Mark Vahrmeyer Blogs - Page 2 of 9 - Brighton and Hove Psychotherapy

Is there a good way to break up with someone?

December 11, 2023 by BHP 4 Comments

Why do some of us feel a constant sense of dread?

Feeling dread is dreadful

A constant or pervasive sense of dread is an almost unbearable experience. Rather than being a feeling, it tends to manifest as a bodily experience that comprises a cluster of symptoms such as a heavy feeling in the pit of one’s stomach, a sense of agitation, fast heart-rate and strong feelings of anxiety. It is also possible for the sense of dread to tip over into a panic attack.

Firstly it’s important to understand that all of our emotions and emotional states (which is what a sense of dread is), have evolved for a reason. For example, it is totally normal to feel a sense of dread when you are in mortal danger, or someone you care deeply about finds themselves in such a predicament. The dread is then comprised of a set of feelings that are arising in response to reality – we are in mortal danger and helpless. However, for most of us we rarely if ever find ourselves in such a position so the dread does not really belong in the here-and-now.

Therefore, there must be other drivers that rather than being external, are internal and are being projected onto the outside world.

What causes this constant sense of dread?

Regular feelings of dread that are either constantly there, or triggered by relatively minor events, are linked to high levels of anxiety. People who are anxious tend to experience the world around them as a place that is threatening and they unconsciously spend their time searching for ‘evidence’ of this.

Anxiety

Anxiety is both an emotion and a part of our temperament – meaning that it constitutes ‘who we are’ as a person. Our levels of anxiety in relation to the world come about through a combination of both nature and nurture interplaying with each other and it stands to clinical reason that a child born and raised to an
anxious parent, will themselves likely experience higher levels of anxiety. We know this from studies with Holocaust survivors and their children and grand-children who often show higher levels of anxiety than the general (un-traumatised) population – in other words, anxiety can be hereditary.

Self-hate

There is a second reason why some people experience a pervasive sense of dread which is not mutually exclusive in relation to high anxiety levels and that is self-hate, which we in the mental health field refer to as paranoia.

Self hating people have a self image that is completely unlovable and unworthy and therefore being able to rely on good things and good relationships is not only inconceivable, but highly anxiety provoking – they will get taken away at any moment.

Life is filled with uncertainties, however, as most of us can rationalise, generally the problems that we encounter in life turn out to be resolvable and are not evidence of anything other than an ‘ordinary life’ being lived.

We can therefore say that the fundamental cause of dread (which is amplified anxiety directed out into the world) is a fundamental hatred of the self and a core of shame.

What can you do to manage feelings of dread?

As self hatred/disgust is felt to be an identity, it is not something that can simply be resolved overnight, however there are certain steps you can take to manage this and combat its debilitating effects.

When we are highly anxious, it is very difficult to think – and the same of course applies to a state of feeling a strong sense of dread.

Getting some perspective – Move away from what is causing you to feel the dread and instead focus on being present in moment to moment activities and ideally those that situate you in your body such as walking or exercising.

Reality test – Once you have calmed your nervous system a little you can start to think about the real likelihood that the dreaded event is going to be catastrophic.

You can work through ‘if’ scenarios such as ‘if I don’t get this job, what will actually happen?’ Some events such as The Climate Crisis are causing people to feel a lot of anxiety and for those who have a pre-disposition towards self hate, this can tip over into dread. What can be helpful is to distinguish between what you can control and what you can’t and then to focus on what you can control – such as getting involved with some form of awareness raising or activism.

What’s outside is actually inside – work on differentiating between a ‘felt state’ and the outside world. We all have feelings about others or events that are ‘projections’ meaning that they are derived from our own inner world, or working model of life, and then super-imposed onto an other person or event. By working on developing a helpful dialogue with ourselves, being compassionate that we are feeling anxiety and dread but that it is not evidence of anything bad, can be very helpful.

Would would someone else think? – If we are able to imagine that much of our dread is a form of self hate projected outwards (paranoia) then we can ask ourselves what someone else might think and feel in relation to the event we are facing – would they feel dread and would they imagine it is going to be a catastrophe? We can then use this to challenge some of our own faulty perspective.

If you can talk about how you feel and what you imagine might happen, your friend may be able to help you reality test in sharing their perspective with you.

