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Unexpressed emotions will never die

Short sharp, to the point and written by Freud. His full quote is ‘Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways’. What does he mean and is he right? 

With this statement Freud is defining on the pillars of psycho-analysis and psychotherapy – to uncover repressed and unconscious memories and provide a relationship in which those ‘traumas’ can be expressed through language and contact. 

What evidence is there that unexpressed emotions don’t die, after all, is passage of time not a great healer as the popular expression goes? We know that unexpressed emotions don’t die because otherwise people with traumas would simply recover and live contented and fulfilling lives.  Instead we know that this is not the case and trauma gets ‘stuck’. 

And with regards to the glib statement that ‘time heals’, this is only true when feelings can be expressed – losses grieved – and reality come to terms with, otherwise the past will continue to repeat itself in unconscious ways in the present. After all, the unconscious has no concept of time. 

How do unexpressed emotions come forth?

Unexpressed emotions – in other words emotions that cannot be acknowledged for fear of their impact on the psyche – express through a variety of means and present in an infinite number of actual behaviours or presentations. For me it brings to mind a quote from a Woody Allen movie where a character (played by Allen) says ‘I never get angry …. I grow a tumour instead’. 

Some of what we see as clinicians with clients who are defending against expressing difficult feelings can be: 

Acting out – Engaging in behaviours that are destructive to self and or others the reasons for which the client is often unaware of; 

Mania – Frantically ‘doing’ to avoid being in touch with one’s inner world; 

Depression – A pervasive deadness and inability to be in touch with desire as a result of emotions  being unexpressed. Being dead is preferable to feeling; 

Repetition compulsion – The compulsion to repeat an event or behaviour over and over again without an ability to clearly think about and consider why that may be; 

Reaction formation – A defence against the anxiety produced by feelings towards something causing the person to over-compensate in the opposite direction – an example would be someone terrified of death who engages in dangerous sports or activities; 

Mental illness – This is a catch all phrase, a product of the medicalisation of psychiatry whereby clusters of ‘symptoms’ are given different diagnoses. Essentially, mental health diagnosis or not, the work remains the same. And psychosis can be seen as the mind protecting itself from unbearable feelings and emotions by ‘going mad’. 

Somatic (body) symptoms – Back to the Woody Allen quote – in lieu of feeling, many of us develop physical ‘pains’ far less dramatic than tumours, but chronic nonetheless. Examples could be  gastro-intestinal problems (IBS), migraines or other more obscure symptoms. 

Dissociation – We all dissociate, which broadly means to ‘zone out’, however dissociation can manifest in powerful and extreme ways whereby the person ‘splits’ their mind akin to ‘the left hand  not knowing what the right hand is doing’, however rather than it being about one hand not knowing what the other is doing, it is in reality one hand not knowing what is BEING DONE to the other. 

And this list is by no means exhaustive or conclusive. 

Expression vs repression – living vs dying 

Expression of emotion is essential, however, cruelly paradoxically, those who have needed to repress have done so because there has not been a sufficiently available adult (in chronological as well as psychological terms) to be in relationship with. This is the role of the therapeutic relationship. 

Without titrated expression of emotion – I am no fan of new-age catharsis – and done in the context of relationship, living is simply not possible; only existence is possible where the client is at the mercy of powerful unconscious forces and exposed to their repressed emotions coming forth later in uglier ways. 

Grieving is part of living 

Grieving is extremely painful – whether that is grieving a loss in the present, or grieving the loss of what never was. However, without grieving we cannot feel alive – we cannot be born. 

Being born in the biological sense means leaving the safety of the womb, but also the ‘nothingness’ of the womb. In the womb we cannot experience reality other that filtered through our mothers. And so it is psychologically too – being born through psychotherapy means to face losses and bear reality, however painful that may be, and through that to come alive. If loss can be borne then desire for life can emerge and emerge it will. 

Psychotherapy is about expressing what has previously been inexpressible and it is in the context of the therapeutic relationship and encounter using language that this takes place: language gives trauma shape and form.

 

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

 

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 ready by Mark Vahrmeyer –

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

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Why is Love Island so Popular? And why it’s not for the reasons we think

For those of you that don’t know, Love Island is a British ‘reality television’ concept that has become a global phenomenon. Arguably deriving from the first global reality programme, Big Brother, which launched in 1997 it is the latest incarnation of this genre.

The premise is one whereby a group of (young, physically attractive) singletons are isolated from the rest of the world in a luxury villa dotted with cameras throughout. The singletons then must avoid elimination (eviction) from the villa through coupling up with another contestant. And like Big Brother the public ‘votes’ to eliminate contestants who do not please them. The ultimate price? Love? Eternal happiness? No, a pot of money.

What is the appeal of watching reality television?
To answer this question we first have to define how reality TV differs from regular TV. Clearly, reality TV is (to a greater or lesser extent) unscripted. And a cynic may argue that it is cheap to produce as the ‘talent’ is free, however I am more interested in the viewers drive rather than the profit margins of the production company.

For the viewer, they are aware it is unscripted – anything could happen. And with offering the audience a piece of the action – the control to vote out contestants, the experience becomes seemingly interactive, almost relational in that viewers feel a form of connection to the contestants.

Reality TV is reminiscent of the Romans and their staged ‘fights’ between gladiators and prisoners, or between imprisoned wild animals and unfortunate humans. And whilst the humble Roman had no direct power over who survived, they could look to their Emperor who would decide with a simple thumb’s-up or -down whether to spare the life of the barely alive prisoner. In turn the Emperor would be guided by the furore of the crowd, hence the illusion of control and investment in the outcome. Fundamentally though, it was entertainment at the expense of an
other(s).

Now let’s consider how reality TV and regular drama such as soaps – Eastenders and the like – differ. Watching a soap opera is a narcissistic endeavour where the lives of fictitious characters are watched according to a script. All are aware of the ‘pretend’ quality. A performance is being given and the boundaries between real people and characters are clear.

Reality television invites the participants to ‘star’ in a version of life judged by the viewer. And the viewer rewards the contestant through sparing them or eliminating them dependent on how ‘entertained’ they feel. It is a game of exhibitionism and voyeurism. One can argue that unlike prisoners of the Romans who were ‘thrown to the lions’, reality TV stars enter into the ‘game’ with their eyes fully open and can be handsomely rewarded. On the face of it this is true, however, taking ‘Love Island’ alone, there has been significant media coverage of three suicides of people
connected to the show. Whether the latter is causation or correlation, my argument is that both the contestants and viewers of reality TV are being driven by something unconscious.

So what’s the appeal?
I believe that this genre of television has become so extraordinarily popular because it appeals to out innate need to feel part of a community. Unlike soap operas, we know that what happens is real – and even if it is not; both contestant and viewer believe it is so the fantasy is complete.

In reality TV we are invited into the intimate lives of a group of people and can exert influence over them – it creates a kind of pseudo-connection. Exactly the kind of pseudo-connection present in a collusive exhibitionistic/voyeuristic encounter. By definition therefore, it is a form of perverse relationship in that it is rigid and without emotional contact. It is a relationship based on power and control rather than real intimacy.

