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Client or Patient; Patient or Client – Does it Matter?

A topic of certain difference, and at times discussion in the field of psychotherapy, is whether we refer to those we treat as ‘clients’ or ‘patients’.

Why might this matter?

On the face of it, it should arguably matter little to someone attending psychotherapy, as to what the therapist calls them on paper; in the room they will be referred to by name and thus, to some extent, the nomenclature used is academic.

However, psychotherapy is about how the psychotherapist thinks about the person who engages their services and this thinking will inevitably influence how the psychotherapist refers to those who come to see them and vice versa.

Why such different terms?

Psychotherapy was born out of psycho-analysis. And in both classical and modern psychoanalysis, as well as in the language of many psychoanalytical psychotherapists, the term patient is commonly used.

Historically, this is derived from Freud’s use of the term, whereby he situated psycho-analysis firmly in the medical field.

There is an additional term that is used in analysis which is ‘analysand’ – the person who goes for analysis. Whilst it bridges the gap between client and patient, I find it somewhat clunky and it is not a valid term to use in psychotherapy.

Who is the expert?

Much progress has been made in the field of psychotherapy to shift from a ‘blank-screen’ model on the part of the psychotherapist, to a relational approach – meaning broadly that the psychotherapist plays an active role in co-constructing the relationship and works within the context of the relationship to bring about change.

Many in the more humanistic field argue that one of the goals should be to bring about as much equality between the therapists and ‘client’, so as to eliminate the power imbalance.

Whilst a noble endeavour, I think this is naïve, as firstly, we are are there in an expert capacity and those of us who are trained and work at depth, understand that we carry an enormous burden of responsibility to those who engage our services. We are therefore, not equals.

Secondly, depth psychotherapy, using a psychoanalytic model, works with what the client or patient ‘projects’ onto us – something we refer to as transference. In the transference, we inevitably represent one of the parents for the client and it is arguable that the treatment process in psychotherapy is one of re-parenting.

Parents and children are never equal

I believe that roles come with firm boundaries – many of which are frustrating. For example, it is a parent’s role to always be a parent to their child. This role will evolve and change over time and eventually there will be two adults in the relationship, however, this does not imply that there are two equals. Part of the frustration of being a parent (and the child of a parent) is in acknowledging the firm boundary, meaning that a parent should not become a friend to their child, no mater the age of that child. This does not mean that this does not happen in some families, however, I view this as unhelpful.

The therapeutic relationship between a psychotherapist and their client or patient is sacrosanct – as should be the relationship between parent and child. We are there in an important, and at times, critical capacity and co-create with those who come to see us a deep intimate relationship that must be alive, messy, creative, conflictual, loving and hateful – but always and forever boundaried.

Boundaries frustrate but facilitate grieving

Over the past decade of being a UKCP registered psychotherapist, I have seen a fair few people come and go from my practice. Most have stayed for years and, I believe, done some very good and important work.

As in life, the relationships we form with those whom we see week after week matter to us and I have grieved with the end of the work and having to say ‘good-bye’ when treatment ended.

The grieving is necessary as, irrespective of how much we have come to matter to each other, I shall always be in the role of psychotherapist for all of my former patients. Most will never cross my threshold again, however, it is vital that they can hold me in mind in the role they assigned me and that I don’t deviate from that position and ‘befriend’ them. Whilst this may feel seductive to both sides (as it does for a parent and child), the boundary enables the relationship to work and continue working in the capacity it must for the patient.

On why I use the term ‘patient’

I have shown my hand in the previous paragraphs in using the nomenclature of ‘patient’ and shall now explain why I have, over time, shifted in my way of thinking.

Patients come to me because they are in distress. I am there as an expert, not to tell them how to live their lives, but to help them understand how and why they live their lives they way they do and offer them a stable and secure relationship through which to bring about change.

Psychotherapy is about change – it is not about enabling existing behaviour and this needs to be agreed between therapist and patient.

I view the term ‘client’ as representing a grey area when it comes to boundaries – with clients we can ‘have a chat’ and maybe take the relationship outside of the context in which it began. It also seems to me to be very transactional. This is a personal view and not an accusation of anyone who has a preference for this term.

