and get back into the drudgery of washing, shopping, school runs and work.

Equally, we would not appreciate the exciting times – the highs – if life was permanently like that. Therefore, the first step in coming to terms with the change in energy and mood is to embrace it and accept it as part of the experience.

Once we have accepted that the energy of the world around us, as well as our own, will feel different to Christmas, we can plan activities that correspond to this energy. Walks in nature, snoozing on the couch, watching a film in the afternoon, or connecting with family in a less heady and fun-filled way than at Christmas are some examples.

I suggest that Twixtmas is an opportunity for reflection on both the year that has passed and the year that is about to arrive. It offers an opportunity to slow down and converse with our inner world as to what we may want, not only from the new year, but also from our lives. Some people find it uncomfortable to be confronted by their inner world, and the excitement of Christmas – whether you love it or hate it – is a perfect distraction from our desires, wants and needs.

I suggest that if someone feels disappointed or glum during this period, that either it is an ordinary response to the change in rhythm from festivities to calm, and/or the feelings are telling them something about their life, and may be an indication of something that is missing or needs attention.

Surviving Twixtmas with kids

Getting through Christmas can feel like an uphill struggle for many, and once the day has passed it may feel like there is little left in the tank to give to demanding children.

As suggested, getting out and about with the family can be a good way to both blow away the cobwebs as well as tire out the little ones. However, despite the promises of winter wonderlands on the Christmas cards, we all know that in the UK, late December is more likely to be a wash out!

This is where planning the children’s gifts comes into its own. Thinking about what gifts will occupy your children for hours and building your gift list around this objective can be a good way of ensuring that they remain engaged and stimulated in the immediate lull after the big day. Starting a new book, learning to play a new board game or creating art with paper and paint can all engage children for many hours.

Final thoughts

A leaf can be taken out of the book that tells us that good Christmases are rarely about what gifts we are given and more about a sense of connection and family. There is opportunity for this during Twixtmas, but with a different flavour.

Where people have a sense of meaning, they generally find their own purpose in the context of that meaning. If Twixtmas is simply a dead week punctuated by the start of the sales, it can feel pretty barren and empty. If, however, it can be embraced as a time for calm, rest, reflection and connection – with oneself as well as friends and loved ones – then there is significant meaning to be found during this period.

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.

Further reading by Mark Vahrmeyer –

How to minimise Christmas stress if you are hosting

December 16, 2024 by BHP Leave a Comment

How to minimise Christmas stress if you’re hosting

Christmas can be an emotionally challenging and difficult time for many of us. There is such expectation on how Christmas ‘should’ be, yet like the weather, it often fails to deliver on the ‘winter wonderland’ scenes on the TV adverts. For so many of us our family experience often falls far short of the loving idyllic family reunions depicted in those same snowy adverts. And if you are hosting, this can bring with it an added pressure to deliver the ‘perfect Christmas’.

There is lots of advice available on how best to organise yourself practically in advance in the big day, such as food prep hacks. However, I wonder if there is another way of not only coping but getting something from the day for yourself?

Think about your own needs first

An example that I often use in clinical practice when illustrating to patients how it is vital that they think of their own needs, is the pre-flight safety briefing that happens before a plane takes off.

Anyone who has flown has sat through at least one of these and there is a particular point in the briefing where the cabin crew explain what you should do if the cabin loses pressure, the oxygen masks drop down and you are travelling with a dependent. The correct approach is to attend to your own mask first and then your dependent, however, it is surprising how many people think that they should help their dependent fit their mask first, before attending to their own. Why is it this way around? Because if you try and help your dependent first and have not tended to your own needs, there will be two people in distress rather than one. And yet for so many of us the inclination is to ignore our own needs and attend to those of others.

Applying the same logic to Christmas, before deciding whom to invite and having any conversations with family and friends about the day itself, first think about your own wants and needs. What are your physical limitations and needs? What can you and can’t you do? How many people can you host without feeling overwhelmed? Who’s company do you enjoy and who is draining? What do you want to get from the day?

The next step is to think about what is negotiable and what is a firm boundary. For example, it may be that you are willing to cater for an additional number of people if you have help or support from others with cooking. Or, it may be that you are willing to tolerate the presence of someone you find contentious, if another member of the family assures you that they will help you manage that person. However, a firm boundary may be that you have a certain time by when you request everybody leaves (stated in advance).