And like any pseudo-connection, whilst it may feel exciting and glamorous, it has the nasty habit of leaving us feeling less connected and thus more prone to feelings of depression, anxiety and loneliness when it all ends. And it always does. For the viewer, they can move onto the next reality TV series thereby keeping their need for authentic connection and vulnerability at bay; for the contestant, they can perpetuate the fantasy through building a career (brand) build on image, or they fall spectacularly from grace or fade away (both are equally devastating for the narcissist).

A loss of belonging
I therefore suggest that ultimately the rise of reality TV correlates with the erosion of community and a sense of belonging. It correlates with an increasingly individualistic world where narcissistic interactions are the norm.

Ultimately though, it speaks of our desire for contact and real relationship, something that can never be fulfilled through reality television or any other kind of perverse relationship where the premise is power and control.

Connection and belonging come from community and from real relationships where two people can take up space and each have their ‘real’ experience validated and understood by the other, rather than one having to be a performing (glamorous) monkey in order to manage to survive (elimination). The latter is pure and simply the definition of a deeply narcissistic and perverse relationship.

 

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

 

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

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

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Five Top-Tips for Surviving Christmas – And one Extra Thanks to Covid-19

This blog is a re-post with some further reflections in it to account for not only Christmas is a challenging time, but that Christmas during a pandemic may be a particularly challenging time.  Original blog post from 25 December 2017:

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 fails to deliver on the ‘winter wonderland’ scenes on the TV adverts, for many of us, our family experience often falls far short of the loving idyllic family reunions depicted in those same snowy adverts. With 202 having been the ‘mother’ of all challenging years and with Covid and the accompanying restrictions remaining firmly in place, Christmas 202 promises to be one like no other.

What makes Christmas particularly difficult – and Christmas 2020 especially so?

Aside from the expectations we put upon ourselves, it has all the classic ingredients of being either an explosive disappointment or a damp squib. With the pandemic where many of us have been starved of contact with family, expectations for the perfect Christmas may be running particularly high and yet we may find that friends and family are unable or unwilling to take the risks to visit us or allow us to visit.

Family of choice versus family of origin

Christmas is often a time when we get together with family members we would only ever see on other festive days or, as the saying goes, weddings and funerals. Often, we have a little close relationship with these family members. Yet somehow we expect to feel a close bond with them on this day in particular.

Many families are now what is referred to as blended families.  Nowadays, it is normal to grow up with step-parents, step-siblings and half-brothers and sisters. While this does not necessarily lead to conflict, it can make the delicate balance of Christmas Day complicated and fractious. Compromise is often the order of the day.

Christmas is often a difficult time thanks to the ghost of Christmas past. Many relationships break down over Christmas and can leave us with tainted childhood memories of parental feuds and the accompanying grief.  This then plays out in the present, potentially contributing to conflict with family members – the trauma repeats.

And then there is the one extra ingredient that can make things seem so much worse than they are; the explosive charge in many Christmases – alcohol. Consuming alcohol in and around Christmas is normalised and we can often feel under pressure to ‘join in’. Many of us also use alcohol as a way of coping with the day, the family members who descend upon us, the expectations, unhealed rifts and so on. However, when it comes to managing emotions and conflict, alcohol has never been a solution.

Five top tips to surviving Christmas Day and an extra one thanks to the pandemic!

  • Support through relationship

If you are in a relationship, talk to your partner.  Explain to them that you may find the day hard and agree how you will ask for support when needed, or how you will support each other. Examples may be anything from starting the day together and connecting through to holding each other in mind. You can demonstrate this through small reassuring gestures such as visually checking in with one another.

  • Reality Testing

Christmas is only a day. The expectations we feel in relation to it are largely in our own head.  By pausing and accepting that there is no such thing as a ‘fairy-tale Christmas’ (except perhaps for some fortunate children) we can gain a little space to see it for what it is.

  • The past is not the present

Memories of past Christmases, while present, need not dominate our experience in the here and now. Accept that it is a difficult time for you, know that it is for many others, 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 have the power to create something different.

  • Alcohol 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.

  • Hold Yourself in Mind

One of the traps people often fall into is that they imagine that they have no choices on the day; they simply have to do what is expected. Doing what is expected is a choice in itself!  Even if you do feel that there is little on offer for you during the day, a change of perspective and holding in mind why you are choosing to make these choices can be helpful. For example, rather than framing it as “I have to go see X person, or Y will be disappointed”, you can rethink it as “I choose to see X person as I want to give that as a gift to Y’.

  • Hold the Future in Mind

The pandemic will pass.  And whilst things will not ‘go back to normal’ in the sense that we can never go back, restrictions on our lives will ease and we will find new and creative ways of finding meaning and connection in our lives.  The only certainty in life is a change which for all of us is anxiety-provoking.  Connection is the antidote to anxiety and that is fundamentally the opportunity/challenge that Christmas presents.

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. See my blog on avoiding panic attacks for a simple but effective practice to calm yourself and return to the here and now – particularly helpful during the pandemic.

 

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.

 

Further reading by Mark Vahrmeyer

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

 

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Why do ex-boarders find intimate relationships difficult?

This is a question I often ask couples who come to see me for couples therapy. Most cannot answer the question beyond the superficial. However, it is an important question to ponder: relationships are not easy for the most well-adjusted of us and so there has to be a fundamental reason why we (generally) choose to pair bond (be in a committed intimate and romantic relationship with one other person).

I believe that we choose to pair bond as on an unconscious level it is the closest that we can come as adult humans to replicating the ideal) experience of childhood where we had a parent who was there for us, who would listen to us and who, most importantly, would help us make sense of our feelings so that we knew we were not alone. This is essentially what strong functional couples do – they listen to each other and try and work out what feeling their partner is trying to convey to them. The general term for this is empathy.

I therefore believe that this explains what we all want and why we all go into relationships. And also why so many of us keep on trying to find ‘the right person’ even after so many disappointments.

What happens to boarders?
Ex-boarders also harbour hope of a good relationship, however, may be at odds in identifying one. The attachment damage they have sustained and the abandonment (couched in privilege) that they have experienced, leaves them unconsciously yearning for that idealised mother who will be there unconditionally for them. Of course, what they eventually find in any relationship with another adult is that they are not in an unconditional relationship (no such thing exists) and then they withdraw to avoid being hurt or disappointed.

What does it look like?
We are all different and so are ex-boarders, however, many have some traits in common which I shall list:

Ex-boarders tend to-

  • Withdraw emotionally from relationships in order to keep themselves safe and default to their indolence survival strategy;
  • Struggle to make sense of what their emotions are telling them and lack the ability to navigate them without becoming overwhelmed: ex-boarders are good under pressure until they are not;
  • Have an over-reliance on logic and rationality to make sense of the world – this does not work when confronted with a partner who is trying to share their emotions;
  • Regulate (read manage) their emotions by controlling their external world – exercise, career success, sex, alcohol, drugs etc. Some may be less harmful than others but all show an inanity to be in contact with their inner world;
  • Live a pseudo-life where they can never really allow themselves to feel alive as that can only happen through bringing themselves fully into relationships and navigating their needs through communicating boundaries.

What can be done?
The effects that the abandonment a child suffers from being sent to boarding school can be enormously significant. Often ex-boarders will only resent for therapy when they have ‘hit a wall’ in some way.