My work as a psychotherapist is to ‘treat’ my patients. I am accountable for understanding their minds and helping them find a way through their distress. If they knew how to do this, they would not need me.

Lastly, rather than being a distancing term, I view ‘patient’ in this context of one towards which I can show the upmost respect. It does not imply, to me, that I am better than them, but it does show that I am willing to take on the responsibility for my part in their treatment and that the boundary will always hold. For me it is ultimately a term of ‘love’, in the way Freud meant it.

 

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

 

Further reading by Mark Vahrmeyer

How to minimise Christmas stress if you are hosting

Can couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

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The Psychological Impact of the Recession

So we are officially in a recession in the UK. And not just any recession, but ‘the longest ever recession’ is predicted ‘since records began’. The word ‘recession’ is one that fills most working-age adults with a sense of dread, only further exacerbated not only by the suggestion that it will be ‘longer’ than ever before, but that it comes off the back of a couple of extremely anxiety provoking years thanks to the global pandemic. Will there be any respite for us all?

Our nervous systems have evolved to protect us from threat and very good they are at it too! We experience increased levels of anxiety and vigilance when our nervous system locates anything in our surroundings that may be threatening to our existence. For centuries, this would involve the literal threat to life resulting from the risk of becoming food for a wild animal or the victim of an attack by a neighbouring tribe. However, the world that most of us now live in is, fortunately, not punctuated by wild animals prowling around us or a neighbouring tribe mounting an attack. This is not to say that there are not dangers around us, but the risk of imminent death has unequivocally reduced as a result of multiple factors such as the rule of law, healthcare and our dominance over nature. Our nervous systems just don’t seem to have gotten the news.

Anxiety, which is the predominant emotion we feel when initially under threat is unlike other emotions in that it seeks to attach to an external event (rather than always being triggered by an external event). Thus, our ancestors would have an underlying level of anxiety they would navigate the world with and invariably when they felt a threat their anxiety levels would shoot up and they could appropriately respond to the threat. The same process happens with modern humans, however, the anxiety we feel is now often unhelpful when facing ‘modern threats’ as these, whilst real, are not imminently life threatening and even if they do represent a sort of existential threat – like a recession may – they are not something we can run from, fight, freeze up against or fawn; these are the four options our nervous system presents us with when we feel under extreme threat.

The psychological impact of the news of a recession can be similar to that of the psychological impact our ancient cousins would face when confronted with a sabre tooth tiger. And this stops us being able to think things through calmly. We then become reactive rather than able to take action.

What can you do?

I am no financial adviser and it is important to remember that each and every one of us will be impacted differently by economic events such as a recession, just as we are all impacted differently by all other events happening around us. But what I do understand is the human nervous system and anxiety.

Firstly, remember that ‘The News’ irrespective of the outlet, is designed to grab your attention – much like that sabre tooth tiger sticking its head out of a bush and into our face. News headlines are designed to sell newspapers, or in the modern world, to get ‘clicks’. This does not mean that it is ‘fake news’ but the devil is in the detail, not the headline. Take time to read the whole article and digest what it means. Think about whether you will actually be directly impacted and if so in which ways. Then you can take the time to take action methodically.

Remember that recessions are a part of the ordinary cycle of an economy and that each time one has arrived, it has once again passed and followed by a period of growth. People are affected but again, like the headlines, the news will report these effects from a ‘newsworthy’ perspective, rather than as a balanced view or perspective on society as a whole.

Limit your exposure to too much ‘news’ even though you will likely be drawn to ‘consume’ more.

This is human nature – your nervous system has signalled that this is a threat and so you are inclined to gather as much information as you possibly can. However, a recession, unlike a marauding tribe, is something that is approaching slowly and will also unfold slowly in relative terms – you do not need to get into a panic.

