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How to get a Mental Health Diagnosis

The term ‘mental health’ is pretty broad and encompasses emotional and psychological health.

When people talk about mental health they are often referring to symptoms such as depression or anxiety but rarely do they mean psychiatric disorders such as schizophrenia, for example. Therefore, the answer to how to go about getting a mental health diagnosis is – it depends.

It is possible to go to a GP in the UK and present with symptoms that fit the criteria for anxiety or depression and to receive a ‘diagnosis’ from this doctor. In turn they may ‘prescribe’ counselling or offer you medication such as anti-depressants.

However, receiving a mental health diagnosis is not the same as receiving a diagnosis for a physical disorder. Let me explain.

Nobody has seen a mind.

If you are unfortunate to break a bone due to a fall, it is safe to assume that unless you are encountering an incompetent doctor, you will receive the same diagnosis irrespective of which hospital you attend wherever in the world; a broken bone is exactly that.

When it comes to mental health, the criteria is different as we are really talking about the ‘health’ of the human mind (or in many cases the emotional system), and the problem is that nobody has ever seen a mind.

Most mental health diagnoses are therefore based on the presentation of ‘clusters’ or groups of symptoms that a patient experiences over time. A GP will consider your experiences and the duration over which you have experienced them and on that basis will offer you a ‘diagnosis’.

Whilst this may be helpful in order to access medication of brief counselling, it is unlikely to resolve matters. And bear in mind that most GP’s have had very little mental health training – generally only weeks, compared to the years of training around physical health.

A psychiatric diagnosis

If you have severe symptoms that quite possibly may include delusions, you may be referred to a psychiatrist. A psychiatrist is a medical doctor who has specialised in ‘diagnosing’ psychiatric disorders and on the basis of a diagnosis you will likely receive medication and/ or psychotherapy.

Counselling and Psychotherapy

The parallel but distinct professions of counselling and psychotherapy are both related to mental health and approach treatment of mental health conditions through what is known as ‘the talking cure’. In reality the cure comes about far more through listening, rather than talking on the part of the clinician.

Whilst there is disagreement about the fundamental differences between counselling and psychotherapy – which I have previously written about here – a reasonable differentiation is that counselling is used to as a shorter term treatment working on a more superficial level.

Psychotherapy, as defined by the UKCP _United Kingdom Council for Psychotherapy) involves a similar process to counselling but working with a clinician trained for a longer period of time who is crucially able to formulate, unlike counsellors.

Formulation is the word psychotherapists use to ‘diagnose’ but as we do not tend to work within the ‘medical model’ and recognise that mental health issues encompass both psychological as well as emotional issues, we use a different language and different models to the medical model in order to make sense of a person’s inner world.

Is psychotherapy about getting rid of symptoms?

Whilst most people presenting for psychotherapy simply wish to ‘feel better’, a large part of the process of therapy is to become curious about one’s symptoms in the context of the therapeutic relationship. Psychological or emotional symptoms, much like bodily symptoms, are often there to inform us of something important that needs attending to.

Psychotherapy is fundamentally about working to create a deeper relationship with oneself, through the relationship with the psychotherapist. And through this deeper relationship we can come to understand our symptoms better as signals that are telling us something about our life: often either about something in the past that has not been processed or worked through, or something about what we yearn for in the future.

 

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 do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

Mental health problems in Brighton

by Leave a Comment

What is Psychotherapy?

Psychotherapy is a method of treating mental health issues through psychological, rather than medical means.

Known as ‘the talking cure’ a psychotherapist’s role is to work with patients or clients, generally on a minimum of a weekly basis, over a period of months or years.  The work takes place within what is called a ‘therapeutic relationship’, characterised by the psychotherapist listening and thinking carefully about the client’s experience and working with them to make sense of it.  Thus, whilst known as the talking cure, it could be more accurately described as the listening cure.

Psychotherapy developed from psycho-analysis, which is similar in nature, but involves multiple weekly sessions (up to five) and can often last for up to a decade.  Freud referred to (psycho) analysis as a ‘cure through love’ and this applies to psychotherapy in much the same way.  The relationship between psychotherapist and client is unique and one in which all the focus, attention and thought is about the client’s process.  The closest example to this type of relationship is between mother and child, or primary-caregiver and child, and it is often due to failings in this primary attachment relationship that clients seek out psychotherapy in later life.

Do I need to have a mental illness to go into therapy?

Whilst it is very common for people to seek out the assistance, support and expertise of a psychotherapy due to them feeling like they are in a crisis in their life, the crisis is often only the catalyst that brings a client into psychotherapy.  Indeed, it was once again Freud who said that psychotherapy (analysis) only begins once the patient’s crisis has passed.  What did he mean by this?

One of the goals of psychotherapy is to bring space and contemplation into a person’s life so that they feel less at the mercy of their emotions and more able to hold themselves in mind.  Once a crisis has passed, clients can often start to focus on using the therapeutic relationship and space to examine why they think and feel the way they do and to develop a construct or idea about who they would like to be.  Psychotherapy is thus about getting in touch with our appetite, or passions.

Whilst most people access psychotherapy due to an issue covered by the term ‘mental health’, most remain for months or years in order to learn to have a better relationship with themselves and others.

How does psychotherapy work?

Human beings are relational beings, meaning that we are, from the moment we are conceived, in relationship to another.  Relationships shape not only our worldview and our relationships to others in our life, but also shape our relationship to ourselves.

If we have learnt through early relationship(s) that others are unsafe and/or that we are not worthy of love then this shapes our worldview of all our relationships going forward.  If we have been wounded in relationship then it takes another (therapeutic) relationship to work through all the hurt and to discover a new way of relating through how we are related to.

What training do psychotherapists have?

In the UK, the terms of psychotherapist and counsellor are not legally protected meaning that virtually anybody can use these terms with impunity.

Whilst some clinicians use the terms of counsellor and psychotherapist interchangeably, the UKCP (United Kingdom Council for Psychotherapy) is the largest professional body for psychotherapy clinicians and lays out its training and membership expectations for clinical psychotherapist very clearly.

Psychotherapists in the UK (who are UKCP members) train for a minimum of four years at post-graduate level, undergoing their own psychotherapy throughout this period, obtain at least 450 clinical hours of experience and undertake a mental health placement.  Most UKCP psychotherapists will therefore have a minimum of a Masters degree in the field.

What’s the difference between psychotherapy and counselling?

There is much disagreement about the differences between counselling and psychotherapy and this is something I have previously addressed here.  Fundamentally, psychotherapists are trained to work at a deeper level than counsellors and have been trained to formulate – our word for diagnose.

How do I find a psychotherapist?

Finding a psychotherapist can feel daunting.  Brighton and Hove Psychotherapy is a physical clinic comprised of a group of skilled clinicians offering psychotherapy across the greater Brighton and Hove area and Lewes.  You can use our search function to find a psychotherapist near you.

Alternatively, the UKCP holds a directory of all registered UK based psychotherapists which can be found 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 – 

How to improve mental health

How do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

by Leave a Comment

How to Improve Mental Health

Mental health is constantly in the news and not a day goes by without an article, blog post or news piece on the topic.

The great contradiction is that whilst we know more about mental health now and how to manage it, the busy, chaotic and plugged-in world we live in does little to help our mental health. Nor is it often that clear what exactly is meant by the term ‘mental health’.

Mental health is a ‘catch-all’ phrase that encompasses our emotional, psychological and social wellbeing. It therefore includes our mind, our emotional system and our social world. It stands to reason that good mental health means attending to all three, but I would argue that there is a fourth – the body – which is intrinsically connected to good mental health.

When people refer to their mental health, what are they really saying?