Psychotherapy can help and indeed is the only way to remap the brain and help ex-boarders come to life. As the damage is relational, the only remedy is a therapeutic relationship where the cut-off feelings of loss, abandonment and emptiness can be retrieved and experienced in the safety of a psychotherapeutic frame.

 

The term ‘Boarding School Syndrome’ was coined by Jungian analyst Professor Joy Schaverian around a decade ago. Since then, it has gained significant traction as a model for explaining the experiences and symptoms of adults who were sent away to boarding school as children.  Please refer to Mark’s previous blog.

 

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

 

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 ready by Mark Vahrmeyer –

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Why ‘Cancel Culture’ is about the inability to tolerate difference

What is Cancel Culture?

This seemingly new trend is one of promoting the ‘cancellation’ of people, brands or television shows as a result of what some (the cancellers) perceive to be some form of offensive comment, remark, view or behaviour. It has surged on social media with various derogatory hashtags, notably #RIP.

A recent high profile ‘celebrity’ who has been on the receiving end of social media trends to have her cancelled is J.K. Rowling for her, views on transgender issues that some find offensive.

Is it that new?

The term may be new and the platforms used may serve to whip up a storm of support against those who some wish to have cancelled, however the concept is by no means new at all. Cancel culture is essentially a form of social banishment whereby in traditional tribal communities one of the most severe punishments would be the banishment from the tribe: to be cast out.

To be cast out of ones tribe would mean more than social death; if not literal death through being vulnerable to attack from predators and other tribes, banishment most certainly meant the death of the sense of belonging, which in psychological terms, could potentially instigate a psychic collapse (going mad).

However, whilst this may seem primitive, historical and anthropological evidence shows that it would be a punishment of last resort and would be handed down by the elders of the tribe – in other words, there would be some form of judicial process in place that sanctioned the banishment.

This is where cancel culture differs profoundly from tribal banishment or ‘being cast out’. It is not a decree from wise elders or some sort of judiciary; it is generally used as an attack against the views, opinions or behaviours of others that some disagree with.

Why does it matter?

Put simply, it matters because there seems to be an ever decreasing array of opinions and voices allowed and cancel culture is an immature way of trying to ‘kill off’ anybody holding views or opinions that may not be comfortable for others to hear.

Feeling offended and causing offence

There is a difference between a person feeling upset or even offended by another’s views and with another trying to purposely hurt a person or group of people. The former is what we may experience when we encounter others and are confronted by a different perspective. The latter is when we encounter sadism.

Sadism is unacceptable and should not be tolerated, however the mark of being an adult is the capacity to tolerate a different perspective and a different mind. Even if we may feel offended.

On mergers and separation

Although separate from its mother, an infant, when born, cannot differentiate between their mother and themselves. In essence they believe that their mother is an extension of them. Of course, in reality, the mother in question is very much as separate entity, at least physically, and thus will eventually fail to meet the needs of her infant. This is extremely frustrating for the infant in question and the mind of the infant concocts an ingenious defence against the pain of separation – a good and a bad mother is created: the infant imagines it is the good mother who meets all their needs and the bad mother who frustrates them. It is a primitive psychological defence called splitting.

Infants split off the bad until through ‘good enough’ parenting they eventually integrate the two mothers and tolerate reality: mother is not part of them and frustrates them as she has a different mind and a different set of needs. However, mostly, she seems to meet their needs so on life goes and importantly, on psychological maturation goes. The child is on the path from mergers to a world where they can be in separate relationships with others and tolerate a different mind.

Why cancel culture is simply splitting by another name

To be unable to contain ones feelings when confronted by a different perspective and thus a different mind shows a lack of psychological maturity. The world is split into ‘good and ‘bad’ like in a child’s fairy tale. Bad must be killed off so good can live happily ever after. This is not how the real world works; it is how cancel culture works.

How does cancel culture relate to psychotherapy?

In essence, psychotherapy is about outgrowing cancel culture. It is about learning to be in a relationship where difference can be tolerated and acknowledged, without this needing to be threatening. For some this means they must learn for the first time to bring their needs ‘into the mix’ – something that can feel really confronting and may bring on fears of rejection and abandonment. For others it may mean the opposite which is to be able to cope with the separateness of their psychotherapist and tolerate this without throwing away ‘all the good’ – without ‘cancelling’ them, if you like.

Being an adult means tolerating the frustrations of the real world and the frustrations of the others who make up the real world. However, if this can be tolerated then real relationships are possible and people can locate substance and meaning thus moving them out of a fear/threat pattern into adult relating patterns.

If you would like to work on your own intolerances and relationships, get in touch with us to discuss whether psychotherapy may be appropriate for you.

 

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

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

What is ‘Manifesting’ and The Law of Attraction?

Recently a client, somewhat younger than me, described a phenomenon they called “Manifesting”. They felt excited and disappointed in themselves in equal measure that they seemed to be failing in using this ‘secret’ method of working with ‘the universe’ to bring them whatever their heart desired.

Curious, I investigated.

Manifesting is a verb used to describe the active process of using positive thoughts, and a degree of self-hypnosis, to draw ‘good things’ to oneself. Based on the many Youtube videos on this topic, these good things seem to be consumer products or monetary wealth, rather than contentment and tolerance, but then the latter two are really not as enticing as ones own private island.

Manifesting is not new and nor is the concept original. It seems to have been re-hashed in a 2006 ‘documentary’ and book entitled ‘The Secret’ which explains the mystical process of using the ‘Law of Attraction’ to get what you want in life. What a great concept – if only it were true.

Fate and Destiny
I have previously written about the concepts of fate and destiny and how I do not believe that any idea of fate has a place in psychotherapy – or indeed in the outcome of psychotherapy, which is in essentially becoming an adult who can tolerate reality.

To recap, the concept of fate posits that there is some sort of external force, entity or deity that decides what happens to us. This can be very unhelpful in the therapeutic process as clients can often use the idea of fate to reinforce that what is happening (or not) to them is simply how things are supposed to be.

Destiny, though not a word I personally favour, can be translated to being thought of as taking some degree of ownership of one’s life whilst remaining firmly rooted in reality. Therefore it is possible for most free people to experience a change in their lives, or perception of their lives, whist acknowledging their reality.

Destiny and death
Some years back I spent four years working on the front lines of death – as a psychotherapist in the field of palliative care. Whilst the usual issues around meaning, relationships and mental health problems presented themselves, they were all within the context of death and dying: I worked with patients who had terminal illnesses, were actively dying or with their bereaved relatives. It certainly redefines the concept of ‘psychotherapy’ when sitting beside the bedside of a patient who has hours to live and is engaging with you through a cocktail of opiates!

Despite the confronting nature of death and dying – the patients’ ‘fate’ was sealed – nonetheless, many of the people I worked with were able to find purpose and meaning in their predicament and to mourn losses not previously addressed. They were engaged in changing their destiny.

Magical thinking
We can all, at times, make use of magical thinking. It can be a way of assuaging anxiety and giving us the illusion of being in control. The practice is as old as human beings and embedded in a language such as in the saying ‘touch wood’ or in the belief that walking under ladders brings bad luck. Human beings are symbolic creatures who make the unreal real. This is perhaps how we cope with our knowledge of finitude – death. However, we also confuse the symbolic with the real.