This has a two-fold set of benefits: we reality test and we are in relationship with another and when we are in relationship and able to share how we feel, we feel calmer and gain some perspective.

Working through underlying feelings of self hate that manifest as paranoia and anxiety towards the world is not an easy thing to do and this is where talking with a psychotherapist can be extremely helpful. A psychotherapist will work with you to slowly dismantle this faulty self-image you have of yourself and through the therapeutic alliance, help you build a more solid sense of self and healthy self esteem.

Further reading by Mark Vahrmeyer

Can self help become an identity?

Can Self-Help become an identity?

November 27, 2023 by BHP Leave a Comment

Is there a good way to break up with someone?

Breaking up with someone is hard to do. Often we feel a degree of ambivalence about our own emotions and our instinct is to both find the easiest and fastest way of ‘just ending it’.

Whilst this may seem seductive, the easiest and fastest way is often more likely to cause conflict and to leave us feeling ‘unresolved’ about the ending.

I believe that it is possible to end a meaningful relationship with another whilst holding ourselves in mind and essentially being ‘selfish’. I often refer to being ‘selfish’ (with a small ‘s’) in my consulting room as being the act of first and foremost holding ourselves in mind whilst not dismissing another’s experience.

Even good things must end

The first step in holding ourselves in mind is to bring an end to the relationship. If you have made up your mind then this represents a ‘hard boundary’ and is not one that can be negotiated.

The second step is to think about how you want to feel after the break-up. This is another step in being selfish in that you are thinking about your own sense of integrity and self esteem. If you are ending a relationship with someone you have cared about and the ending is a ‘no fault ending’ then it is unlikely you will feel good about yourself if you simply ‘ghost’ them.

Accepting different emotions

If your partner is not expecting the relationship to end, it is likely they will have a very different emotional response to the news than yours. Whilst this may feel uncomfortable, it is entirely natural and providing they do not verbally or physically attack you nor try and make you feel responsible for their emotions, they are allowed to have their emotional experience.

I would suggest that relationship endings should always be done in person and in private. It can be tempting to create distance when initiating a break up – such as ending things via text message – but this is far more likely to cause a ‘messy’ ending than by meeting with the person. By meeting in private it gives you both the opportunity to say what needs to be said and importantly feelings to be felt, without the discomfort of strangers witnessing your relationship coming to an end.

When we are uncomfortable about delivering a message that may hurt another, we can have the tendency to try and ‘soften the blow’ by using gentler language, however, this can backfire as the person receiving our message may hear this as a sign of hope and fail to recognise that the relationship is truly over. Clarity is ultimately kinder to you and your partner.

Being compassionate does not mean staying when you want to go

You can empathise with your partner’s feelings of shock, hurt, disappointment and sadness without backtracking on your decision or making yourself ‘wrong’. Remember, they are entitled to their emotions and you are entitled to yours.

I would recommend being boundaried with the time you spend delivering the message and thinking about where the balance lies between delivering what you have to say compassionately and sacrificing your needs. Perhaps plan in advance how long you will spend talking to your (ex) partner before leaving and creating some distance.

If your partner is able and willing to have a dialogue with you then you can discuss how you will approach letting your sider family and social circle know about the break-up and agree a narrative you both can adopt.

If possible, cut off all contact following the break-up, so as to allow space to grieve and start to move on. You can think about this in advance of your meeting and I would suggest that a minimum of a few months can be a helpful period of time to grieve some of the rawer feelings.

Let’s be friends…

Don’t commit to being ‘friends’ at the break-up. Whilst this again may feel seductive, neither of you know how you will feel about the other once the dust has settled and you have grieved. You may be able to be friends or you may not. The romantic relationship needs to first come to an end and only in time will you know whether any form of platonic relationship is possible.

Recognise that even though it is you who has initiated the break-up, this does not mean that you will not feel grief and need to give yourself time to let go of the relationship and your now ex-partner. Getting used to the ‘space’ left in our lives after a break up – a shift emotionally from ‘we’ to ‘me’ – can take time and feel uncomfortable. The inclination can be to ‘fill’ that space with dating, however, this rarely works out well and is a way of avoiding the grieving process.

Further reading by Mark Vahrmeyer

November 13, 2023 by BHP Leave a Comment

Can self-care become an identity?