As I write this article, the media will have us believe that mental health is currently under crisis in the UK. Waiting times to see a mental health practitioner are at an all time high, people are increasingly struggling to cope with high stress levels and many folks remain isolated or fearful for social contact following the numerous and lengthy Covid lockdowns.

Poor mental health can manifest in a range of symptoms from low level depression and anxiety through to diagnosable psychiatric illnesses. For most people concerned about their mental health, the latter is fortunately not very common and therefore we can think about how you can take responsibility for improving your mental health.

Steps you can take

Sleep is crucial to good mental health and it is no coincidence that many of us struggle with poor sleep which ever time can have a very detrimental impact on our mental health (as well as our physical health).

Establish a sleep routine and stick to it – going to bed at a set time and avoiding stimulants such as caffeine before bed can be very helpful. Another stimulant that you would do well to avoid is watching the news prior to bed – whilst informative, the news impacts significantly on our nervous system and can leave us feeling ‘activated’ exactly when we need to get to sleep.

Exercise is good for the body, but also the mind. Many folks are put off exercise as they see it as something that involves strenuous exercise in a gym, however, this need not be the case.

Exercise does not need to cost anything and can be a way of combining being in nature with moving the body. A brisk walk or sea swim (in the midst of this heatwave) are both good forms of exercise.

Eating sensibly is another activity associated with physical health but which can also have a significant impact on our mental wellbeing. Stimulants such as coffee and sugar impact on moods and with this can in turn impact on sleep patterns, so be aware of when you consume stimulants and avoid eating anything late into the evening.

Socialising is not only enjoyable but is also good for our mental health. Human beings are relational, meaning that we are born into relationship and require relationship(s) to develop. Even when we are alone, in a psychological sense we are in relationship to someone – we call this an internal object – and constitutes how we hold ourselves in mind and make the ‘best’ choices for ourselves.

The mind body connection

All of our emotions stem from the body. They start as sensations and we then notice them and group them into emotions; feelings are the words we use to describe emotions.

Each feeling, or set of emotions, has its own somatic (body) blueprint, which means to say that each feeling is made up of a unique set of sensations in the body. For example, anger, whilst ‘feeling’ different for everyone has the in-common body sensations of tight stomach, tight jaw, clenched or tightened fists and a narrowing of the eyes. Conversely, joy, is felt in the body as an openness and moving towards something or someone. Joy tends to bring a smile to our face and it is as if our whole body opens to receive more of what we are enjoying.

Everyone has a different shaped and sized body and everyone has a body that can perform different tasks depending on fitness, ability, age and (dis)ability. However, unless a person has a ‘good enough’ relationship with their body, it is simply not possible to have good mental health.

Hence why the body must be included in psychotherapy and feelings stemming from the body attended to.

Practicing gratitude towards your body for what it can do and how it looks after you, getting curious about what your body needs and wants and treating your body with respect, are all significant pathways to good mental health.

Talk to someone

When things get too much it can be good to talk and whilst a social and support network is important, some things need to be thought about with a mental health professional such as a psychotherapist.

A psychotherapist is someone who has trained at postgraduate level for a minimum of four years and undergone their own journey of analysis or psychotherapy throughout their training and ideally well beyond. In the UK, psychotherapists are registered with the UKCP who hold a directory of qualified clinicians or you can search for one using the search function on our own website.

People generally enter in psychotherapy because of a crisis of some sort in their life, however, they tend to stay because they find the therapeutic relationship so invaluable in not only improving their mental health but in developing an appetite for their lives. As Freud said, psychotherapy (analysis) begins after the crisis has passed.

 

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 do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

Mental health problems in Brighton

by Leave a Comment

How do I find the right Psychotherapist?

Finding a psychotherapist can feel like a daunting task. For starters, the difference between a counsellor and psychotherapist may not immediately be apparent. Then there are the different modalities, or approaches to therapy. And lastly, there are the different professional bodies to make sense of.

The term ‘psychotherapist’, unlike ‘clinical psychologist’, is not a legally protected term in the UK. This means that there is very little to stop anyone claiming that they are a psychotherapist, without having undergone an accredited psychotherapy training (or indeed any training at all).

There is also, as of yet, no agreement across the different professional bodies as to what exactly constitutes a psychotherapist, and the two main professional bodies – the BACP and the UKCP – both have very different training and competency standards in relation to the title, all of which further muddies the water for anyone seeking psychotherapy.

If a client is wishing to go into therapy then my advice would be first and foremost to seek out a professional registered with the UKCP – the UK’s largest and most rigorous professional body for psychotherapy professionals. The UKCP have a helpful website which enables users to search for clinicians based on location, as well as other criteria.

Once you have a list of UKCP accredited psychotherapists, you may wish to consider which approach, or modality, in which the clinicians in question have been trained. Whilst this may seem confusing, it is important to remember that research has shown that it is the quality of the therapeutic relationship combined with the approach, that leads to the most successful outcomes in therapy. Therefore, look for a clinician who is able to explain how they think and work in clear and understandable language – remember, it is their job to help you understand how they can assist you, rather than you needing to figure it out by wading through complex jargon yourself.

Many people make the decision to seek out a psychotherapist when in a crisis. Whilst this is common and the sense of urgency strong, it is important to take the time to find the right ‘fit’ and this may mean contacting various clinicians, as well as attending potentially more than one initial consultation. When new clients come for an initial consultation with me, I always set a goal with them at the start of the session in suggesting that it is their job to
work out whether they feel comfortable enough (but not too comfortable) working with me, and my job to work out if I believe that clinically, I can help them. This often comes as a surprise to new clients in that they are there to make a judgement and choice in relation to working with me, however, therapy needs to be a co-created and collaborative process from the outset.

How do I know if my therapist is right for me?

If you find that you are working with a therapist and it does not feel like you are getting what you hoped for or are feeling uncomfortable then raise this. As I stated earlier, psychotherapy is ‘work’ that two people undertake and a big part of the work is in establishing a particular kind of relationship – a therapeutic relationship – or alliance.

If your psychotherapist is unwilling to hear your concerns and to discuss these with you, then that is a strong warning sign that the person you are working with is not a good fit (and arguably not a very good clinician).

I suggested earlier that psychotherapy should be a process that feels supportive and comfortable, but not too comfortable – you have sought out a psychotherapist because you have a problem and want support. Your psychotherapist is not there to be your friend.

They are equally not there to collude with you, but to appropriately and mindfully challenge you.

I previously referenced the different approaches to psychotherapy – the methods. These can seem confusing – and even cause a fair bit of infighting amongst the therapeutic community! One way of thinking about these approaches is to consider them as ways of conceptualising, of thinking, about your inner world. It may be that after a period of time you discover the way your psychotherapist thinks simply does not ‘fit’ with the way you think. Remember, psychotherapy is about understanding the human mind and nobody has veer seen or touched a mind – it is a concept, a construct, and as such is shaped and brought to life by language.

What is ‘good’ psychotherapy?

There are many answers to the question – ‘what is psychotherapy?’ – which is another way of asking the question ‘what is good therapy?’. As there are so many ways of helping people make sense of their inner world, there are an equal number of answers as to the goals of therapy, however, there is commonality.

Rather than ‘good therapy’ being one thing, it can be better expressed as a formula: A solid frame combined with a containing relationship. Let me explain: Us psychotherapists frequently reference ; ‘the frame’ in psychotherapy and this refers to all the elements that enable a solid ‘containing’ relationship to form between the client and their therapist. The frame consists of a regular meeting day and time, a stable and unchanging consulting room, sessions that start and end on time, a therapist who is ready and attentive – these are some examples.

By ‘containing relationship’ we are talking about the very unique role that we, as psychotherapists, must play for our clients. We are there to think about the client every second of the encounter and must not make the relationship or sessions about us.

Therefore, when in psychotherapy, if you ask your psychotherapist a question – something such as ‘how was your weekend?’ – they will likely explore with you what lies behind the question before answering.