Whilst touching wood and avoiding ladders is relatively harmless, subscribing wholeheartedly to fantasies that there is some ‘secret’ method or means of ‘manifesting’ objects into ones life is dangerous and deluded. In psychological terms, it is a way of avoiding growing up and being born. A way of believing that the world can be just how we want it if only we imagine it hard enough – a sort of womb, in essence.

The power of magic
The reality of being in weekly or more frequent psychotherapy is that it is not very magical at all.  In fact, it is the opposite. Psychotherapy generally takes place in a fairly ordinary consulting room (or online), you see the same face week after week and often find yourself going over the same ground. Clearly, promises of Ferraris and private islands are far more enticing. However, the consistency and regularity, along with having someone there who holds us in mind and helps us think can be life-changing. If we are thought about, just perhaps we can learn to think our own
thoughts about ourselves rather than follow a script on who we are. If we are not alone then we can learn to bear reality, however hard that may seem.

Psychotherapy does not promise magic. It is, in fact, the opposite in that often our job as psychotherapists is to help clients and patients lift the veils of illusion and see life and their history for what it was – only then can the mourning begin. And it is only through mourning that eventually, desire can emerge – a sense of self and a sense of what that self wants.

Desire
When desire emerges it is rarely if ever about Ferraris or private islands. It is not about consumer products period. It is about a deeper recognition of what will bring contentment and peace in the context of the realities in which that person lives. And that can be achieved even on a death-bed.

Of course, as a final blow, unlike manifesting, psychotherapy also has science on its side. And a long studied evidence base. It may not get the Youtube hits but then real life was never to be found in movies.

 

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

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

by Leave a Comment

Why does the difference between counselling and psychotherapy matter?

What a difference a year makes. For all of us the world is an inconceivably different place to a year ago. Not only are we all living with greater uncertainty, we have all had to enormously adapt to living, socialising, relating working, and not least, having therapy in a different way.

Almost exactly a year ago I wrote a blog on entitled ‘The Difference Between Counselling and Psychotherapy’, which has received some traction. More recently, the age old question pertaining to the difference between these to related disciplines has come bursting forth through a collaborative project SCoPEd project which seeks to set out training requirements and practice standards for counselling and psychotherapy. This project is receiving a lot of attention
(accompanied by fierce criticism) by many in the ‘talking therapies’ field. I have no wish to get drawn into the intricacies and politics of the actual project but do firmly believe that from a client’s perspective, standardisation of training requirements and robust practice standards that differ between counsellors and psychotherapists can only be a good thing. More so, I believe that they are essential.

Many of my clients come to be after trying some form of ‘talk therapy’ which may or may not have been helpful. Many come because they are unclear about why they don’t feel better and have ‘stumbled’ across me and my practice via a search engine. Few really understand that there is a difference between counselling and psychotherapy and few understand what they may need and why that may be a psychotherapist.

The fact few understand this has nothing to do with the fact that there is a fundamental difference and put simply, the more I have trained and the more years of experience I have, the more cognisant I have become not only of the differences, but also of how to assess what someone needs and whether they are in fact suitable for therapy.

I have written extensively about the differences between psychotherapy and counselling in my blog a year ago and if you are interested, you can read them here. My blogs are aimed predominantly at lay people who may be considering entering into therapy, rather than at the counselling and psychotherapy community.

Why do clients need to understand the difference between counsellors and psychotherapists?           

At present the distinction (in the minds of many) is blurry. Many counsellors believe the two terms to be interchangeable and are thus aggrieved by any proposed framework that should distinguish between the two disciplines: most counsellors think they are psychotherapist; few psychotherapists consider themselves counsellors.
The distinction matters from a duty of care perspective. Deeper work with clients dealing with complex trauma, personality disturbance and psychiatric disorders requires an in-depth understanding of how to identify these issues and an assessment of our ability to work with such clients and the client’s ability to ‘make use’ of the therapy, their robustness.

Turning clients away

My practice is generally full as my work is long-term, however, when considering taking on a new client I undertake a clinical assessment of their suitability for therapy. I aim to answer the question: ‘can I help this person?’ It may seem counter-intuitive, however, I am far more likely to turn down clients pre- or post-assessment now than when I first started out as a counsellor.

Why? Because I now know what I do not know and where my limitations lie.

A GP will not undertake surgery as they have been trained in general practice. They can, however, recognise that a patient needs to see a specialist who can offer an expert opinion and in-depth complex treatment. A GP is invaluable precisely because they are aware of what they do and don’t know and work within their limitations.

This is the ethical responsibility that I believe all counsellors and psychotherapists would carry at the forefront of their minds, however, without training in formulating (our word for diagnosing) how can a clinician know what they don’t know? Herein lies the problem.

Do no harm

The Hippocratic Oath, subscribed to by medical professionals the world over applies to us too.  In trying to help (rescue, fix, therapise, relate to) a client, unless we are acutely aware of what we are dealing with, we can do more harm than good.

Is there a place for counselling?

Unequivocally yes. Counselling is enormously beneficial and most psychotherapists started their careers as counsellors in some capacity. Counselling is often all a client needs and it can bring about enormous change for many. However, it is not appropriate for more complex or serious relational or personality disturbances.

In turning clients way it is not solely or even frequently because their requirements lie beyond my abilities; I often suggest to prospective clients that counselling may be more appropriate for them, especially if they have no prior experience of ‘talking therapy’ and are wanting to work through a time-limited issue.

And beyond psychotherapy?

The clients I do turn away as their requirements lie either beyond my knowledge base or holding capacity, I do so from a position of ‘doing no harm’ and making an often tough ethical decision. It may be that that person requires psychiatric support but it may also be that their level of disturbance is best treated by a multi-disciplinary team. And then there is, of course, psychoanalysis.

Inaccessible for many – sadly as Freud saw Analysis as being something that should be accessible for the general population – provides something that psychotherapy cannot: the ability and framework within which to work at depth with powerful regression.

To summarise, the difference simply must be acknowledged and accepted between the professions for the safety and well-being of clients and patients. To do otherwise is plain hubris.

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

 

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

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Why psychotherapy sessions should end on time

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Love in the time of Covid

I admit the shameless plagiarising of the title of Gabriel Garcia Marquez’ – ‘Love in the Time of Cholera’ as it fits as a Segway into considering the tresses and strains of both finding love, and holding onto in, in the current pandemic. 

The statistics

Disturbing statistics are emerging of surging rates of domestic violence, sadly predominantly perpetrated by men upon women, exacerbated by the circumstances brought about by the ‘lock-down’. A surge of somewhere between 25% and 35% in the rates of reported domestic violence hide all that goes unreported. 

Alongside the extremes of domestic violence lie other statistics such as the reality that many couples have suddenly been catapulted from spending a couple of hours per day together, to inhabiting the same space (indoors and out) for the entire of the day. A young couples dream has become many seasoned couples challenge (and for some a nightmare). 

On finding love 

The old rules of dating have gone through a revolution in recent years from what dating constitutes, through whom we date (gender fluidity) into how we date revolutionised by the internet. 

However, suddenly, the seemingly endless supply of opportunities to physically meet others has dried up with us being left with all the tools and little of the substance. We can swipe left or right, however, we cannot meet those we like (unless we risk social judgement and our own physical health – both of which may paradoxically make the whole encounter that much more exciting). 