Wants versus needs

The nature of Christmas combined with the pressure to host, can often mean that any consideration of what you may want from the day gets lost and the focus shifts to being one of ‘surviving the day’. What if it does not have to be like this? What if you could take some time to calmly consider how you would like not only to ‘host’ the day and cater for everybody, but to play an active role in creating the day that you would like? In other words, what if you were to value your own needs as much as you value everybody else’s?

Hosting does not mean sacrificing yourself

Consider how you do not need to sacrifice yourself in order to host an event for others. People who are worth being in relationship with (and therefore arguably worth spending Christmas with), should be people who are interested in your wellbeing and needs and will therefore be open to hearing about not only what you can and can’t offer on the day, but also what you would like from it. If they aren’t, then perhaps question whether they are really wanting to celebrate with you as a person, or are simply making use of what you can provide.

Support through relationship

Putting your needs into the mix can feel daunting if it is not something that you are used to doing. And it is generally only possible if we can rely on having an ally, or allies, by our side who are encouraging – this is often our partner or a close friend. If you are in a relationship, talk to your partner about your needs and wants of Christmas well before the day arrives. Explain to them how you wish to approach hosting Christmas and risk asking for support – emotional as well as practical. This is something you can do with a friend, or friends, too.

It can also be really helpful to agree up front how you will ask for support on the actual day and how you would like your partner or friend(s) to support you. Examples may be anything from starting the day together and connecting, through to specific practical requests. You can demonstrate support for each other throughout the day through small reassuring gestures such as visually checking in with one another or making physical contact.

Reality testing

Christmas is only a day and that is really worth bearing that in mind. However the day goes, the world will keep on turning and in all likelihood, the relationships that matter will still be there for you. The expectations we feel in relation to Christmas are largely in our own head and can therefore be challenged. By pausing and accepting that there is no such thing as a ‘fairy-tale Christmas’ we can gain a little space to see it for what it is. It does not have to be perfect nor is it likely to be. Is the goal a ‘picture perfect’ Christmas, or one in which you feel like you are connecting with loved ones and friends?

The past is not the present

For many, memories of past Christmases are difficult and they can reappear like ghosts. However, these ghosts need not dominate your experience in the here-and-now. Accept that it is a difficult time for you and know that it is for many others too, be compassionate with the feelings that the season evokes and remember it is only a day. Sometimes we feel strong emotions on particular days that are simply reminders of the past – echoes – and we actually have the power to create something different. The more you are able to anticipate your wants and needs ahead of Christmas, the less likely the ghosts of the past are to appear and dominate the day.

Alcohol generally makes things worse

Nobody is telling you not to drink on Christmas Day. However, if it is a day that evokes sadness or anxiety, alcohol will not improve these feelings for long. Once it wears off, they will be back with a vengeance and accompanied by a hangover. The opposite of using alcohol to self-soothe is to soothe through relationship. Even if you are not in a relationship with another, you are in a relationship with yourself and can hold yourself in mind.

Even if the day feels full and focused on others, it is always possible to take a few minutes out to calm yourself. You can breathe, come back to the here and now and remind yourself – Christmas is only a day.

Listen to your body

This doesn’t mean act impulsively. It is more about listening for what the vulnerable part of you needs. This may be a hot bath with a good book, a warm drink by the fire, a nice home cooked meal or spending time with a supportive friend. It could also be a long run, or a dance or yoga class. Whatever self-care tool helps you feel well and connected should form part of your preparations for the day and be in place after the day.

Further reading by Mark Vahrmeyer –

Don’t tear down psychological fences until you understand their purpose

December 2, 2024 by BHP Leave a Comment

How do you get self-esteem?

Self-esteem is often spoken about and seen as something that we should be aspiring towards. However, what is less clear is exactly what constitutes ‘self-esteem’ and how we can best define this concept.

What is self-esteem?

Well, according to Jordan Peterson it simply does not exist. However, he is in the minority with this.

Whilst self-esteem is difficult to quantify, in my view it is certainly something that exists and is important to us all. Self-esteem is a measure of how positively we feel about ourselves on a profound level.