Barely a day goes by without self care and specifically mental health being talked about in the media. And with this the long-standing taboo around men’s mental health is finally dissipating and more and more men are both willing to talk about their struggles and to admit the benefits they have got from accessing psychotherapy. But is there such a thing as over-indulging in therapy?

Is psychotherapy self care?

In a word ‘no’. If someone were truly capable of self care they would not need to be in therapy.

So what is it then?

Psychotherapy is generally a lengthy process of meeting on a regular basis with a skilled clinician where the focus is on building up a specific type of relationship through which unconscious processes and relational patterns of the patient can be worked through. Many of these stem back to childhood and can end up repeating in the present in maladaptive relationship patterns, however, this does not mean that the purpose or goal of psychotherapy is to treat the patient as a victim and simply blame their parents.

Ultimately, depth psychotherapy is a process of coming to terms with reality, mourning what has been lost and finding a way to build a life of meaning and purpose in that reality – it is about growing up psychologically.

There are plenty of other self-help approaches, some of which may work well alongside traditional psychotherapy, such as developing a mindfulness practice for example, whilst others have no bearing on psychotherapy or may be obstructive to the process. It is through psychotherapy that patients learn to have
a different relationship with themselves and thus learn to self care.

One of the realities of psychotherapy, which in my view mirror the realities of the world, is that there is no one single answer on how to live a life. This is something an individual must discover for themselves and arguably, this is only possible through a suitable childhood environment or failing that, a subsequent therapeutic relationship.

TikTok knows best!

There is a trend which is being amplified by social media to take complex psychological concepts and distil them down into binary positions, which is at best unhelpful and at worst extremely misleading. One of these is the concept of ‘trauma’. Trauma as a term has become ubiquitous in popular culture and has become a substitute for a more nuanced narrative around complex emotions and feelings, as well as being used by some as a ‘trump card’ to play in order to justify a position of entitlement or shut down another’s argument.

Trauma is very real and has both physiological and psychological markers that any clinician worth their salt and training is able to understand, evaluate the degree of trauma and their clinical ability to work with it.

However, what most people in popular culture seem to define as trauma is better described as something evoking a strong feeling – distress, rage, grief etc. These are not trauma responses – they are ordinary human emotions. If someone is regularly having a trauma response – like dissociation – this is a serious mental health
condition and I would strongly suggest they seek psychotherapy.

Human beings are able to become obsessive about almost anything and therefore as a clinician I would focus less on what they are obsessing about and more on whether something is an expression of desire, an interest or an obsession. Self-care practices that are no exception and some people can become obsessive about rather than simply focusing on living a full and meaningful life.

Can self care become obsessive?

Obsessions tend to develop as a defence against underlying anxiety. It is a way and a means to try and gain a sense of control when feeling out of control.

Therefore, if someone is obsessing about some self care ritual at the expense of other healthy elements of their life such as socialising or relaxing, I would suggest that it has ceased to be a healthy focus and is instead being used in the service of trying to manage uncomfortable feelings.

And obsessing about your therapist?

When people first come onto psychotherapy it is not uncommon for them to idealise their psychotherapist somewhat. They may finally feel that they have someone alongside them who really understands them – this is a very powerful feeling and it is therefore understandable that they may ‘wax lyrical’ about their therapist.

The role of a psychotherapist is not to tell someone how to live their life and nor is it to be perfect for the patient. Therefore, if this process of idealisation persists, I would suggest that they are either not in good psychotherapy (the therapist in question is promoting this idealisation and positioning themselves as some sort of ‘guru’) or being in therapy is being weaponised to shut others down on the part of the patient.

Psychotherapy focuses on relationships and those who engage in depth psychotherapy tend to become interested not only in why they do what they do but also in those around them. In other words, it helps people to develop empathy. And when we are able to feel and express empathy we are cognisant and mindful of the experience of others who are in our company.

Can self care become self obsession?

I would suggest that someone who focuses all their time on ‘self care’ and negates the experiences of others in favour of talking about themselves and through weaponising either psychological terms or their actual therapy, is behaving in a narcissistic way.

Narcissistic people are self obsessed and self absorbed and are unable to imagine the mind of another – nor do they care to. Now, paradoxically, the treatment for narcissism is depth psychotherapy, but it takes time and empathy is not developed overnight. And truth be told, relatively few narcissistically structured people present for psychotherapy, though they do often engage in all sorts of pseudo-therapies where their fragile egos will not be exposed.