Referring to statistics, there has been a surge in pornography use as those who are isolating alone seek out some virtual simulation and those isolating with partners seek out some sense of novelty. Throw into the mix the likely enduring requirements for ‘social distancing’ and it raises questions around what dating may look like going forward? 

On keeping love 

Coping with ‘lock-down’ can be challenging on any relationship whether new or old, robust or fractured. That is because relationships all rely on certain key ingredients that make relating possible – all of which have been outwardly challenged during lock-down.

Space 

It is abundantly obvious that for all of us, our physical worlds have shrunk down. Socialising, leisure trips and the distractions of shopping have all been taken away. And many of us find ourselves cooped up for 24 hours per day (bar the ubiquitous exercise sorle) with our partners. 

Negotiating physical space is always a part of a healthy relationship involving discussion, negotiation and compromise. The world of Covid lock-down has amplified this and with it the requirement to communicate effectively around personal space. In lieu of healthy communication, some couples find themselves acting out and reacting to what they perceive as intrusions by the partner, when their partner is probably trying to carve our a little space for themselves too. 

Boundaries 

Boundaries are similar to space though in this context I shall be referring to them as the management of internal space – emotional closeness and distance. In any relationship, no matter how healthy, it is very unlikely that the two protagonists (or more if you are polyamorous), have the same needs for emotional intimacy. This is inherently frustrating. More so now than ever, but remember, it is also a simple truth of being in an adult relationship with another adult (rather than regressing to the fantasy of a union between mother and infant). 

Boundaries need to be explicitly named and negotiated and naming how one is feeling (taking turns to do so) is a key foundation in managing boundaries: if we know what we are feeling then we can communicate it. 

Difference 

The two former headings bring me neatly onto the concept of difference. One of my pet hates is when couples refer to their partner as ‘my other half’ or some iteration of this fantasy merger. 

Being in an adult relationship with another adult means having to tolerate reality – the reality that our partner is different to us and therefore has different views, thoughts and feelings to us, irrespective of how odd we may find them. 

When tensions are heightened (cue the Covid lock-down), humans can find difference threatening and will seek out consensus and similarity. This happens of a national scale where many differences are (temporarily) put aside for the common good and presents itself in relationships too. The problem is – it is an illusion. 

Sure, we can all agree to put aside differences in challenging times in order to achieve a goal, however the differences remain. And in lock-down, those differences are far less likely to be ‘life or death’ issues between couples and far more likely to be around an opinion about a film, a meal, or some other triviality that when mixed with anxiety, becomes evidence that just perhaps our partner is rather mad and not the right person for us to continue our journey through life with in the post Covid landscape. 

Couple who genuinely fare well in daily life in terms of negotiating and compromising; in observing difference no mater how hard it is – the cornerstone of empathy – will fare better in this crisis. 

The third table leg 

We all know that in order to build a stable table a minimum of three legs is required: two leads to instability. The same goes for relationships – not that we need a third person in the relationship – just the spectre of a third. Let me explain: 

Relationships are a complex balance of wanting to be one with our partner and suffering the frustration of knowing that that cannot happen. To get too close kills the relationship as the couple can no longer see each other and the relationship becomes a merger – a fantasy re- enactment of the womb experience. Too distant an intimacy and connection is not possible – this the the couple dance. 

For many couples their partners interaction with the outside world makes them interesting and enables each to see the other as a separate person who has a life outside of the relationship. Couple work, play and socialise, at least in part, separately. And this is the way it has always been and remains in tribal communities such as, for example the Aboriginal communities of Australia where ‘men’s business’ and women’s business’ was culturally and ceremonially embedded so observe difference. 

Under Covid, many of us have lost jobs, are being paid to stay at home or are trying to work from a co-living space with our partner – we no longer have to wonder about the ‘mysteries’ of men’s and women’s business as we are exposed to it 24 hours a day. The third table leg has become decidedly wobbly. 

On kindness 

Just like ‘Love in the Time of Cholera’ is not actually about cholera, nor are the current relationship challenges really about Covid and the lock-down. They are about who we are and how we navigate adult to adult relationships sacrificing the certainly or a pseudo infant- adult relationship for one that is real and therefore difficult and frustrating. Marquez’ book is ultimately about the reality of relationships in all the glory and pain and that is what is being brought to the forefront in this crisis for many couples. Being kind to each other is harder than it sounds when so much of what we rely on externally to manage our relationships vanishes in a lock-down.

 

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 –

Coronavirus Lock-Down – Physical Health vs Mental Health

Why psychotherapy sessions should end on time

Coronavirus Induced Mental Health Issues

Coronavirus (Covid-19) Counselling

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Why am I feeling more anxiety with Covid-19?

During the last 100 days, all of our lives, across the globe, have been turned upside down. Whilst scientifically overdue and rationally unsurprising, the pandemic has shaken the foundations of our outer, and thus, inner worlds. What we came to see as normal has been curtailed or removed; what we relied on for our own sense of normality has been fractured. 

Is everybody feeling more anxious? 

No, but that does not make those who are wrong or ill. Some people are feeling less anxious as their ‘ordinary’ level of anxiety (which may be quite high) now have an outlet – something tangible to attach to. Think of the example of a soldier who is able to thinking function efficiently in a war zone but who, upon returning home to an ‘ordinary’ environment, struggles to function as they locate threat behind every corner. 

There are also some who have a healthy relationship with their ‘anxious’ selves and are able to recognise the source of their anxiety and to use it whilst holding onto a thinking mind – such folks may feel a broader and deeper range of all their emotions at present but would not describe themselves as ‘more anxious’. This is possible for us all. 

We are all going to die! 

It is a fact – no way round it – we are all going to die. Though probably not from Covid-19. In fact the likelihood of death from Covid-19 is statistically very low. 

I am not interested in getting into the actual mortality rates etc. for Covid as they have little to do with the anxiety I am addressing – suffice to say that Covid is real and each death is a personal tragedy – like deaths always are. 

However, there is more than meets the eye in the sub-heading of this section of my blog which may shed some light on heightened anxiety levels which I shall attempt to explain. 

Let’s start with the premise that human beings, generally, have a strong biological drive to live – like all other mammals. 

Back to Freud 

Freud posited that the majority of our decision making and therefore emotional work remained largely unconscious to us. He was right about this as has been evidenced in neuroscience experiments. 

Freud also suggested that we have a profoundly unconscious fear of death linked to our consciousness of self – we know that we are alive and therefore we also know we must die and this presents a dilemma. 

All anxiety is death anxiety 

Anxiety is not like the other emotions. It is free floating and pervasive. We all must live with anxiety whether it dominates our experience or is just a flicker on the horizon. 

All other emotions are ‘attached’ to something in that we generally know or can work out why we feel a certain way. We generally know what we feel happy or sad for example – and if we don’t the psychotherapy can uncover the reasons. 

Anxiety is different in the sense that it ‘seeks to attach’ to something. So, rather than being anxious about a presentation, a flight, an exam or a date, our anxiety ‘finds’ something in our environment and then attaches to that convincing us that that thing is what is causing our anxiety. 