A containing psychotherapist is also one who can ‘survive’ their client – in other words, the client is free to express themselves how they wish and the job of the therapist is to be able to hold the boundary no matter what. When the frame and container are solid, that is a good starting point for successful therapy.

Can it be dangerous to see the wrong psychotherapist?

Let us assume that by ‘wrong’ therapist we are assuming a poor fit rather than any kind of abusive relationship, as clearly the latter presents significant risks to the client and would constitute a breach of the psychotherapist’s (UKCP) code of conduct.

Psychotherapy is, amongst other things, about helping client to understand their wants and needs and to help them put appropriate boundaries in place in relationships. If a client is continuing to see a psychotherapist where they are getting little to nothing from the sessions and feel that they cannot raise this, then this is only going to further undermine their self esteem and confidence which is utterly counter-productive to the process. This would be an example of the client’s experience in their relational world repeating in the therapy.

How important is it that my therapist is accredited and what should I look for?

As I have previously highlighted, psychotherapy remains largely formally unregulated in the UK. Membership of the various professional bodies is voluntary and for clients, it can be hard to distinguish between them.

As a UKCP registered psychotherapist I am acutely aware of the rigorous training standards of my professional body and understand the level of training that other psychotherapists, irrespective of their modality, have received who are fellow members.

Anyone crossing the threshold of a psychotherapist’s consulting room has been on the receiving end of some degree of neglect or abuse in their childhood. This makes them susceptible to further relational injury from working with someone who either is misrepresenting themselves, or has received inadequate training to understand their
limitations.

UKCP registered psychotherapists have trained for a minimum of four years at post-graduate level, undergone years of their own personal therapy, achieved over 450 hours of training sessions, attended a mental health placement and been taught to formulate – our word for ‘diagnose’. I would therefore always recommend a UKCP registered psychotherapist to any prospective clients I could not see myself and we have quite a few on team at Brighton and Hove Psychotherapy.

 

Mark Vahrmeyer is available at our Brighton and Hove practice and the Lewes Practice.

 

Further reading by Mark Vahrmeyer

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

Mental health problems in Brighton

The limitations of online therapy

by Leave a Comment

Why do people get the birthday blues?

Birthdays are generally depicted in the media as happy events that should be celebrated. However, for no small number of people birthdays can be complicated and evoke difficult feelings such as sadness, listlessness and even feelings of depression. Why is this?

The ‘birthday blues’ is a term used to capture the range of difficult emotions that some people experience around birthdays. They often come on in the lead up to a birthday, peaking on the actual day and then quickly dissipating, at times with a sense of relief.

There is no single clinical reason why people may feel down or depressed on their birthday and nor is it a pathology but rather a combination of association and arguably somatic memory. Let me explain.

Whilst we all have seen images heard stories or seen films depicting ‘the perfect birthday’ for children, for most of us this was not the case, but overall we enjoyed the day because we were allowed to celebrate it with those we love. However in many cases this simply is not so. For example, for children of divorced parents birthdays can be difficult as the loss of one of the parents may be highlighted on that ‘special day’. As a clinician this is something I encounter often with clients whose parents divorced acrimoniously – they wanted nothing more than to spend the day with both parents but can’t. Worse still I have encountered stories whereby my clients as children had to choose between their parents as to with whom they were going to spend their birthday. The outcome was that birthdays become something to dread rather than eagerly anticipate.

So, birthdays can represent a marker date (not dissimilar to Christmas) – a reminder – of a painful event which is compounded by the societal expectation of how a person should feel. This creates an internal conflict between the felt reality and how that person actually feels, which exacerbates the problem and can lead to symptoms of depression.

Why are birthdays so important to so many people?

Human beings are defined by time. We did not invent it as it passes whether we are aware of it or not, however, we structure our lives around time and use it not only as an important guide in terms of the passing of the seasons but also in measuring our time on this earth.

Birthdays are seen as something to celebrate as an achievement which may seem somewhat arbitrary in the modern world, however in a world in which infant mortality was rampant and few people lived beyond their forties – which constituted much of human existence – there was arguably much to celebrate in living another year.

However, I believe that there is something else that sits beneath this explanation that operates on an unconscious level and that is how birthdays represent an overcoming of death. It could be argued that becoming yet another year older is nothing to have a party about – especially once we have passed our youth. Birthdays mark the passage of time and bring us ever closer to death – something us humans have a hard time dealing with. So by marking birthdays and celebrating them, we are perhaps avoiding contemplating our mortality. They function in part as a form of
death denial.

Like the actual new year, birthdays are psychologically and thus symbolically representative of an opportunity for renewal – we can put the bad or mediocre of the past year behind us and start another year with good intentions. Sadly, like new year’s resolutions, little generally changes following birthdays as we take our old selves with us into the ‘new year’.

Is there any physical reason why people would feel differently on their birthday?

From a medical perspective, there is no reason why anyone would feel differently on their birthday, however, as noted earlier, birthdays can evoke powerful memories that may be pleasant, difficult, or a combination of both.

We know from neuroscientist and Professor of Psychiatry Steven Porges’ work on Polyvagal Theory that our neural network extends to our gut and that we receive significantly more ‘data’ from our gut to our brain via the vagal nerve than the other way around. It therefore stands to reason that where we have powerful memories associated with a significant date, that we will feel and possibly experience those memories in our body too. How may these manifest?

Some people may feel lethargic or achy and others may have headaches or migraines in lieu of experiencing the actual feelings – and this is particularly likely in cases where there is a conflict between how the person feels, and how they believe they should feel based on social or family expectations.

How can people start to think differently about their birthday?

When I was a trainee psychotherapist, one of my tutors would say ‘if you feel stuck with a client, find the feeling’. Ultimately psychotherapy is about grieving – what clients grieve will vary, but they are coming to grieve whether they know it or not.

If birthdays have in the past been difficult and remain so in the present then there is something that has not been grieved. For example, where a client began to dislike their birthday or even dread it due to a family event such as parental divorce, and that feeling repeats in their adult life, then I would suggest that there are feelings relating to that loss of the parental unit that remain unresolved. Once these have been worked through, birthdays will be ‘freed up’ so a different meaning and set of memories can be ascribed to them.

So, the first step is in grieving whatever needs to be grieved and then the second step is in recognising that a birthday is largely symbolic and that as an adult we can take control of them and take responsibility for creating of them what we wish. The latter is critically important as it may be that one person’s idea of a ‘good’ birthday is a full-on bash with friends whilst another is a quiet walk in the woods. Both are equally valid.

Are birthdays as important as people think?

Human beings are symbolic and are unique (as far as we know) in world of mammals in that we are the only creatures that inhabit a symbolic world. The majority of what we do, create and celebrate has no pragmatic purpose, however that does not mean that it is not important.

The symbolic is the basic fabric of culture and we all subscribe to a culture, as it is through culture that we gain our sense of belonging and self esteem. Culture (whichever one you happen to belong to) gives us three fundamental stories which enable us to cope with death anxiety according to psychoanalyst Otto Rank, who was one of Freud’s acolytes – culture tells us where we came from, how to behave whilst we are alive and lastly, it tells us what happens to us when we die. Without culture, we have very little.

Birthdays are symbolic and embedded in culture thus they are important in us being a part of the world in which we live. However, particularly in Western Culture where we subscribe to individualism, we are free to create of our birthday whatever we wish.

I would therefore suggest that birthdays are important as all cultural markers are important, however, that does not mean that we should be indentured to them.

Are the birthday blues real?

Anything that a person feels is real, as it is their felt experience. This does not mean, however, that that feeling or set of feelings belong in the present. Nor does it mean that the ‘birthday blues’ are a pathology but rather a term that helps us makes sense of what someone may be experiencing.