Further reading by Mark Vahrmeyer –

September 18, 2023 by BHP Leave a Comment

Can psychotherapy help narcissists?

In my last two blogs on the topic of narcissism, I have covered off what narcissism is (and is not), and provided my perspective on whether we are, collectively, becoming more n arcissistic.

In this final blog (for now) on this topic, I shall offer my perspective on the commonly asked question of whether psychotherapy can help narcissists? As with pretty much every question relating to mental health and psychotherapy, the answer to this seemingly simple question is ‘it depends’.

First off, what is mean by narcissism? Has the person in question received a diagnosis of having a narcissistic personality? And if so, by whom?

The clinical definition of narcissism is one that differs significantly from how the term has been hijacked and is now used in popular culture. Clinicians are far less concerned with outward behaviour that pop culture seems to label as narcissistic and instead think about how the personality of the patient is organised. We are all capable of selfish and inconsiderate behaviour at times, however, this does not mean that we all have narcissistically structured personalities.

I shall not revisit the detailed clinical definition in this blog as for those of you who are interested, you can read more here. However, in summary, someone who has a narcissistic personality style ‘scaffolds’ their sense of self through constant external validation. They therefore have a very fragile sense of self – of who they really are – and instead define themselves by their purchases, conquests or achievements. How most narcissists portray themselves to the outside world (and to themselves) is in direct contrast to how these folks feel on the inside – insecure, inadequate and unlovable.

There is a second type of narcissistic personality which is generally overlooked and often misdiagnosed and that is the deflated or collapsed narcissist. On the face of it deflated narcissists seem to be the opposite to their grandiose counterparts in that they present as depressed and as if nothing they have ever done is any good. However, unlike people with depressive personalities, deflated narcissists are filled with a sense of rage and injustice that they have not been afforded the life and opportunities they believe they deserve – in other words, their internal world is grandiose and consumed by fantasy, whilst externally they seem collapsed.

OK, so now we know what we are dealing with, I can return to the question of whether narcissism can be treated?

The successful treatment of any patient in analysis or psychotherapy is dependent on that patient’s desire to change. As treatment unfolds, it often becomes clear to the patient what change involves and that all change on a structural level is slow and painful. Whilst many people successfully engage with psychotherapy, most if not all harbour a secret wish that change can happen without them actually having to change! This is generally an even stronger fantasy in the world of the narcissist.

Unlike other conditions, people rarely if ever present for therapy because ‘they are narcissists’ – after all, why would they? They are not the problem – everyone else is!

As long as the narcissistic person’s defences (systems of external validation) are working, then they simply will not see that there is a problem. If someone with a narcissistic structure does attend therapy it is either because their defences have failed and they want help putting them back in place, or they have reached an age (usually middle-age) where they realise that the quality of their relationships is limited to non-existent and they want to understand why. The latter is the hopeful position.

In clinical language, there are couple of formulas that enables us to evaluate how successful psychotherapy is likely to be for someone with a narcissistic personality: firstly, how rigid is the personality – the more rigid and towards the realms of personality disorder, the less likely treatment will be successful; secondly, whether there narcissistic personality is combined with elements of psychopathy (anti-social personality). Where someone has a strong combination of narcissism and anti-social traits (or sadistic traits) then treatment outcomes are very poor.

Assuming we are dealing with someone who has a dominant narcissistic personality, but one that is neither too rigid nor mixed with sadism or anti-social traits, then there is hope.

The two approaches

There are two main schools of thought in the psycho-analytic community around how best to treat narcissism which were put forward by two of the main thinkers in the field – Kohut and Kernberg.

Kohut proposed that because what has been lacking in the narcissistic patient’s childhood was an empathic and attuned parent who could see the child’s needs, the work should therefore focus on an empathic and attuned approach of validating the patient’s feelings and working to enable the patient to both bear their ordinary vulnerability as well as to combat their shame about having emotions.

Kernberg, who it has been argued focuses more on the pathological end of the spectrum, takes a more confrontative approach to the narcissistic patient and advocates (in the context of a robust therapeutic relationship) the need to challenge the perspective of the narcissistic patient and to push them to consider the experience of those with whom they are having a relationship. Kernberg’s theory centres around challenging the narcissists central tenet that everything and everyone revolves around them.

So which is right?