Of course real things cause anxiety, however, on a profound (ontological) level, all anxiety stems from an unconscious but ubiquitous knowledge that we are going to die. It is therefore death anxiety. 

Covid represents the perfect vehicle to which our anxiety can attach – it kills. Just not very many of us. It is not a Hollywood movie like Independence Day where the enemy will destroy us all unless we mount a global war (and towards an enemy that we can see – and is monster-like). Covid is invisible to us but nonetheless has triggered a profound death anxiety in all of us – we are primed to feel anxious in the face of death as though we are hard-wired. 

What can I do? 

Earlier I mentioned the term ‘a thinking mind’ and this is one I have written about before. Even though are all primed to feel more anxious when reminded of death (check our Terror Management Theory for empirical evidence of this), it does not mean we need to lose our rational minds and succumb to the anxiety and the accompanying acting out. 

Your mind is capable of thinking and scanning for evidence. For example, if you are reading this piece right now, stop breathe and look around you. Look out of a window and notice that in this precise moment, you are not dying. You can use your sense to ground you: 

  • What can I see; 
  • What can I hear; 
  • What can I smell; 
  • What can a taste; 
  • What can I seen – my breath, my heartbeat, tension in my body etc. 

I must buy toilet paper! 

Much has been made of the compulsive need to purchase toilet paper as the pandemic emerged and took hold. And this seem to be a global rather than local phenomenon (though Americans seem to have a compulsive need to purchase firearms – but that adds confirmation to the theory below). 

So why toilet paper? Well, when anxious humans would rather do something rather than just sit there – and what we often need to do is stop and just sit there. Particularly when we are not about to immediately die. 

Toilet paper is intricately linked to a biological need that we would prefer didn’t exist. The need to defecate. The need to defecate links us to nature and to being, at least in a significant part, animal. Being linked to nature and thus being an animal means that we are mortal – something that is unconsciously unbearable for the part of us that is ‘God-like’ and able to project ourselves back into the past or forward into the future. In short, toilet paper became a manic defense against death but ensuring that we had the ability in the face of death to ‘wipe away’ any evidence of our animal nature. 

Briefly returning to the questions of guns and our American friends – I posit that guns are the way Americans take responsibility for avoiding death anxiety – by protecting themselves against the enemy. Perhaps thank Hollywood for this (even though Covid-19 cannot be shot). Oh, and I am fairly sure they also stocked up on toilet paper.

 

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 –

Why psychotherapy sessions should end on time

Coronavirus Induced Mental Health Issues

Coronavirus (Covid-19) Counselling

How being ordinary is increasingly extraordinary – On the role of narcissistic defences

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Coronavirus Lock-Down – Physical Health vs Mental Health

As I write this blog, we are entering into the fourth week of so-called ‘lock-down’ across the UK. Despite daily speculation, nobody has any idea how long the restrictions on life will last for. 

Everything has changed and this has been hard to cope with in a society where stability and the ordinary continuity of life has been severely disrupted and curtailed; the UK population is currently in limbo, isolated from the wider community and possibly in closer physical contact with family than ever before. 

We know why we are doing this – we are reminded multiple times per day – to ‘save lives’ and ‘protect the NHS’. 

There has been much talk of the compelling priorities of the health of the nation vs the health of the economy. Arguably initially it was the later that took precedent in this country meaning we are now facing large numbers of fatalities. However, beyond the obvious economic costs of ‘lock-down’ and social distancing, the mental health impact seems to have been largely overlooked. 

Why start now? 

Despite a strong history and legacy of psychoanalysis and psychotherapy in the UK, mental health provision has long-since slipped from the forefront of policy-makers minds. Gone is the aptitude to be curious and instead a culture of symptoms has emerged increasingly oblivious to the fact that symptoms are communicating emotional and psychic distress. Depression has ceased to be seen as an inability to mourn and is instead an illness to be medicalised – as if it can be caught from the air like Coronavirus. 

So, in the midst of the pandemic, it is not surprising that any meaningful discussion on the impacts of quarantine, lock-down and social distancing will have on mental health, not to mention the ongoing rhetoric of how the socially interactive parts of our lives will be ‘changed forever’; today the WHO suggested that wearing a face-mask in public must become the long-term norm without the being any consideration to what the psychological impacts on self and others would be from such a policy. For example, where healthy development of an infant is contingent on them constantly scanning their care-givers face for reassurance and validation, what will the effect be of masking these quite literally behind a surgical mask? 

Compelling needs 

Whilst some of us may remain in denial, there is no question that social distancing is the only real means available at present to combat this pandemic. It is the oldest method in the book for dealing with epidemics and remains all we have (at present). 

However, for relational beings (which is what humans are) the strategy is psychologically and emotionally challenging (and for many catastrophic). 

Humans understand themselves and gain a sense of meaning through relationships with others. This is not a luxury – it is essential both as we develop and throughout our lives. Not only do humans needs to be able to communicate verbally, but we also require contact that is ‘non-verbal’. 

The mortality of isolation 

Isolation may keep us safe from the Coronavirus, however isolation is linked is not the cause of many mental health problems such as depression and anxiety and is fatal, particularly for the elderly (who, it would seem, are also being most impacted by Covid-19). Indeed, some studies have shown that loneliness is, indirectly, the biggest killer of the elderly. 

Virtual connections 

We live in an age where we can make use of virtual connections and video conference software to stay in touch with each other – my profession – psychotherapy – has overnight shifted to online working to ensure the continuity of therapy sessions. This is a positive, however, it will not migrate the tsunami of mental health and relationship problems that will arrive in the wake of the health crisis. 

Meaning making propositions 

For many, our daily lives, often revolving around work, provide us with a profound and anchoring sense of meaning and purpose. Not only has the ‘treadmill’ stopped, but with it much of the sense of purpose and meaning that many of us have. These two combined can be difficult to manage contributing to anxiety and depression – a literal crisis of meaning. 

Anxiety 

In the absence of meaning and purpose, and with the distractions of ‘ordinary’ life removed, anxiety can bubble up. It can leave us with a profound sense of unease and discomfort in our own skin and the wider world. And at present, it is hard to escape from. Of course, in reality anxiety can never be escaped from – it is part of us. It can, however, be faced and used to ask difficult questions about how we live our lives. 

Depression 

We are faced with a narrative from the media and politicians that ‘things will never be the same again’. I am unsure really what this means other than that it sounds like a warning or premonition of some kind. Being alive means accepting that things cannot remain the same and that we adapt. Change is hard and it forces us to be confronted with difficult emotions that many of us would rather run from. In the current climate of Covid, running from emotions has simply become harder. 

Whilst there simply cannot be a national or state managed balance between physical and mental health needs at present, this does not mean that as individuals we cannot be staying with our discomfort and asking ourselves what we ultimately want from this precarious life. 

 

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 –

Why psychotherapy sessions should end on time

Coronavirus Induced Mental Health Issues

Coronavirus (Covid-19) Counselling

How being ordinary is increasingly extraordinary – On the role of narcissistic defences

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Why psychotherapy sessions should end on time

Boundaries are critical not only to a psychotherapeutic relationship, but, as many clients learn through therapy, are essential to healthy adult-to-adult relationships.