If people are habitually getting the ‘birthday blues’ which is a set of difficult feelings akin to depression, then something from the past has got ‘stuck’ and is repeating as an experience each year.

A psychotherapist would work with you to uncover what it is that brings on these ‘blues’ around the time of your birthday and to work with you to resolve the underlying grief or address what it is in your appetite for life that is being suppressed.

Can birthday blues ever be a good thing?

Whilst it may seem counter-intuitive, it can be helpful to be curious about how we really feel around our birthday and to work out whether those feelings are perhaps telling us something important.

It’s no secret that in my profession the peak time for couple’s therapy enquiries is in early January (the same is true of a family solicitor friend of mine). This I believe is in no small part to the pressures of family Christmas being combined with a new year and a desire for new beginnings.

Birthday blues can also be a sign that something in a person’s life needs addressing and perhaps changing. Birthdays are a reminder of the passage of time and can increase feelings of anxiety when deep down a person knows they are not really living the life they want to.

If we can be curious about them, birthday blues can tell us important information about what we may want or what is missing from our life. And if you can’t make sense of it, it can be really helpful to talk to a psychotherapist who can help you unpick what the blues might mean – whether that is a loss that needs to be grieved or an appetite that needs to be expressed.

 

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

Are people with mental health problems violent?

Mental health problems in Brighton

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

by Leave a Comment

Is Happiness the Opposite of Depression?

It’s not a secret that most people presenting for therapy come with symptoms of depression or anxiety and in many cases both – more about that later.

And it is also not uncommon for people unfamiliar with psychotherapy to simply want to be ‘happier’.  After all, don’t we all on some level wish to be happier?

What is depression?

Depression is a word that has become part of daily vernacular.  People often will use it to describe feelings of prolonged sadness as in ‘I have felt really depressed lately’; people will use it to describe feelings that are actually grief and it also it is also a medical diagnosis for which medication is prescribed.

In my view as an analytically informed psychotherapist, depression is a state of inner ‘deadness’.  It is heavy and dulls down life so that very little seems to have any meaning at all.  In this sense it therefore would seem to be the opposite state of happiness, however, this is too shallow and reductionist an interpretation and limits further thinking around questions of meaning and purpose.

Is psychotherapy about making me happy?

Happiness is an enjoyable feeling but it is just that – a feeling – and feelings are fleeting in that they come and go.  The key to this sentence is that feelings ‘come and go’, or at least, they should.

Psychotherapy is about many things but not least about learning to listen to our feelings and then to think about those feelings.  Neither thinking nor feeling can, on their own, guide us through life.

If we rely solely on our feelings as our navigation system, then we are prone to be reactive and can confuse feeling states that belong in the past, with events occurring in the present.

Conversely, to rely solely on thinking renders us unable to access our inner world and unable to understand the inner worlds, and thus the experience, of others; we become in essence like a version of Star Trek’s Dr. Spock.

Psychotherapy is not about making people happy – in fact, the process of going through open-ended therapy is one that can be immensely difficult and at times painful.  So why do it?  Because it is only through grieving what we have either lost or never had, and then learning to navigate by listening to our emotional world – our deepest desires and wants – that we can start to lead a fulfilling life.  Fulfilled lives should include moments of happiness (I hope many) but most importantly they bring meaning and purpose, which is far more valuable than some fantasy notion of perpetual happiness.

Why depression and anxiety are two sides of the same coin

I stated earlier that many patients/clients present for therapy with symptoms of anxiety and or depression – why is this?  On the face of it depression – a state of deadness, and anxiety – a state of agitation, seem very far removed from each other.  However, both originate from the same cause: the inability of feel alive in the world.

Feeling alive in the world is arguably what a successful outcome of psychotherapy should be – again, not to be confused with being happy.  Feeling alive is being able to feel and to navigate those feelings and make sense of them as signals telling us something important.  Navigating ‘in the world’ is the next step, which is taking those signals, understanding them and converting them into action in the world as it is presented to us.

People who cannot really feel and are too fearful or limited to bring their desires into the world and into their relationships, become stuck and will likely oscillate between depression and anxiety.

Is there an opposite to depression?

I hope that it is now clear that the opposite of depression is aliveness and that aliveness is defined by being in touch with both our inner world, the world of feeling and emotion, and our outer world, finding a sense of purpose and meaning in our community based on what we desire.

‘In our dreams we can have our eggs cooked exactly how we want them.’

Anna Freud, Sigmund Freud’s daughter, and an enormously influential psychoanalyst in her own right, used the above expression to talk about the maturity and courage it takes to take a desire or fantasy (the idea of a plate of eggs) and risk turning that into reality.  Anna’s point was that once we turn a desire into reality it will not be as we expected and so we must tolerate that – ie. once we cook we eggs we have imagined, they will always turn out slightly differently to how we imagined.  They may exceed expectations, they may disappoint, but however they turn out, they will differ to our idea of them.  And so it is with all of our desires: we bring them into the world and we learn to accept that once we set them free in reality we will, to some extent, lose control of them.  However, coming back to Anna Freud, she would argue that a plate a of real eggs is always superior to a fantasy as at least we can actually eat them!

Being in the world, and thus feeling alive, is about breaking eggs and finding satisfaction in the outcome even if it differs from what we expected. This is the opposite of depression.

 

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

Are People with Mental Health Problems Violent?

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

by Leave a Comment

Are People with Mental Health Problems Violent?

The stigmatisation of mental health and mental illness is nothing new and can be traced back through the centuries and across cultures.

Despite much improvement in the treatment of mental illness and an increasingly open dialogue about the effects of mental illness from sufferers and professionals, the evidence shows that paradoxically increasing numbers of the general public fear violence from those who are mentally ill.

What is mental illness?

Whilst the term mental illness is ubiquitous, it is a ‘catch all’ term which fails to differentiate between people struggling with their general mental health, people who struggle to regulate their emotions and the tiny minority who have an actual illness as defined in psychiatric terms.

In its most extreme form, mental illness is an inability to ‘hold’ onto reality and is a terrifying experience for the sufferer – this would be the definition of psychosis. However, as terrifying as this is, there is simply no correlation between violence and mental illness.

Where does this fear come from?

The fear of mental illness seems to be profoundly primal. Human beings pride themselves on the rationality and intellect and to be exposed to someone who has ‘lost their mind’ triggers fear – if it can happen to them, can it happen to me? Losing ones mind can feel like losing the connection with what makes us human.

Periodically these fears are brought back to the surface, often as a direct result of some unfathomable act such as the recent school shooting in Texas where 19 children and two adults were murdered by an 18 year old gunman. How can something like this happen? Who would do such a thing?

Human beings seek to ‘fit in’. We all to a greater or lesser extent abide by the rules and laws laid down by our culture and society. Where we abide by the rules and perform well, society tends to reward us. The rewards are multiple, but are generally related to social standing and financial payment which propels us to continue to do well: fitting into culture affords us self esteem.

Many people who suffer from mental health problems have experienced trauma during their lives – it can be argued all of them. We now know, in no small part thanks for the 1998 ACE study (Adverse Childhood Experiences) conducted by the CDC-Kaiser Permanente, that the more adverse childhood experiences a child is exposed to, the higher the likelihood that they will suffer from mental illness.

However, whilst striking, it was not only their mental health that was likely to be affected, the higher the number of ACE’s, the higher the risk of emotional and cognitive impairment, physical disease, poverty, criminality, social problems and substance abuse problems, all culminating in a higher likelihood of an early death. Trauma therefore impacts on a person in every facet of their future life. Trauma is not caused by poor mental health – poor mental health comes about through trauma, accompanied with the long list of symptoms above.