We can all engage with activities that make us ‘feel good’ in the short-term. However, not all of these are going to lead to self-esteem, and in fact many such activities may damage our self-esteem or how we feel and think about ourselves.

We all pursue pleasure, joy and trivial or frivolous encounters and there is nothing wrong with this. However, when they are in lieu of working towards something that is based on long-term desire and appetite, they function as distractions and brief manic events, rather than being the building blocks of a positive sense of self.

What is the key to building self-esteem?

Many people erroneously believe that the goal of life is to pursue happiness. However, as I have previously written about, happiness is simply an emotion and is no more valid as a feeling than any other.

Rather than pursuing happiness as a goal, I believe that pursuing meaning in life, based and built upon our deeper long-term desires, is not only the basis for a good life but is also the vehicle through which we can build solid and positive self-esteem.

It’s not the pursuit of happiness; it’s the happiness of the pursuit.

Self-esteem comes from identifying the metaphorical mountain that we are going to climb; something that is deeply personal to each and every one of us, and arguably the discovery of which is one of the main functions of working with a psychotherapist in a process of depth therapy.

Therefore, it is not the achievement of the goal that brings happiness, but engaging in a meaningful process of working towards that goal, that brings a sense of contentment and meaning and bit by bit contributes to good and enduring self-esteem.

The self-esteem formula

Jordan Peterson believes that self-esteem is in essence nothing more than an index of a person’s tendency to experience negative emotions, and that it can be calculated through subtracting neuroticism from extraversion. In my view, human beings are far more complex than simple formulas, and whilst some of us may score more highly on the tendency to experience negative emotion (neuroticism), the concept of self-esteem remains useful.

On the role of desire

I am not attached to the phrase ‘self-esteem’ and have no particular interest in imposing it on a patient. In a therapeutic relationship, the language used is co-created between patient and clinician.

However, a word I refer to often in the context of desire – what we want – is appetite. Appetite is a word we associate with eating, and eating is a useful metaphor. When we are hungry in the truest sense of the word, we simply need to eat. However, this says nothing about our appetite – what we desire. Eating because we are hungry is akin to simply surviving. When we have an appetite for a particular food type or dish, we are expressing a desire in the context of having choice and thus being alive.

When we apply appetite in a broader context to life, then it is an expression of what we desire for ourselves and thus an expression of aliveness, rather than survival.

Nothing that comes easily or simply is an expression of appetite in life. We are complex beings, and living versus surviving is all about allowing ourselves to dream about the kind of life we want, and is, crucially, an expression of our individuality. Much like that which we have an appetite to eat, appetite as an expression of our life’s desire(s) is deeply personal to each and every one of us.

This is ultimately the concept of ‘the hero’s journey’.

Desire and self-esteem

When we have the courage to pursue that for which we have an appetite – that which we deeply desire – we feel alive and positive about ourselves. We embark on a journey, the destination of which we cannot be sure of.

Self-esteem is derived from every step forward we take on this journey. Every time we hit a dead-end and find the will to take another path, or dust ourselves off after life knocks us down, we add to our self-esteem.

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.

Further reading by Mark Vahrmeyer

Don’t tear down psychological fences until you understand their purpose

September 2, 2024 by BHP Leave a Comment

Why is psychotherapy generally weekly?

All forms of psychotherapy, from the classically analytical, through to humanistic, evolved from psychoanalysis and thus Freud. The cadence of psychoanalysis has changed very little over the years, with sessions taking place between three and five times per week, generally at the same time each day.

Psychotherapy evolved directly from analysis but is also quite different. For example, those who are suited to psychotherapy may not need analysis, and in cases of more troubled or disturbed patients, weekly psychotherapy may not be sufficient and psychoanalysis is recommended. However, despite the frequency difference, the consistency remains the same.

Those who are trained in-depth and adhere to the principles of the psychotherapeutic framework, which is to say all the non-verbal factors that enable the process of psychotherapy to take place, will also subscribe to seeing their clients or patients on the same day, at the same time each week. But does it have to be this way?

There are psychotherapists who see their patients less frequently than weekly and that includes those who work at depth, and/or analytically. The most obvious example is those who work with couples where the frequency of sessions is less critical, or tapers off towards the end of the work.