Focus on helpful ways of managing your anxiety such as taking time in nature, sharing your feelings with friends, practicing mindfulness, doing exercise or anything else that both brings you into your body, into the ‘here and now’, and calms your nervous system. Why is this important? It’s not about denying reality – on the contrary, it is about calming you enough so that you can once again think and if you can think you can make plans, rather than simply react to the news.

It is also worth bearing in mind that at present, what you are reading about the recession is a prediction. In other words, not may not be as bad as predicted or pan out quite as predicted.

We have all, collectively, got through the pandemic and coped with the anxiety of the unknown – the virus – that we all faced. This is likely to be the same.

 

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 couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

How do I find the right psychotherapist?

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Why do People Watch Horror Movies?

Horror as a genre of ‘entertainment’ has, I would suggest, always been a part of the human experience, as it is through this collective narrative that we give shape and form to a world in which we have very little control. Long before movies existed and extending back to before the written word, our early ancestors would ‘invent’ super-natural beings with whom they would do battle in story and ritual. Why?

Anxiety

Human beings are inherently anxious beings. One can argue that this anxiety has come about as a result of two facts: the first being that until very recently we had good reason to be anxious as much of nature and the animals and plants in it posed an existential threat to us – only the anxious survived.

Secondly, and perhaps more psychologically relevant, is the suggestion that humans are the only animal who is conscious, self conscious, hyper conscious. What fundamentally makes us stand out from other animals is our ability to project our minds into the future which renders us capable of planning and achieving great feats, however, also brings us into brutal contact with the knowledge that we are destined to die. We are therefore in the impossible position of being able to largely shape our destiny (providing we don’t get eaten by a wild animal) only to face a certain death at the end of life (if we are lucky), or potentially at any moment. This renders us anxious in nature.

Humans use all sorts of methods and means as individuals and in groups to manage their underlying anxiety such as having children and building a career, through to subscribing to a culture (being British), that provides constituents with shared answers to cosmological questions – where have I come from, what happens after I die? So how may this apply to horror?

It has been noted that more than half the population enjoys watching horror as a genre. What is specific to this group is that they tend to score high on neuroticism which, amongst other characteristics, is denoted by high levels of anxiety.

When we think of anxiety as being the price we pay for our consciousness, and we consider that humans are always trying to somehow manage their anxiety, the draw to horror movies becomes a little clearer, particularly when considered in conjunction with the events of the past couple of years.

Why are we collectively watching more horror movies?

As a collective global society, any notions of safety and security were suddenly taken from us in early 2020 by the emergence of a virus that swept the world. We were all required to remain at home, stay away from work and consider friends and loved ones as ‘high risk’ and potentially contagious. For our nervous systems this represents a horror movie in itself! The problem is that it unfolded far too slowly for us to ‘attach’ our anxiety to it and then let it play out over 90 minutes.

Watching horror as a locus of control

I would suggest that one of the prime reasons that horror has become so popular over the last couple of years is that it represents a vehicle onto which those who already have a disposition to using horror as a means of evacuating their anxiety through projection, to do so by ‘projecting’ the anxiety of the unknowns generated by the fallout of the pandemic, into something tangible – a movie.

Psychologically horror movies may also function in a pseudo-ritualistic manner, in the way a dance or group ritual may have worked for our ancestors to gain mastery over their world – even if only in fantasy. The themes in horror movies are primal and archetypal in nature – they represent what lurks in the deepest recesses of our minds – and what we once imagined lived behind every tree out in darkness as we cowered by our campfires with mere sticks and stones to protect us.

Horror movies represent the ultimate battle of good versus evil and as it is a battle that plays out on screen we feel activated in the way our ancestors did when facing real and imagined dangers, however, it provides a locus of control to the viewer in that they are choosing to feel anxious and embark on the quest they experience playing out in front of them.

I therefore do not believe that horror films represent a conscious desire on the viewers part to confront their fears about the real world ‘head on’ but rather that it is a displacement activity whereby anxiety can be expelled in a socially sanctioned and safe manner. It is a method and means of gaining mastery over unbearable feelings through experiencing them safely.