All human beings harbour thoughts and feelings that we consider to be in conflict to how we see ourselves and how we wish to be seen. Psychoanalysis was the first discipline to start to talk about how we all have sadistic drives, harbour murderous thoughts and take glee in the suffering of others. Psychotherapy seeks, amongst other things, to help people know themselves and to integrate these parts of their character.

However, where this integration has not happened people can ‘split’ these parts of themselves off – as if it simply is not a part of themselves – and ‘project’ them into others: I am ‘good’, you are ‘bad’, or in this case, I am ‘sane’ you are ‘mad’.

I would therefore suggest that much of what drives the stigma around mental illness and the association between the latter and violence is driven by fear leading to the psychological defence called projection. ‘Mental illness’ or ‘mental health’ is a convenient scapegoat for the parts of ourselves that we disavoy.

What can be done to challenge the misconceptions around mental health and violence?

In order to challenge the misconception that people with mental health problems are violent, we need to be able to have a mature and complex conversation about society, trauma and how we are all collectively responsible for ‘othering’: scapegoating and ostracising certain groups of people who are vulnerable. There is correlation between childhood trauma and violence, but violence is not caused by mental illness.

Alongside this we need to use factual statistic to show that simply having a psychiatric diagnosis or ‘suffering from depression’ makes a person no more likely to be violent or to commit a crime than anyone else. What does significantly increase the possibility is childhood trauma, contributing to feelings of low self esteem, a lack of belonging in society, poverty and feelings of disempowerment.

The effects of stigmatising those with mental health problems

Through engaging in an open and honest debate around mental health and mental illness, we can not only support those who are suffering to talk about their experiences and seek help, but also acknowledge to ourselves that we are all in no small part likely to be affected by a mental health issue at some point in our lives. This makes it ‘our’ problem rather than ‘theirs’.

Where people with mental health problems are stigmatised it further alienates them from mainstream society and the opportunity to ‘contribute’ to that society and feel a sense of belonging, purpose all leading to greater
self-esteem.

Stigma and scapegoating leads to shame and shame makes it even harder for people to access help. People with mental health issues need support, compassion (not sympathy) and a pathway to belonging in society. It is no more helpful to pretend that they have no problems than it is to demonise them.

Mental illness is a social problem

As discussed earlier, trauma – particularly childhood developmental trauma – impacts on every aspect of a persons ability to lead a fulfilling, healthy life. And trauma begets trauma, meaning that it is passed from generation to generation. Therefore, rather that scapegoating those with mental health problems, perhaps we need to collectively pause, reflect and look in the mirror to see what sort society we are all contributing to.

 

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

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

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Mental Health Problems in Brighton

Brighton and Hove Psychotherapy, as the name would suggest, is an applied psychology practice located in central Brighton and Hove in operation since 2014. Whilst many of our clients travel from further afield to see and be seen by our clinicians, and whilst we offer online therapy, most of our clients over the years have been from the Brighton and Hove area. As such we are in a privileged position to have a good insight into the specifics of the state of mental health amongst the general population of this city.

Do different cities have specific mental health trends?

There is much in the media being published about the poor state of mental health (and mental health provision in England) at the moment. Years of austerity, the pandemic and soaring addiction problems are fueling a national mental health crisis across the nation. This is no different in Brighton and yet some of the issues that people present for therapy within Brighton will also be an expression of the demographic and culture of the city.

The demographics of Brighton

Brighton is a vibrant city on the south coast of England, within easy reach of London. It has a relatively young, highly educated population, many of whom move here for the lifestyle or have graduated from one of the two universities in the city and made the city their home.

It boasts both the highest proportion of small and medium sized enterprises in the country as well as the most start-ups per capita; both these are testimony to the young, highly educated population many of whom are liberally minded and self-starters.

Brighton considers itself not be ethnically diverse though statistically this is not reflected in the figures with 87% of the population being white. Brighton also markets itself as a ‘hip and happy’ city that is the epicentre of the LGBTQ community, though again, the statistics and perception may mask certain realities.

Millennials and mental health

As Millennials have come of age and are now approaching their thirties and beyond, we are noticing increasing numbers of them presenting for therapy. This is a national trend, however due to the large numbers of young people living in Brighton coupled with their education and entrepreneurial spirit, we see many Millennials presenting for open-ended psychotherapy to use as a relational tool to get deeply curious about who they are and what they want from their lives.

Whilst everyone who crosses the threshold of a psychotherapy practice has a ‘presenting issue’, these Millennials will often stay in therapy for a long time to engage in a depth relationship in with to get in touch with their deeper desires. They are often extremely bright as a population group and well-versed in psychological concepts. This in contrast to my own generation – Generation X – who consume the most alcohol and drugs of any generational group and will often only present for therapy once they reach crisis point (a generalisation, but true nonetheless).

Drug and alcohol use

There is a saying in Brighton that nobody who lives here is actually from Brighton. Of course this is a complete exaggeration, however, the city does attract a lot of ‘migrants’ from other parts of the UK as well as beyond. It is liberal and open at heart and, as already discussed, has a young demographic. It is therefore not surprising that drug and alcohol use and misuse is at the highest rate for the South-East of England and one of the highest for the UK. Indeed, back in 2011, Brighton held the disconcerting record for being the drug-death capital of the UK.

Another saying that seems to go some way to defining Brighton is that it is a ‘Peter Pan Town’ where nobody wants to grow up. This would be the ‘shadow side’ of its fun, hip culture in that the city and its culture can draw people into an ongoing cycle of ‘living for the moment’ and avoiding the realities of life.

Psychotherapy has many goals but one is that it is about growing up psychologically – working though past losses and moving with purpose towards what you want. Peter Pan, beneath his boyish charm, was someone who was frightened of the future and of adult responsibility, but unlike Peter Pan we all must grow up as otherwise life simply passes us by.

The LGBTQ community and feelings of not belonging

Brighton prides itself on inclusivity and this is reflected in the size of the LGBTQ community. However, as with everything, there is also a shadow side here and over the years myself and colleagues have worked with individuals who identify as LGBTQ but feel no sense of belonging in the Brighton community, or worse still, feel ostracised.

There is prejudice everywhere and some research has shown that minority communities can unconsciously exhibit higher levels of prejudice towards others who do not meet the criteria of ‘their community’. This is not unique to the LGBT community nor to Brighton and has been observed in racial minorities who have been seen to express higher levels of racism towards other minorities that is present in the general population.

To what extend the above is ubiquitous in Brighton lies beyond the scope of this piece, however, I have had numerous clients over the years who felt that they ‘did not belong’ in the Brighton LGBTQ scene and who found this enormously difficult and painful as it had been one of the reasons why they moved here. They felt that the way they were ‘gay’ or ‘lesbian’ was not accepted.

We all need a sense of community and belonging and it can be extremely painful if we intentionally move to a place to be a part of a wider community with whom we identify on a profound level, only to find that the way we are in that identity is not accepted.

Cities are communities and communities are collectives of people who, through their unconscious process, create a collective unconscious that’ has an identity to it – so it is with Brighton.

Psychotherapy is a relational process embedded in culture and thus practicing as a psychotherapist in Brighton, the specifics of the community will both be expressed and need to be worked with.

 

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

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

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The Limitations of Online Therapy

Online psychotherapy is not a new concept; it was around before the pandemic and successfully used as a medium for delivering psychotherapy, counselling and coaching. However, what is new is how nearly all of us were obliged to work online to maintain continuity of sessions for our patients and clients during lockdown and how ubiquitous it remains. It is clearly here to stay but does that mean that in-person psychotherapy is a thing of the past?

Online psychotherapy brings with it some advantages over seeing a psychotherapist ‘in the flesh’ such as:

  • Access to a wider pool of clinicians;
  • Less time consuming as no travel is required;
  • Some people may find it easier to ‘open-up’ online rather than in person.