There are, of course, therapists who see individual clients on a less than weekly basis, however, with one or two possible exceptions, this is not something I or most colleagues would advocate.

There is significant emotional and psychological benefit to sessions being consistent, and something the patient comes to rely on in terms of where it sits in the week. In the same way the clinician makes space in their diary, and time in their mind, available for that patient, the session being on the same day and time each week allows the patient to do two things – start to hold themselves in mind, and start to bridge the gap between sessions.

Psychological change is slow and it is hard. This is not the same as behavioural change which may be tough but is something that can in simple cases be achieved through working on a superficial level. However, behavioural change, whilst important, says little about the underlying reasons why a person ‘does what they do’ – the unconscious process. And it is in the unconscious that the trauma lies.

Bridging the gap between therapy sessions can be hard for patients – to be able to hold on to not only the content of what was discussed, but more importantly the relationship between their therapist and themselves. Bridging the gap means being able to hold on to the experience of ‘being held in mind’ and therefore not falling back into feeling hopeless and alone in the world. For some patients this is a particular challenge and a more frequent schedule of psychotherapy is agreed, such as twice-weekly sessions.

For the patient, the regularity of the session being on the same day and time each week is something that becomes a part of their weekly routine – something that they can rely on and expect. That is not to say that patients look forward to sessions each week, but simply that come rain or shine, they are something that happens and is consistent.

An analogy I like when thinking about the cadence of psychotherapy sessions is that the weekly session is like keeping the kettle gently on the boil – any less and the kettle goes cold.

Each clinician works differently and tailors their approach to each patient, which is also why the concept of an ‘approach’ is something of red herring. A clinician is either trained to work at depth and with the unconscious, or not. With me, psychotherapy is at a minimum weekly and on the same day and time each week. And it is open-ended, meaning that it goes on for as long as it is clinically appropriate for it to go on for, which is generally many months and often years.

Further reading by Mark Vahrmeyer –

Don’t tear down psychological fences until you understand their purpose

I worked as a psychotherapist with death. Here’s what I learnt

August 19, 2024 by BHP Leave a Comment

What’s the difference between spontaneity and impulsivity?

On the face of it, these two words seem to have similar meanings, however, spontaneity is generally deemed a positive attribute whilst impulsivity a negative one. Why is this?

If we check how the dictionary defines the act of being spontaneous, it suggests that it is an adjective used to describe someone given to acting upon sudden impulses. The words ‘internal forces’ are also used as descriptors which would suggest that to act spontaneously is to act on the basis of something from within that is beyond our control – the unconscious perhaps?

And how about impulsivity? According to the dictionary this refers to an individual being swayed by emotion, or involuntary impulses. So, it would therefore seem, at least according to the dictionary, that these two words have very similar meanings. But that’s not the whole story.

In the world of depth psychology, we are interested in why people do what they do, and in the meaning of what they do, rather than necessarily the act itself. And, in depth psychology – and in particular psychoanalytic language – these words have vastly different meanings and give profound insight in the psychological maturity of an individual.

I have previously written about the human mind and how growing a mind is very much a function of becoming psychologically mature. A mind – whilst an abstraction in that it is a concept rather than an object – is an essential aspect of being a psychologically mature human. A mind is what enables us to mediate between thought and feeling and to make sense of our appetite. Appetite is an important word that we will come back to, as it is the key difference between spontaneity and impulsivity.

We all get urges, impulses, drives that we notice and then have different ways of responding to, if we have a mind. Because a mind enables us to consider the implications of an impulse, urge or drive and to map that against our sense of self, our values and our goals. This does not need to be a lengthy process and can often happen quite quickly, but it is a process. Spontaneity is born out of this process and thus becomes an expression of appetite – something we want that is a part of our desire.

Impulses do not get considered in the same way. They are reacted to rather than acted upon and that is a key difference. Many people who have reacted impulsively will often say ‘I have no idea why I did it’ and they are being completely honest about that – the process of thought and reflection did not enter into the mental equation.

In the world of understanding personalities, we often associate impulsivity with some of the more serious psychopathologies such as narcissism, psychopathy and in terms of character organisation, a borderline structure, which is the psychoanalytical understanding of the level of development between neurosis and psychosis.