The correct approach to treating a patient with a narcissistic personality will be tailored to that patient by the clinician – just as it is for every patient.

My perspective on treating patients is that where there is genuine will on the part of the patient, treatment outcomes are often successful.

Psychotherapy, whether for someone with a narcissistic personality, or indeed any presenting issue, is a courageous endeavour. What brings most of us to therapy is a need for change and change is frightening and painful.

Whilst it is a part of my role to assess and evaluate whether a patient is suitable for psychotherapy, I do this from a clinical and ethical position, rather a moral one. If I cannot help someone, or believe therapy will exacerbate their symptoms or push them into psychosis, I have a duty to not take them on and to refer them for other treatment.

Narcissism, contrary to TikTok and other social media platforms, is not a trait that can be diagnosed just on how someone behaves or treats us. Often it takes a fair number of sessions before I fully understand that someone is developmentally stuck with a narcissistic personality that dominates. However, as long as they want to attempt to enter into a relational world of others then I believe there is hope.

Further reading by Mark Vahrmeyer

August 14, 2023 by BHP Leave a Comment

Are we becoming more narcissistic?

We are living in the age of narcissism – or so the media would like us to believe. People in The West seem to be focussed largely on themselves and the pursuit of happiness – the answer to which for increasing numbers of the populace is to be found in the soundbites of TikTok celebrities or from the wisdom of other social media ‘influencers’.

But are we collectively becoming increasingly narcissistic and what does this mean?

In my last blog I dispelled some of the myths around this condition and explained rather than it being a description for a set of behaviours, it is a personality style and in its more rigid manifestations, a debilitating one from a relational perspective. I shall therefore not be revisiting all that again and you can read my in-depth blog on what narcissism actually is here.

The argument that behaviour tells us anything much about a person’s personality structure – particularly when it comes to narcissism – is naïve and reductive.

Changes in behaviour online

We know that people behave differently in online interactions as compared to when they are face-to-face with another human being. It is the actual, as well as the perceived distance, from the other’s humanness that seems to give many licence to behave in selfish and thoughtless ways.

Whenever we cease to view the other as human and objectify them, we are not acting relationally as the very word ‘relational’ implies a willingness to understand another’s perspective and to be able to tolerate difference, even if we don’t much like their views.

Is modern man (and women) less able to tolerate differences than prior generations? I am not so sure. What I do know is that the internet, and specifically social media, provides platforms to both those who rather like the sound of their own voice (but arguably have little actual wisdom to impart) and it provides a huge scope for attracting an audience.

Where not so long ago an individual may have believed that they held the key to a successful life (whatever that means), they may have attracted a few lost souls in their tribe, village or town. Now, with expert ‘curation’ of their message and image, they can reach the whole world.

On narcissistic personalities

Behaving in a selfish or egocentric way does not mean that someone is a narcissist. Certainly narcissists can be grandiose, self-centred, entitled and enjoy the sound of their own voice, however we can all at times behave in this way.

Narcissism is a personality style, and we all have a mix of personality styles, generally with one or two that dominate a little more than others. If someone has a narcissistic personality then this particular style of personality is dominant and can be viewed on a continuum (of rigidity) from pathological through to personality disordered.

In psychoanalytic theory, clinicians view these personality styles as being primarily laid down by our early infant and childhood experiences (generally up to around the age of two).

Someone who has a narcissistic personality has not been related to as a separate individual but rather has learnt from a very early age to adapt their behaviour to the needs of their caregiver. In essence, they have internalised the message ‘do not exist’. As a result of learning that their role is to meet the needs of others (their primary carers), the child in question develops a ‘false self’ to compensate – they present a front to the world suggesting that they are perfectly fine.

Beneath this front is a vulnerable child who cannot show his or her feelings for fear of abandonment by the parent. For narcissistically structured people, others – relationships – are a major problem. They need others, however, they also profoundly fear being used or ‘taken over’ by others and so to defend themselves by objectifying those around them. Relationships are about doing or being done to, rather than love.

How might this apply to the collective?

My sense is that it is unlikely that there is now a sudden increase in parents who are failing their children and raising narcissistically structured personalities. However, as the old adage goes, ‘it takes a village to raise a child’ – no child is solely influenced by their parents.