Like many psychotherapists, during the pandemic I had to abruptly move my whole practice online and together with my clients adapt to virtual sessions. Now at the tail-end of the pandemic the world is a different place and yet I have found that the vast majority of my clients have of their own volition decide to return to in-person sessions. I have explored this with them and below is a synthesis of some of the limitations of online psychotherapy and why, I believe, it will never replace in-person face-to-face sessions.

Psychotherapy is a body to body communication

Though often referred to a ‘talking therapy’ psychotherapy is much more a ‘listening therapy’ and the clinician is trained to listen in a very particular way – to what the client says as well as how they say it.

More than half of our communication is non-verbal and is a combination of tone and delivery in conjunction with body language. With online therapy much of the latter is lost due to the limitations of what can be seen on screen. But there is another reason why it gets lost – online psychotherapy is ever so slightly ‘out of synch’. It is almost imperceptible (most of the time) but there is a slight lag between the delivery of the sound and the delivery of the image which makes for a disconnect between the spoken and unspoken. And whilst almost imperceptible to the conscious mind, it gets registered by the emotional system.

Psychotherapy as re-parenting

Everyone who crosses the threshold of a psychotherapist’s consulting room is bringing with them unresolved experiences and patterns from their childhood. Many of the patterns are laid down in the formative years of bonding and dictate our attachment style. And because they were laid down between birth and around 2 years of age, they are non-verbal (and unconscious).

Psychotherapy is about working with these patterns – often referred to as ‘working in the transference’ – to understand how the client ‘does’ relationships; in this sense it is a process of re-pare helping the client to feel safer and more secure in relationships and in expressing boundaries.

The transitional space – travelling to therapy

Travelling to sessions in person can be time consuming and with today’s fuel prices, expensive. However, the travelling aspect has an important psychological function as it operates as a transitional space between the ordinary world and the unique world of introspective psychotherapy.

In online sessions I have often found that clients can be distracted as they have literally just ‘left work’ and entered my virtual consulting room – they have no given themselves time to make the journey to psychotherapy and it can then often take a significant part of the sessions for them to arrive.

Likewise, I have had clients who have scheduled work meetings immediately after their online therapy which can act as a powerful prohibitor to allowing themselves to ‘be in therapy’ as “I don’t want to get upset because I have a meeting with my boss”.

Lastly, when clients visit my consulting room in person, I am responsible for most of the physical boundaries. Clients know where they will be sitting, where the furniture will be positioned and this will remain the same week after week – it is part of be providing a consistent experience. Seeing a psychotherapist from home may mean that the space feels less safe with other members of the family in the same home or just simply having daily distractions around such as a picture of the family on the desk next to the monitor.

Psychotherapy is about making contact

Starting psychotherapy in any realm can feel like a daunting prospect. Coming into a consulting room, which is the domain of the psychotherapist, is a brave step.

Clients have often sat on my couch and mused or fretted about what to talk about. I generally sit in silence as they try and find their words as, to me, what they say is often less important than why they are telling me. If a client tells me anything they are telling me something about themselves that they feel is important and that they want me to see as important – often we need to figure out together why it is important but we generally get there in the end.

Therefore, psychotherapy is about ‘coming into contact with another’ – taking a risk to be seen and heard. Whilst this can be achieved to some extent online, nothing can be a substitute for in person contact where two bodies are in the same room and in communication and contact with each other.

Until we start raising babies and infants over virtual connections and can do so successfully – which is neither desirable nor remotely possible due to our physiological and psychological make-up – face-to-pace in person psychotherapy is not going anywhere.

 

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 –

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Parental Alienation and the impact on children

by Leave a Comment

Pornography and the Online Safety bill

Having just come off a phone call with the Child Sexual Abuse and Exploitation Policy Lead, my thoughts have been drawn to the enormity of the problem we face with pornography and the ‘pornification’ of society, particular the world of young people.

Pornography use has become ubiquitous and normalised to the extent that increasingly the world of pornography seems to influence and infiltrate wider society through body shape, appearance, hair removal, sexual behaviour, dating, all the way through to the core of our identity.

From my perspective as a clinician, I have no particular moral take on what consenting adults do behind closed doors and indeed, it is my job to hold curiosity about this as with any other aspect of my clients’ lives.  It could be argued that pornography falls into this category.  However, whilst I have no particular moral take on (some) aspects of pornography (consumed by adults), I have a strong healthy perspective on the issue much like I do on the consumption of alcohol for example.

A person may choose to live their life drinking a bottle of wine per night.  Other than this they don’t negatively impact society, they maintain a job and pay their way in the world.  However, I would hold a health perspective on this issue and whilst as a lay person I am as aware as anyone else about the physical health risks of excessive alcohol consumption, I believe that in my role as a psychotherapist I can claim an expert position on the mental health impact of excessive alcohol use extending to the wider social context.  And so it is with pornography.

It is easier for anyone to access pornography via the internet than it is to buy alcohol.  At the very least, alcohol must be physically purchased and paid for whilst porn is free – in the monetary sense.  However, I believe that what seems free to consume is in fact a Faustian deal in which the consumer sells their soul – in this case their mental and emotional health.

It is also extremely disturbing and concerning that it is easier for children to access pornography of virtually any description than it is for them to be able to access alcohol.  Let’s be clear, I am not advocating children have access to alcohol, however surely it should be at least as well regulated and policed and the risks considered? To date, the impact of pornography use by children, teenagers and young people has been vastly underestimated and as a mental health professional, I and my colleagues see the fallout of this.

We face a pornification of society whereby the young now trade in sexual pictures of each other and sexual acts that would until very recently have been considered ‘fringe’ at best, have become normalised such as non-fatal strangulation.  The effects of this pornification of our young is leading to enormous self esteem issues, relational problems and mental health conditions such as eating disorders, depression and anxiety.

As a society we therefore need to safeguard children from child abuse – and to be clear, permitting children to view pornography constitutes child sexual abuse.  The online safety bill aims to do just this – it is imperfect and won’t solve the problem in that legislation can never solve social ills, however the first port of call is to safeguard children and then a more nuanced consideration of the insidious effects pornography is having on society can take place.

Psychotherapy is about relationships and at its core it is about helping clients to have a healthy relationship with themselves and others in a two-person world.  Pornography is by its very nature perverse – it is narcissistic and is about voyeurism and exhibitionism rather than relating.  It is therefore by its nature in conflict with the very essence of the psychotherapeutic journey and a healthy society.

 

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 much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

 

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Does the sex of my counsellor or psychotherapist matter?

A question I have often either been asked or has come up up is whether the gender of the clinician matters (or should matter) to the client?

The answer, as with most questions relating to the intricacies of psychotherapy is not categorically ‘yes’ or ‘no’.  However, the question opens up other questions which may themselves be more interesting such as, what are your beliefs about psychotherapy and why should the sex matter?

To start with, there are clearly cases and instances where it is entirely appropriate for a patient or client to want or need to work with a therapist of a particular gender.  Aside from the fact that this may simply be the wish of the client (and therefore to be respected) valid reasons may include a history of sexual abuse by one gender leading to the client feeling safe with the other gender (often their own).

However, if we drop beneath the obvious, the question takes on more of a philosophical slant and how it is answered gives much insight into what a clinician believes about psychotherapy – let me explain.

There are many ‘schools’ of psychotherapy and many methods, however most of these have more in common than they don’t and secondly, most clinicians are to a greater or lesser extent ‘integrative’ in that they use different models in their clinical work.  The greatest distinction, or divide, perhaps lies in whether or not a method, and thus a practitioner, believe in unconscious process or not (and spoiler alert – I do profoundly).