It is interesting to me that lay language somehow reflects a psychological understanding of some degree of difference between spontaneity and impulsivity even if this is not defined in the dictionary. For example, nobody was ever called impulsive as a compliment!

We can never fully free ourselves from internal drives, and the unconscious can only become conscious to a degree, however, through depth psychotherapy we can learn, with the benefits of thinking alongside another mind, how to critically evaluate whether a ‘whim’ is an expression of appetite – our desire – or whether it is an impulse that cannot be thought about and considered.

Psychological maturity is about freedom from being driven by our unconscious process which in turn contains unresolved trauma. Once free and able to mentalise, that is to use our mind to weigh up something we feel like doing, we are free to express our spontaneity in the world.

Further reading by Mark Vahrmeyer –

Don’t tear down psychological fences until you understand their purpose

I worked as a psychotherapist with death. Here’s what I learnt

July 22, 2024 by BHP Leave a Comment

Why we should be disappointed

Life is disappointing. That sounds terribly negative, however, being able to tolerate and work with this reality can make the difference between success and failure. Relationships are also disappointing, but, like life, they are many other things too. Let’s delve into it.

Being able to tolerate and work with disappointment is one of the hallmarks of psychological maturity. It is a developmental step that most of us succeed in achieving to varying degrees, but this is not true of us all.

The process of learning to tolerate disappointment starts with the painful but necessary experience of feeling disappointed in our caregiver who, for the purpose of this piece, I shall refer to as the mother. Young infants are entirely dependent on their mothers for everything that ensures their survival. This includes the emotional as well as the physical.

Infants soon learn that their mothers sometimes seem to be fully available – magically so even – and other times can take time to meet the infant’s needs, or in some cases fail to do so entirely, such as in the case of soothing an aching tummy for example.

This ambivalence is intolerable to the infant, and psychologically the infant creates two mothers in her head; one who is good and one who is bad. The good mother, who takes on a fairy godmother-like status, is perfect, whilst the bad mother is akin to the evil witch in the woods. This is the basis of children’s fairy tales by the way. Us psychologists refer to this defence as ‘splitting’.

Splitting the world into ‘good’ and ‘bad’ is a primitive way of remaining in control and either idealising or dismissing parts of it, including people. The problem is that the real world is neither purely ‘good’ nor ‘bad’ and neither are the vast majority of people. Splitting in this way seems to be on the rise, and evidence for this can be seen in how politics is conducted across the Western world, with parties adopting more extreme positions in relation to each other and cross-party collaboration now virtually non-existent.

Returning to our infant, over time with enough positive and attuned parenting, she learns that she does not have two mothers but simply one. Whilst this is disappointing, it is tolerable, because, on balance, her mother is ‘good enough’.

Anna Freud, Sigmund Freud’s daughter and esteemed child psychoanalyst, once said ‘in our dreams we can have our eggs cooked exactly how we want them, but we can’t eat them’. I find this a powerful quote that relates to the concept of disappointment in that what Anna is really hinting at is that we can have all sorts of fantasies about our wants and desires, in this case how we may wish to cook our eggs, but that a fantasy does not lead to substance.

If we move on from having a fantasy or dream about cooking eggs, we need to go and cook them and invariably they will turn out differently to how we imagined. They may taste and look better in some ways but it is equally likely that they will disappoint in others. And when it comes to appetite and desire, disappointment is always built in, as once we have something, we no longer desire it and therefore are contending with a degree of loss in this context.

Some people go through their lives living either in the fantasy world of their heads, or increasingly in the modern world, in a simulated online world where they can simply ‘start again’ if their eggs go wrong. This is how social media functions: even if it takes twenty goes to make those eggs which are then photographed using a filter and ‘air-brushed’, we are sold this fantasy as a reality to which we then aspire, and which can cause us to feel more disappointed in our own lives.

The argument I am making therefore is that being able to tolerate disappointment in life, ourselves and others, is part of being a mature human being who is able to navigate the world and build something – relationships and a life of substance. It will not be perfect, but it will be real.