The clinical research would suggest that we are not becoming more narcissistic in terms of personality style, however, what has exponentially changed are two major factors: we have lost collective meaning because the world is changing too fast for us to cultivate and uphold meaning, and secondly, technology is playing an all encompassing role in dehumanising us.

The role of meaning

Human beings are meaning making creatures and we live in a symbolic universe which is probably what renders us unique amongst animals. I have previously written a piece on the role of Culture and the need for belonging in enabling us to have healthy self esteem, which you can read here.

Essentially, as traditional values and means of making meaning either fall away or are dismantled, we are left with two problems: higher anxiety and less collective means of gaining self esteem.

This may then cause us to both behave in more individualistic and hedonistic ways to feel alive but without substance – we deny our vulnerability by becoming more narcissistic.

The role of technology

We are at the start of a technological revolution where only our imagination can predict what the world, and by extension, our relationship to it and others in it, will look like.

Technology is not intrinsically good nor bad – it depends on how we use it. And to date how we have used it is in a rather dehumanising fashion. Convenience has trumped connection and this can be seen in the proliferation of parasocial relationships (where we have relationships with influencers or YouTubers and believe they are real and personal, when they are in fact one-way), and the evolution of dating through online apps whereby we have commoditised ourselves.

On the symbiotic relationship between Echo and Narcissus

The origins of narcissism were taken, largely by Freud, from the 2,000 year old myth written by Ovid. This Greek myth – a myth being a story that reflects a collective truth – is entitled ‘When Echo meets Narcissus’ and whilst most people are to some degree familiar with the myth, it is often misconstrued: many believe that Narcissus fell in love with his reflection in a pool of water; And few even know of the role of Echo.

Narcissus is someone who is admired by all and who cannot tolerate intimacy. Echo, meanwhile, is a river nymph whose voice has been taken by Juno, the Goddess, for gossiping. Echo can therefore only repeat the last words she hears.

This is how the stage, and the symbiotic relationship, between Narcissus and Echo is set both on the myth and for all time: Narcissus needs Echo just as much as Echo needs Narcissus but neither can have a relationship with the other – they are in symbiosis.

Returning to the question of whether technology and specifically how online relationships are being shaped is rendering us more narcissistic, if it is it is, it also rendering us more like Echo – willing to sacrifice our voice to be in the shadow of those we admire; we believe that there is a relationship happening but there simply is not.

Narcissistic people need echoists; we are collectively responsible for admiring those who need to be admired rather than having something of substance to offer. Human beings are adaptable to our environment – it is why we have been able to colonise every corner of the globe. Equally, we absolutely need relationships, as we are shaped and formed not only in childhood by relationship, but throughout our lives.

My view is that as a result of a combination of both a loss of meaning and the ease of online interactions, we dehumanise both ourselves and others and thus become more narcissistic, or at least egocentric. However, unlike those with true narcissistic personalities, it is reversible and as a clinician I know only too well the power of change that comes from a therapeutic relationship.

Further reading by Mark Vahrmeyer

What is a narcissist?

Client or patient; patient or client – does it matter?

July 3, 2023 by BHP 2 Comments

What is narcissism?

Since the time of Sigmund Freud, clinical terms around psychology have made their way into everyday language. Narcissism is no exception to this and yet it stands in a category of its own for both how ubiquitous it has become in popular culture, alongside also being so misunderstood.

Frequently used as a term of insult or abuse to describe someone who displays little regard for others, narcissists are defined in society by their outward displays of behaviour. However, for a ‘condition’ that evokes so much of a backlash, collectively we seem to secretly admire the fantasy life we attribute to narcissists and envy the way they glide through life unaffected by the trials and tribulations of us mere mortals. Narcissism and narcissists are envied and denigrated in equal measure.

Alongside the ubiquity of the term, there is no shortage of material available to enable us to navigate a world filled with narcissistic others. From podcasts to YouTube seminars, TikTok videos to old fashioned books, narcissism is everywhere. Many titles suggest an extreme danger or risk of being near or around narcissists with titles such as ‘surviving narcissism’, ‘narcissism epidemic’ and ‘defeating narcissism’ being common. And yet most of these resources fundamentally fail to understand the essence of narcissism and what constitutes a so- called ‘narcissist’.

Indeed, it is interesting that of all the personality styles, such as depressive or obsessive-compulsive, it is this personality style that has become a label for the entire human being: rather than having a narcissistic personality, people are simply labelled as narcissists.