As a psychoanalytically informed psychotherapist, I work with the unconscious which means to say that I take very little on face value and work with my clients to understand why they think, behave and act in the way they do; in other words, how is their past experience influencing their perception of the present without their knowledge.  Through therapy the past can be uncovered, worked through, grieved and its hold on the present reduced.  This frees clients up to make informed and thought through choices based on their reality as it really is now rather than where they were previously stuck.

Those who don’t believe in the unconscious (namely behaviourists or person-centred therapists to name a couple) take things on face value.  They do not believe in unconscious process and work very much in the ‘here and now’.

How does the unconscious link to the sex of the therapist?

Those of us who work with the unconscious will, to a greater or lesser extent, work with transference – that is, work with whom we represent to the client in the room.  And whom we represent will invariably be one of the client’s caregivers, usually a parent.

Transference is very similar to projection, which is something we all do at times – we ascribe values to a person based on prior assumptions rather than on the reality of who they are.  The difference with transference is that the clinician, if trained well enough, will receive the client’s projections and be thinking about who they are (represent) for the client.

Freud believed (and rightly so) that transference occurs irrespective of gender/sex.  We will therefore ‘transfer’ our unfinished business relating to either or both parents onto the therapist.  This too is my experience as I work in the transference and so recognise that how the client relates to me tells me something important about how they learnt to relate as a child and I can represent their mother just as easily as their father in the transference.

Therefore, whilst in some cases the sex of the therapist may matter, in most, it does not.  And I believe that has also been my clients’ experience over the years whereby they may have had a preference in working with a female, have ‘ended up with me’ and we have done excellent work.

 

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

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Parental Alienation and the impact on children

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

by Leave a Comment

How much time should I devote to self care?

In this blog I explore the concept of self care – what it means and how much time you need to consciously devote to active self care per day: it is probably less than you think!

What do I mean by self care?

In basic terms, self care refers to ‘looking after oneself’. Some people really struggle with the basics of this and once external factors such as poverty have been eliminated, good basic self care correlates to good mental health.

People struggling with depression can find it really difficult to undertake tasks such as getting out of bed in the morning or getting themselves to work.

People with anxiety can struggle with focusing, controlling their thoughts and feelings and in holding onto a thinking mind.

And people who are dealing with eating disorders can struggle to eat for healthy reasons using food to suppress difficult feelings (obesity) or retain an illusion of control over the body (anorexia).

And people who struggle with bulimia can struggle to ingest ‘bite size chunks of life’, instead feeling flooded by others and eventually having to vomit it al out.

These are all real and serious mental health problems and psychotherapy is there to work through what set up these coping patterns and to bit-by-bit help people to better manage their emotions.

The 50 minute hour

Most psychotherapy session are of the duration of what we in the trade call ‘a psychotherapy hour’, which is in fact 50 minutes.

Good psychotherapists stick to the hour and do not overrun as this is unhelpful for the client – it demonstrates poor boundaries and a lack of self care on the part of the therapist.

Over time, clients must learn to keep the therapy and their therapist ‘alive’ between sessions; they must learn to bridge the gap from one session to the next. This means internalising their psychotherapist and thereby holding themselves in mind outside of the therapy room in the way their therapist does. This is where the shift happens from dealing with the presenting crisis (depression, anxiety etc.) to more sophisticated methods of self care.

Psychotherapy is not enough, but it is essential

It is not enough to simply attend therapy and then expect miracles to happen- they won’t.

By bridging the gap between sessions, clients hold themselves in mind and can become curious about what else would be helpful to them in living calmer, more fulfilling lives.

At first bad habits may get dropped – staying up late on work nights, drinking a glass of wine or two every evening, eating junk food – and then a shift can occur to an active engagement with good habits.

These are in addition to living a calm and ordinary life and are constitute self care that is aimed at good mental and emotional health (arguably good physical health too).

Examples may include yoga, meditation, dancing, singing, walking, swimming, meeting friends for connected conversation and so on. The list is virtually endless providing whatever you engage in is mindful (you are present with what you are doing) and leads to sustainable and enduring good feelings afterwards.

Can you spare 4% of your day?

Imagine if all it really took was 4% of your day to make an enduring and significant difference to how you felt and felt about yourself? Well, this is arguably a good figure (and achievable figure) to aim for and guess what? It is only one hour of your day!

So, on days when you are not in therapy, how about spending one hour actively self caring by mindfully engaging with an activity (or activities) that makes you feel alive, positive, brings you into you body and sets you up for the day?

Dedicating one hour per day to self care is a good way of bridging the gap between sessions and in devoting the weekly therapy hour to active self care on the other six.

 

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

Why is Netflix’s Squid Game so popular?

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

What is the purpose of intimate relationships?

by Leave a Comment

Why is Netflix’s Squid Game so popular?

If you haven’t heard of the phenomenon that is ‘Squid Game’ then you either have not got Netflix, or are asleep. However, for those of you who haven’t, here is an extremely brief synopsis:

Squid Game is set in modern day South Korea and is a dystopian nightmare of a game whereby the wealthy and entitled prey on the indebted and vulnerable in society through enlisting them into a ‘game’ based on Korean children’s games, however, where the contestants are killed if they fail or lose each round. Beyond the set design and superficial concept, the characters are ubiquitous and the finale relatively predictable. What really stands out on this series is firstly the astonishing level of macabre violence and secondly, how popular it has been as a global phenomenon.

Narcissism by another name

We are all fascinated by car crashes hence why it is not uncommon to witness secondary crashes alongside the scene of the first, as distracted drivers fetishistically scan the crash rather than watching the road (commonly known as ‘rubber-necking’). Squid Game does a good job of drawing viewers in with its almost limitless supply of violent deaths.

However, Squid Game is more than a mere car crash, it is a carefully choreographed and scripted example of extreme narcissism.

Dystopia or a social commentary?

Much has been made of how many of the elements of Squid Game reflect the social and income inequalities present in Korean society and there may be some truth to this.

Indeed, social and income inequality, when rampant, is a product of narcissism, where fellow humans are considered inferior or less than others.

However, to suggest that a series in which literally hundreds of people are murdered and psychopathology and sadism are the norm, is some sort of social commentary, really is an enormous stretch.

So is it a dystopia? Orwell’s 1984 was a critique on a dystopian future as was Huxley’s Brave New World. Squid Game is pure and simply gratuitous horror and violence for the sake of it. Nothing more nothing less.

What is narcissism?

Narcissism gets a bad rap, and whilst pathological narcissism is arguably responsible for many of the ails of the world, narcissism is on a spectrum.

Healthy narcissism lies in the middle of a spectrum between two extremes: one where a person cannot hold themselves in mind, and the second, where a person cannot hold anyone else in mind.

Healthy narcissism is one of the goals of successful therapy – to help clients hold themselves in mind whilst not losing sight of the individualises and thus the needs of others. The therapist holds the client in mind and becomes ‘an other’ to the client.

In Squid Game, the world is one wherein nobody can hold themselves in mind nor can they hold anyone else in mind. Holding oneself in mind means being able to think about the consequences of behaviour and choices on oneself and others. This is therefore extreme narcissism.

One person universes

Pathological narcissism – those with either strong traits or narcissism or narcissistic personality disorder – is a developmental arrest. Those afflicted are, in all but age and body, as sophisticated in relating as your average two-year-old child.

Young children have to learn to relate, which means learning to live in a world of others. And living with other means not only tolerating difference but also trying to imagine the mind of another – empathy. This is the core of relating and sadly, whilst being strongly narcissistic is a serious developmental deficiency, it is ubiquitous through every level of society. Pathological narcissists live in one person universes where everyone else is either a reflection of them, or against them; nobody else is therefore real.

So why, in the end, are so many people watching and commenting on Squid Game?