In a good psychotherapeutic relationship, there is a solid contract between client and therapist such that clients know what to expect and when.  And part of this knowing by the client is knowing what time the session ends; most psychotherapy sessions last for a ‘therapeutic hour’ or 50 minutes.

Door-stop moments

Every clinician has encountered what are known as ‘door-stop moments’ with clients – they happen in the moments leading up to the end of a session where a client suddenly blurts out something emotive and important that can throw the therapist and lead them to extend the session by some further minutes.

Unconsciously, door-stop moments have much significance and represent a relational process between the client and therapist.  Yes, the content may be important, however, why is it being brought into the room (and relationship) in the final moments?

The client may unconsciously want to control the session by ensuring their therapist has no time to explore the content in detail; they may wish to ‘leave’ something difficult with their therapist to hold for a week; and they may be testing whether the therapist will hold the boundaries.  Or all of the above and more.

On hiding an being found

Donald Winnicott, esteemed 20th Century British analyst famously said “it is a joy to be hidden, and a disaster not to be found”.  Winnicott was making reference to the children’s game of hide and seek, which, is only enjoyable if we imagine that someone is looking for us.  If the other game participants give up and leave, we are left hiding with nobody holding us in mind – a disaster.  In this quote, Winnicott is talking about many concepts, but amongst others he is making reference to boundaries and holding others in mind.

Even though in the game of hide and seek the winner triumphs by not being found, they paradoxically only win if the other(s) are still searching for them – the game therefore is profoundly relational and based on an agreed set of rules.

Psychotherapy is also relational at its core and based on a set of rules (boundaries).  One of these is that sessions end on time.  Clients will find all sorts of ways to ‘hide’ from their psychotherapist, however, this is only ‘joyful’ if they believe that they will be found (seen and contained).

When a client presents a door-stop moment to us, it cannot be allowed to derail the boundaries of the relationship or the rules of the game.  Otherwise the client gets what they think they want (more time) but feels omnipotent and thus unsafe with their psychotherapist – in other words, the client has hidden so well the psychotherapist has forgotten about them.

It is never about the client even though it seems it is

Extending a session due to a door-stop moment is never about the client’s needs and always about the psychotherapist’s.  The client relies on their psychotherapist to ‘hold them in mind’ and thus hold their best interests in mind.  It is the latter that gets lost when a session is extended.

How can it be in the psychotherapists interests to extend a session?

Unconsciously the psychotherapist has also ‘got lost’ and is unable to remain separate from the client’s needs.  They thus extend the session to try and ‘please’, or appease the client, which fundamentally is about avoiding the client’s anger’ rage and disappointment.  And the job of a psychotherapist is precisely to survive these feelings in their client and what it makes them feel.

Don’t become a psychotherapist if you want your clients to like you

Psychotherapy is only happening when a client feels either positive or negative feelings towards their psychotherapist (and vice-versa).  If the relationship is neutral, nothing is happening.

It is easy to bask in the glow of a client’s adoration but beware, a fall will come.  And so it should.  As psychotherapists we are not there to be liked – we are there to remain constant in the face of our client’s emotions.

And being constant means ending the session on time.

 

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 being ordinary is increasingly extraordinary – On the role of narcissistic defences

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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COVID-19 (CORONAVIRUS) Important Notice

We would like to reassure all our clients that Brighton and Hove Psychotherapy, including The Barn, in Lewes,  is operating as normal despite the current situation. 

We are coordinating our response to the virus to ensure we can continue to deliver sessions to our clients, look after the welfare of our associates and maintain the continuity of our practices.

Psychotherapy sessions do not involve physical contact and a boundaried physical working distance of more than a metre between clinician and client is maintained in sessions as general good practice.

Should clients or clinicians need to self-isolate, regular sessions will continue using video call or telephone as an alternative means of working, until face-to-face sessions can be resumed.

We are monitoring the situation closely, guided by appropriate health organisation advice (PHE) and relevant government guidelines.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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How being ordinary is increasingly extraordinary – On the role of narcissistic defences

Who wants to be ordinary? The word has unpleasant connotations; like something that offers little that is good or substantial. And yet it is a word I often think about and return to in my clinical practice. It could even be one of the primary goals of therapy: to become ordinary.

In the world today there is more and more in place to protect us from being ordinary, that is, to protect us from being ourselves.

We have an almost infinite number of television channels, live streaming of every conceivable film and box-set and console games set in technicolour virtual reality.  The whole world is modelled on making us all feel special. And it is within reach for us all, if only we have just enough about us to win the latest talent show broadcast at primetime, or to garner enough Youtube followers or win the Lotto – after all ‘it could be you’.

All this presupposes that being simply ordinary is wrong; that being ordinary is settling for something less than. However, being ordinary in the truest sense of the world means being able to be in relationship with our inner world and make decisions and life choices – choices based on desire rather than the need to shore up our defences.

What is ordinary?

If being ordinary has little to do with accepting the mundane or second-rate life, then what does it mean?  Being ordinary means being in the real world, rather than retreating to a ‘fantasy world’ each time the real world becomes uncomfortable.  Or in some cases retreating from the real world to avoid it even the anticipation of discomfort.

On defences

I have previously written about manic defences enlisted in order to protect us from discomfort.  And whilst this blog in essence remains about manic defences, the use of certain defences to avoid ordinariness and strive for the extraordinary are a particular subset in the cluster of manic defences known as narcissistic defences.

Neglected children always construct a story of specialness

Whether it is story of being ‘special’ to a parent who leans on them for emotional support, or it is specialness born out of surviving a difficult childhood, being special or extraordinary can be a short-term invaluable solution to feeling helpless, hopeless, enraged and depressed. Or even mad.

Being extraordinary shores up the empty core of the neglected and abused child.  It enables them to cope and to construct a ‘pseudo-self’ so they can navigate the world. At least for a while.

A special kind of defence

There is an argument that as a society (western), we are becoming increasingly narcissistic: focused on consumerism and fantasy rather than connection and relationship.

The consumer world makes it easy to ‘sell’ specialness or the attainability of extraordinariness.  Even in the western spiritual model specialness is promoted through maxims such as ‘you are unique’; ‘you have a special gift to offer the world’ and so forth.

What’s so bad about being extraordinary?

Life should not be a choice between being extraordinary or being nothing (feeling like one does not exist).  Being ordinary is not the contrary of being extraordinary, at least not in psychotherapy. Being ordinary is the third position.

Being ordinary is a mature position of being able to withstand and navigate real life without flights of fancy; it is a position whereby we can make decisions from a position of strength and desire rather than from an ongoing defence of the fragile self.

In tangible terms, being ordinary means living a real and fulfilling life without a constant need for external validation and approval.  Without being defined by Facebook or Instagram ‘likes’.

Being ordinary is an authentic position and one through which we may have extraordinary experiences if we are lucky, but they will be rooted in reality.

All in all, it seems to me that being ordinary has really become something extraordinary in the modern world.

 

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 –

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

What is the difference between fate and destiny?

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Don’t just do something, sit there! On the role of manic defences

We have all heard the phrase.  Often shouted at a moment of crisis on a television programme or film: “Don’t just sit there, do something!”  As if ‘doing something’, anything at all, will make a difference.  Of course, the reality is that doing something does make a difference, if not to the outcome of the crisis, then at least to how the protagonists in the crisis feel.