Further reading by Mark Vahrmeyer –

Don’t tear down psychological fences until you understand their purpose

I worked as a psychotherapist with death. Here’s what I learnt

What is love?

June 17, 2024 by BHP Leave a Comment

What is a growth mindset?

Having a growth mindset is a term from the business world, referring to an individual who believes that their success in a particular field is contingent on working hard, forward planning and being able to receive and implement constructive feedback from others.

While it is a term that is regularly used in business, and undoubtedly one that many if not most job candidates will profess to possess, the reality is that a true growth mindset relies on a psychologically mature and relational mind.

To believe that our success in business, or any field of endeavour, is contingent on our hard work and performance means that we have outgrown, or let go of, fantasies of omnipotence: any idea that we may be special in some way. It is a mindset, and therefore in its truest sense, a personality, that is rooted in reality, and recognises that whilst we may have a disposition towards a particular way of thinking or working, only hard work will bring achievement.

To work hard to achieve success is in turn contingent on having self-confidence, which is a belief in our ability to apply ourselves, as opposed to narcissism, which is a belief in our specialness. This differentiation is critical and lies at the core of a true growth mindset.

The second requirement for a growth mindset is having the ability to forward plan, that is to say, to recognise where we are now, where we want to get to and what work, effort and sacrifice is required to get there. From a psychological perspective, this requires an individual to be able to bear complex feelings such as anxiety and frustration and move in the direction that they wish to go, which is to face uncertainty.

Lastly, and perhaps critically, a growth mindset can only coexist with a certain humbleness. Successful people are able to use relationships in order to challenge their world view and their way of thinking. This is again in stark contrast to narcissistic people who use relationships to bolster their (inflated) idea of themselves.

To receive and use feedback and criticism and to allow our thoughts, ideas and plans to be challenged requires a certain strength of character – a strong ego – which can differentiate between ourselves and our ideas or thoughts. Again, this is something that a developmentally stunted character cannot achieve – narcissistic characters – as they lack the ego strength to take on board any criticism.

Why is it important to have this over a fixed mindset when moving a business forward?

To be successful in business, as to be successful in life, relies on a person being willing to adapt their approach, modify their strategy and face criticism. Without possessing a mature psychological structure, a growth mindset is simply impossible to achieve and the individual’s pathology will get in the way of their success, as they feel too wounded to pivot from their entrenched position.

Business has always required successful entrepreneurs to be ‘light on their feet’ – willing to adapt to the market. However, with the advent of globalisation and technology, the need to be adaptable has increased exponentially. Where, in the past, ‘slow-and-steady’ were attributes valued by certain large organisations, this simply is no longer true and rigidity in business, which is reflective of rigidity in personality, is synonymous with a business that is weak and fragile.

Tips on how to become more growth-focused

Whilst we can all work on the skills needed to become more orientated towards a growth mindset, it is important to recognise that the foundations for such a mindset are contingent on a certain level of psychological maturity. If one does not possess this, then moving towards a growth mindset simply is not going to work.

By psychological maturity I am referring to how a person relates to both themselves and those around them. Have they established a solid sense of self that enables them to contend with the complexities and realities of the world? This in turn translates to the ability to contend with difficult feelings whilst holding onto a thinking mind. It also refers to the capacity to be challenged in one’s beliefs without taking it personally, and being able to use criticism constructively.

Secondly, is the person able to relate to others in a healthy way, or are others simply there as either a threat or as an extension of themselves? This example is why autocracies are inherently unstable and eventually come unstuck: dictators surround themselves with sycophants who will not tell them the truth, and lock up critics who they see as dissidents and trouble-makers. It is no coincidence that dictators score extremely highly for
narcissistic traits.

Assuming a candidate has a mature personality, a solid sense of self and the ability to relate, then there are some specific skills they can work on to develop a growth mindset.

Be clear about what you want to achieve, and be realistic about how much hard work it will entail and what personal sacrifices will be required.
Start to build a network of people around you who also have a growth mindset, from whom you can learn and garner feedback, and be prepared to be challenged in your beliefs.
Employ a strategic approach to your work, one that is methodical and measurable so that you are able to hold yourself to account and reformulate your plans as you progress.
Learn the difference between a criticism of an idea or vision and a criticism of yourself.
Criticism is uncomfortable and difficult to receive for anyone, but the mark of a mature person is the ability to examine and accept appropriate criticism without it undermining their self-confidence.
Recognise that adopting a growth mindset means to feel intensely – it is impossible to feel excitement without also feeling anxiety. You need to be able to tolerate difficult emotions and hold onto a thinking mind.
Self-care is critical for anyone operating at this level and this means that you also ensure that you are caring for your mind and body alongside your business.