Life imitates art, as the expression goes, however art is first and foremost an expression of the collective experience (the collective unconscious), and so as long as our collective experience is dominated by the horror of the pandemic and war and other existential threats, then I think it likely that horror, as a genre of art, will continue to be made and consumed at a higher rate as a way of us coping with our anxiety.

 

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 couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

How do I find the right psychotherapist?

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Is starting psychotherapy a good New Year’s Resolution?

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

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

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

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

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

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

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

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

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

New Year Reflections

How psychotherapy works

What is psychotherapy?

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Five Top Tips for Surviving Christmas Day

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.

What makes Christmas particularly difficult?

Aside from the expectations we put upon ourselves, it has all the classic ingredients of being either an explosive disappointment or a damp squib.

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 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

  • 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’.

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.

 

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

Can couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

How do I find the right psychotherapist?

by Leave a Comment

How to Minimise Christmas Stress if you’re Hosting

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

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

Think about your own needs first

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

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

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

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

Wants vs needs

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

Hosting does not mean sacrificing yourself

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

Support through relationship

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

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

Reality Testing

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

The past is not the present

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

Alcohol generally makes things worse

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

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

Listen to your body

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

 

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 couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

How do I find the right psychotherapist?

by Leave a Comment

Can Couples Counselling Fix a Relationship?

Most people enter into couples counselling when their relationship has got problems. These problems can take the form of a crisis, such as an affair, or be more chronic, such as a loss of intimacy between a couple over a long period of time.

What does it mean to ‘fix’ a relationship? The word ‘fix’ would suggest that something is broken, and in some instances this is indeed what may have happened, such as where one party in the couple feels their trust has been broken.

It may seem instinctive to want to simply ’fix’ a problem when one arises, however, more often than not, the problem is a symptom of a deeper issue that may need addressing.

Couples counselling can be invaluable in making sense of the problems in a relationship and in coming to understand each person’s perspective. This in itself can improve the dialogue and communication between the couple and make whatever decisions they need to make easier and more empathic. Couples counselling is a process of facilitating dialogue and empathy between a couple, but it does not have any investment in whether a couple stay together or not.

The idea that couples counselling is not invested in whether a couple stays together often comes as a surprise. However, the process works with the desires of the couple – which can often be in conflict – and it is contingent on the couple working out whether they indeed wish to continue with the relationship – essentially to ‘fix it’ – or whether they would be better separating.

As stated, most couples enter into the process of couples counselling as they are in a crisis and they are unable to have a dialogue that enables them to constructively find a way forward.

Couples also enter into couples counselling in order to make use of the facilitating element a trained professional can bring to a complex conversation. For example, it is not uncommon for couples to enter into couples counselling after a significant event such as a life changing illness, a child leaving home or a change in career. The facilitated environment can create a felt sense of safety for the couple to explore ideas and options relating to their future which otherwise may become inflammatory without the stability that a third person can bring – a little like the stability that
comes from adding a third leg to a two-legged table.

If a relationship has hit a real crisis and a couple present for couple counselling, then it is likely that your counsellor will work with you to both explore why the problem arose as well as to work through the feelings that each member of the couple feels. Even in the case of an affair, some degree of responsibility is likely to lie with both members of the couple, even if only one has strayed.

Therefore, rather than the onus being on ‘fixing’ a relationship, perhaps a more realistic approach is to see couples counselling as a process through which intimacy can be re-established and trust built whereby each member of the couple is willing to see the other’s perspective. At times, as painful as it may be, a successful outcome of couples counselling can be a conscious uncoupling – a decision to separate on friendly and kind terms.

One thing is for sure, if one or both parties feel that a relationship is ‘broken’ the way forward is rarely to try and ‘fix’ it the way we might a broken object. Instead it is to see whether something new can be born from what has gone before – and it may just be that something much more intimate, much stronger as a relationship, can rise from the ashes.

 

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 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, 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 either the UKCP or BACP and who can evidence significant clinical experience in the field.  Both of these professional bodies have helpful websites which enables users to search for clinicians based on location, as well as other criteria.

Once you have a list of 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 (BACP or 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.

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?

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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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