Doing something – anything – at a moment of crisis or even simply at a moment of inner discomfort, can be a common way of avoiding uncomfortable feelings.  Doing something can convert those feelings into an external activity whereby they, at least for the duration of the ‘doing something’ do not need to be consciously experienced.

We call defences, such as these manic defences, as their purpose is to rigorously protect us from having to be in touch with uncomfortable feelings.

Is manic defence linked to depression?

Most people associate the term manic defence, or ‘mania’ with depression and in particular bipolar disorder.  And whilst it is correct that some sufferers from bipolar disorder experience acute manic episodes which may or may not include psychosis, all of us use manic defences as an unconscious way of protecting ourselves against psychic pain.

The clinical bit

Manic defences arise developmentally sometime between the age of six months and a year.  This stage is when the infant is starting to come to terms with the fact that his/her primary carer (I shall use the term mother here for simplicity) is separate to them.  In other words, the mother is not a ‘part’ of the infant and that therefore she will frustrate and anger the infant in not being perfect in meeting their needs.  Manic defences protect the infant against painful feelings of control, contempt and triumph, according to Melanie Klein.  Manic defences, therefore, protect the infant against their own uncomfortable feelings and protect the mother, from the infant’s rage.

How do we use manic feelings?

Manic defences come into play to stave off a whole range of difficult feelings from boredom, through to rage and anger – often feelings where we feel impotent, helpless or fear our own strength of emotion.

An example could be to go shopping after a tough day at work.  And, with the advent of the internet, ‘shopping’ is invariably always at our fingertips.

What’s the problem?

The developmental process of growing up is one in which we should all learn to be able to face our emotional and mental discomfort and then use it in a growth-orientated manner to move forwards in our life.

Without this, we remain at the mercy of early, primitive defences that stop us engaging with who we are and how we feel and severely limit our capacity to become an integrated whole person.

How can psychotherapy help?

In order to grow up in a methodical way using our wisdom to make sense of our internal and external world, we must rely on others to teach us what is required.  This is ideally the role of a parent, however, if we have a parent who has been unable to truly separate from their parents and relies on manic defences to navigate the world, then we cannot learn this from them.

Psychotherapy offers and represents a relationship in which our inner worlds can be understood and tolerated.  This is not an easy process, but it is a fulfilling one: when the going gets tough, the tough go to therapy.

Returning to the title of this piece, perhaps the challenge for us all is in being able to resist doing anything, and to simply sit there and observe our internal process and acknowledge our feelings.  This is the mature response, but does not make for dramatic television!

 

Mark Vahrmeyer is a UKCP registered integrative psychotherapist who draws strongly on existential thoughts and theory to help clients make sense on an increasingly senseless world.  He sees clients in Hove and Lewes.

 

Further reading by Mark Vahrmeyer –

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

How do I choose a Psychotherapist?

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Can psychotherapy or counselling be a business expense?

A question that is often asked of us whether or not psychotherapy, and indeed counselling or clinical psychology, can ever be claimed as a legitimate business expense?

What are business expenses?

Business expenses are classified as allowable expenses which constitute the running costs of your business. These will, obviously, vary from business to business. The question of whether psychotherapy is a legitimate business expense therefore applies to people who are self-employed, ranging from freelance workers through to business owners (although for limited companies slightly different rules apply).

How can psychotherapy ever be a business expense?

The answer to this is yes. For example, any counsellor, psychotherapist or clinical psychologist can legitimately claim their own personal therapy as a business expense. Not only is this appropriate as an expense, but it is arguable that all mental health clinicians should be in their own ongoing personal therapy for self-development and to ensure that they are being appropriately supported in the emotional work they do with their clients.

However, in my own practice I have many clients who claim their personal psychotherapy as a business expense and who work in completely unrelated fields ranging from property development through to creative endeavours such as musicians. So how is this justified?

Therapist's sofa

 

What is psychotherapy?

Counselling, psychotherapy and clinical psychology all wall under the heading of ‘talk therapy’. They are concerned in similar ways with helping people to work through loss and trauma. However, both the concept of ‘talk therapy’ and the idea of ‘working through loss and trauma’ cover an enormously large remit and in many instances, this remit impacts upon our ability to work. Let’s consider an example:

Sarah, a freelance musician, has recently been offered a position playing with a major orchestra. This has come about as a result of many years of hard work and dedication; it offers the potential of being the pinnacle of her career. However, to her utter astonishment she notices that every time she joins the new orchestra for rehearsals, she experiences sleepless nights and strong symptoms of anxiety that impact on her ability to play to the best of her ability. Clearly, in this example, Sarah would both benefit from psychotherapy and it can be legitimately argued that psychotherapy for her performance anxiety is a legitimate business expense.

The reasons for Sarah’s anxiety could be numerous ranging from an unconscious fear of success rooted in her mother’s option of her, through to feelings of inadequacy and shame around ‘being seen’. However, from a business expense perspective, the causes are less important that the manifestation of Sarah’s symptoms – her anxiety is impacting on her ability to ply her trade.

Is psychotherapy only a valid business expense in times of personal crisis?

Many people initially enquire and start psychotherapy when they hit a crisis – in other words when their symptoms become debilitating, or at least too distracting to ignore any longer.

So, whilst the initial part of any psychotherapy process often overtly works with the crisis the client brings, the underlying process will be addressing deeper relational issues. It is not uncommon for clients to expect to undergo a period of psychotherapy which then turns into a deep, meaningful, intimate and ongoing relationship that continues week after week. And, in many instances, long-term ongoing psychotherapy remains a valid business expense.

Most businesses are comprised of relationships. Whether that simply means working on behalf of external clients, through to being a part of a team or leading an organisation. And as psychotherapy is a relational process of deepening ones understanding of self through the unique relationship with a psychotherapist, many clients continue to find that an ongoing process of psychotherapy becomes an asset to how they manage stress and anxiety and in turn their relationships with their colleagues.

 

Can couple therapy be a business expense?

Again, the answer to this depends on how the couple relationship is intertwined with the business.  For couples who run a business together – often a complex and stressful experience – couple therapy or marriage counselling can be both invaluable in stabilising the relationship but also in assisting the couple in improving dialogue with each other so as to improve their working relationship. In such a context couple therapy would be a valid business expense.

What if I am not self-employed?

Business expenses apply to those who work for themselves and submit their own (or company) tax returns. So, if you are employed, clearly psychotherapy cannot be a business expense, however, this does not necessarily mean that you cannot get help or support in attending and/or paying for psychotherapy.

Private health insurance

Increasingly private health insurance is offered as a benefit to salaried workers and most private health insurance providers provide cover for psychological support from appropriately trained and registered counsellors, psychotherapists and clinical psychologists. This cover may be capped in terms of a value amount or in terms of the number of sessions, so it is worth checking with you provider to find out more.

Time off to attend psychotherapy

And lastly, where employers may not choose or be able to offer private medical coverage as a benefit, an increasing number of employers are recognising how important it is to support mental health issues. It is therefore not uncommon for employers to allow staff to attend psychotherapy during working hours (with time made up on another day) or to come to a flexible arrangement with staff, such as working from home, to enable them to attend sessions.

All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor 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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