Are there common challenges or obstacles that businesses or people encounter when trying to adopt a growth mindset, and what strategies can be employed to overcome them?

The most common challenge people encounter is the difference between a hypothetical growth mindset and adopting and remaining in one in practice.

Staying in a growth mindset is tough and challenging, and requires not only a robust self-confidence, but also the requirement to have a solid support network in place who can remind us of our goals, and importantly, be in relationship with us.

Empathy often gets confused for sympathy, however, in truth, empathy can be very tough and confronting, as it is the ability to understand how a person is feeling without colluding with that, and offering appropriate challenge when their thinking becomes rigid or fixed.

These are the sort of people you need around you.

Can you provide strategies for handling setbacks or failures in a way that promotes a growth mindset and encourages resilience?

A growth mindset is contingent on holding onto a thinking mind at all times. This may sound simple but is fact a difficult thing to do under pressure.

When our emotions become ‘too much’ they tip us over into a state of overwhelm where we are unable to clearly think anymore. This is controlled by our Autonomic Nervous System (ANS) and is a biological process we have no direct control over. It actually pre-dates our mammalian brain and evolved simply to keep us safe from danger.

We have all heard the term ‘keep cool under pressure’ but what this term really alludes to is the capacity to remain thinking under pressure, which means to be able to feel our emotions and not become overwhelmed by them. Once overwhelmed, the ANS leaves us with four possible coping strategies – fight, flight, freeze and fold.

All of these are critical responses to existential survival but have no place in the workplace.

Whilst we cannot directly control our arousal levels – that is to say the intensity of emotion that we feel – someone who has achieved psychological maturity has a distinct advantage here in that they generally have far more resilience in feeling emotion before they tip over into overwhelm. This is fundamentally because they start from a premise that both they and the world are ‘safe enough’. In contrast, if someone is constantly scanning their environment for threat, they will easily locate it and will struggle to remain able to think
clearly.

Working with a psychotherapist or executive coach trained in this arena can be invaluable in helping individuals to better ‘hold onto themselves’ in the face of strong emotion.

As stated, setbacks and failures are painful and challenging for us all but we can deal with them if we expect them, are able to not take them personally and to see them as opportunities.

A strategy I often espouse is to slow things down. Rather than adopting the slogan ‘don’t just sit there, do something!’, I believe that a successful growth strategy relies on an individual being able to instead ‘don’t just do something, sit there’. This may sound counter-intuitive, however if a person is able to stop, think through what has happened, recognise that they are struggling to think, take some time out and then regroup, that is
generally a recipe for success.

How can leaders effectively communicate and promote a growth mindset within their teams?

One of the biggest problems in organisations is that they espouse to embrace a growth mindset whilst having a fear-based culture that limits and polices staff.

Growth culture orientated organisations are extremely good at empowering their staff to take risks and make mistakes. The risks taken are done so by people who are entrepreneurial and excited, rather than reckless, and mistakes are seen as opportunities for learning. This is a culture of meritocracy and in its heyday was what made American companies so globally successful.

Leaders need to lead by example and adopt a growth mindset themselves which means that they are modelling this attitude in their own approach to work. This is exposing and cannot be faked. There is nowhere to hide when authentically having a growth mindset.

A huge aspect of a growth culture is predicated on the premise of collaboration and partnership rather than competition and envy. This therefore means that a growth culture needs to be implemented from the top down in any organisation, and show that envious attacks on other departments in lieu of working together will not be tolerated.

Employees need to feel safe to express themselves and to take risks knowing that the organisation will not punish based purely on outcome – many a failed idea has come to make an organisation a fortune, such as the story of Viagra which was originally synthesised as a drug to treat hypertension.

Further reading by Mark Vahrmeyer –

Don’t tear down psychological fences until you understand their purpose