As with pretty much everything in life, there is no one single answer. It is, on face value, novel (though the fundamentals of the plot and characters are in fact hoary); it is ‘foreign’ and so brings ‘novelty’ from the usual Hollywood slasher films; whilst in my view it does not reflect society here or in Korea, it is perhaps an outlet for the anxiety we all feel resulting from the impact of the global pandemic.

It is an unwitting study in pathological narcissism and sadism – something we are perhaps all fascinated by: to relate is hard work and the regressive fantasy of the small child in us all is that it would be easier to simply ‘use’ others for our own means. What the fantasy negates is the crushing emptiness and shallowness of the narcissist: it is lonely to live in a one person universe.

On balance, perhaps it maters little why Squid Game is such a phenomenon – social media has made many vacuous memes popular, principally because they are distractions. However, there may just be a paradox at play here: it is popular because in watching what others watch and commenting, we are trying to feel a sense of connection and belonging.

Ultimately, perhaps the question should be is it worth watching? No more so than any car crash we may encounter in going about our lives. It is twisted and perverse and reflects back to us the worst of what humans are capable of.

 

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

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

What is the purpose of intimate relationships?

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

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Parental Alienation and the impact on children

Separation or divorce are painful, difficult and time consuming processes and more so where children are involved. Few couples manage to amicably separate and sadly, this applies to couples who have a child or children together too.

Although it may seem obvious, my experience is that couples who are separating and have children often fail to recognise that they in fact will always have a relationship with each other as parents of the same children. Whether this is openly and maturely acknowledged as in the case of couples who co-parent, or not, as in the extreme case of parental alienation, there remains, nonetheless a relationship.

What is Parental Alienation?

Broadly, parental alienation occurs when a child becomes hostile, fearful and generally unwilling to engage with one parent as a result of the either the psychological manipulation of one parent or, more often, the toxic relationship between both parents. It is extremely damaging to children and can lead to mental health issues including self harm and suicidal ideation.

Parental alienation is on a scale from a parent making negative remarks about the other parent, or one parent ‘forgetting’ their responsibilities on relation to their child (an agreement to pick them up etc.) through to psychological manipulation and control.

The child as centre stage

Whilst the process of separating can be extremely painful and difficult, it is critical that parents find a way to establish a working relationship in co-parenting their child. This starts from the point of agreeing together the narrative they are going to tell their child about the separation through to long-term parenting commitments. The role of psychotherapy. Experienced couple’s psychotherapists are able to work with a couple to move beyond their
grievances and establish a framework within which they will work together to fulfil the same job: raise their child and create emotional stability for them.

The impact of divorce on children

Society and parents tend to enormously underestimate the impact that separation and divorce can have on a child. For children, their entire stability is predicated on the stability of the parental unit and when this gets rocked or shaken to its foundations, the impact on a child can be enormous.

Studies have been undertaken measuring the impact of divorce on children and in many cases the psychological impact can be greater than losing a parent through death. The reason is because, generally, when a child is bereaved, the other parent (along with the broader family and society) enables the child to grieve a very tangible loss. With divorce, and especially where the split is contentious, children often feel they need to ‘pick a side’ and are unable to grieve the loss of the parental unit.

Top tips to focus on when separating and a child or children are involved –

  • Separate out grievances towards each other about the end of the relationship and your job as parents;
  • Agree a narrative that is age appropriate to tell your child about what is happening;
  • Reassure your child that you continue to both be there for them;
  • Avoid displays of conflict in front of your child;
  • Recognise that you NEED to put your child first and that all children want two parents and would prefer their parents to stay together;
  • Allow and facilitate the grieving process for your child.

 

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

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

What is the purpose of intimate relationships?

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

by Leave a Comment

Space: The Final Frontier of Manic Defence

As a boy I was fascinated by space travel. I remember being glued to the television set with awe as the Space Shuttle blasted off into space back in the early 80s – I was born after the epic Apollo programme came to an end and was just the right age to appreciate the engineering accomplishments in launching the Shuttle, without having fully lost my sense of wonder and amazement at the idea of man (and woman) going into space.

In recent years and months it seems a new type of space race has emerged – one that for me lacks much of the romance of the Apollo and even the Shuttle programme and instead halls of something very different indeed. I am referring to the race which seems to be be the vanity project of three of the richest (one middle-aged, and two bordering on elderly) men – Bezos, Branson and Musk.

What drives them?

Well, I am a good psychotherapist but cannot mind read. Nonetheless, there is some commonality between the three which I shall cover further on in this piece. What we can easily derive is that what drives these men has very little in common with the values and ideologies behind the original space race between The United States and The former Soviet Union.

The original space race was about many things but none more so than an affirmation of superiority over the other. Superiority in the space race meant, symbolically, superiority as a culture. Why does this matter? Culture, it can be argued from an existential perspective, is fundamentally religious in nature in that it provides us all with a mechanism be become ‘heroic’ and belong. Culture, whether the so called ‘primitive cultures’ of the world through to the now globally dominant Western culture all have three things in common : a story of how we got here, rules on how to behave whilst we are here and lastly, and perhaps most importantly, a story of what happens after we die. This is ostensibly why ever war ever fought is a war of one culture against another or, put more purely, one religion against another whether Christianity versus Islam or Communism versus Capitalism (or Freedom, as the Americans like to call it).

Bezos, Branson and Musk all share the reality that they have immense and almost infinite wealth. However, whilst this wealth is currently propelling them towards space like modern day space cowboys (a reference to Bezos’ cowboy hat attire after his space trip), they share something even more concrete than their wealth and it is something they share with the rest of us: no matter how wealthy, they are hurtling towards their own finitude (death) just like the rest of us and this renders them anxious.

Existential anxiety

Existentialists have long argued that to feel anxious is to be human; that our very being is defined by a knowing anxiety as we are, as far as we can discern, the only species on the planet who has such a profound awareness of our being that we also know we are going to die. This is unbearable for us and so we invent ways in which to stave off death anxiety – back to the raison d’être of culture.

Bezos, Branson and Musk all live on the same planet as the rest of us mere (financial) mortals – a planet that is reaching its limits on almost every level: we are fast running out of space, clean air, clean water and temperature ranges that provide liveable conditions for us and our animal cousins.

However, to engage with this is deeply anxiety provoking, not just for billionaires but for all of us and to contemplate the planet’s finitude is to be reminded of our own finitude.

A flight from death

Imagine how much good could be done with the combined wealth of these three individuals on this planet: third world debt could be resolved, huge investment created in renewables, diseases eradicated and so on. However to do this it would mean living within the constraints of reality – within the context of finitude. It would mean that each of these men would have to accept that despite their billions, they are mere mortals who are going to die.

Manic defence

A manic defence is a process (unconscious) that humans employ to distract themselves from uncomfortable truths, thoughts and feelings. It is, if you wish, the polar opposite of depression, where one is consumed by negative thoughts and feelings and nothing possible can be accessed.

It is a normal developmental process for infants to pass from a state of denial and splitting to the depressive position whereby reality, with all its disappointments, can be tolerated – not the same as clinical depression.

Whilst the latest wave of space travel is couched as progressive and future orientated by each of these billionaires, in reality what seems to be emerging is simply an expensive and highly polluting contest from see whom has the biggest ego (or other appendage if one is to reference the phallic shape of Bezos’ rocket ship). And what are they offering the world? The ‘opportunity’ for others who are wealthy, but slightly less so, to invest in this egotistical immortality project by becoming ‘space tourists’.

The little boy in me dreamt of space and the idea of being a space tourist. I now am firmly (and uncomfortably) rooted in the reality in accepting my own finitude and that of the planet we all share. Perhaps if the three protagonists in question had spent just a little of their fortune on a curiosity in exploring their inner ‘space’, they would be more able to tolerate actual reality themselves and rather than resorting to mania to defend against existential angst, find culturally heroic ways of making a difference and leaving their mark.

 

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

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

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

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