Popular culture
In recent years few clinical terms have been adopted and taken on a life of their own outside of the clinical context above and beyond narcissism.

When popular culture references narcissism or labels an individual as narcissistic, this is generally based on witnessed behaviour, rather than on any deeper understanding of what may have driven that particular behaviour. Popular culture is not wholly to blame for this as the field of mental health has for years been steadily shifting to diagnosing and labelling based predominantly on outward behaviour, rather than from an understanding of personality dynamics.

The problem is that the word that in a clinical context is used to describe traits or the style of a person’s whole personality, is being used as a description of behaviour – ‘he is behaving really narcissistically’ – which may or not have anything to do with the person’s personality; the behaviour tells us very little. In fact, I am not really sure what ‘behaving narcissistically’ even means!

It is not that there is no truth to the ‘watered-down’ formulation of narcissism in the mainstream, it is just that like so many other mental health terms, the nuance and balance has been lost, not least in the context of the ‘narcissists’ experience of being this way. Fundamentally, what’s lost is empathy.

Narcissism is not an illness, it is a personality style
I would suggest that the psychoanalytic field provides us with the most accurate understanding of narcissism and its impacts, as rather than focusing on external patterns of behaviour, psychoanalytic theory considers both the inner world of the patient – what it is like to be them – and their relational world – how do they relate to themselves and others. In other words, when clinicians talk about narcissism they are referring to a particular type of personality that has ‘narcissism’ as its dominant style.

What is a personality?
Personalities are something we all have and whilst we generally have a mix of styles, most of have a dominant one. So, when we consider somebody’s personality style, we are thinking about what trait is dominant and how rigid their personality is – this can be imagined as a scale from healthy functioning, through to personality disorder (and just to further muddy the waters, there is little agreement on at what point someone is personality disordered).

However, there is a further complication when considering narcissism: narcissism like all more dominant personality styles, one that has come about through relational injury during the first two years of development. It rarely appears in isolation to other personality styles and the other main personality styles frequently, if not always, show elements of narcissism in their foundations. It is therefore not always easy to spot.

What are the traits of a narcissistic personality style?
Most people who have a narcissistic personality present outwardly as grandiose, entitled, selfish and are constantly looking for external validation. However, what presents externally as grandiosity belies an internal world characterised by a deep sense of inadequacy and fear.

People with narcissistic personalities fear ‘being found out’ – they fear intimacy and vulnerability as they imagine everyone will see what they see: that they are unlovable.

There exists in the narcissist a constant drive to shore up their fragile self esteem through the external world – what they buy, who they are seen with, what they achieve. Whilst we all garner external validation to some extend in these ways, most of us have a solid enough sense of self to hold onto a real sense of self esteem that does not need scaffolding.

When it comes to relationships narcissistic people face an enormous dilemma as they desperately need others – to both tell them how wonderful they are, as well as to avoid their primal feelings of abandonment. However, they cannot relate in a two-person manner, meaning that whilst they need greatly, they love shallowly.

Narcissistic people protect themselves at all costs against ‘narcissistic injury’ which comes about when their feelings of shame are triggered. And feelings of shame arise when narcissistic people are challenged or called out – it is unbearable for them and they respond with shame which is transformed into rage. This holds the key to why narcissistic people cannot have real relationships: they cannot content with difference which is what we encounter when we are in a real relationship with another ordinary complex human being.

There is one other ‘type’ of narcissistic style which often gets missed in clinical diagnoses and that is the depressed, or collapsed, narcissist. On the face of it this person would seem to be the opposite of the grandiose narcissist and this is in fact correct! However, what looks to be collapsed, depressed and an outward expression of worthlessness, hides an inner world where this character feels utterly entitled to far more than they have and are. They are rageful that the world has treated them in this way and secretly feel entitled to specialness.

Final thoughts
Narcissim is a complex topic to grasp and even clinicians often struggle to fully make sense of whether someone if a narcissist or not.

One of the problems is that people with this structure tend not to present for psychotherapy and if they do it is never because they feel ‘narcissistic’. It is therefore not a condition that is in their awareness.

There are no dependable tests to check for narcissism and just because someone behaves in selfish or egocentric ways, it tells us nothing about their personality structure – after all, can’t we all be selfish at times?

Ultimately, a skilled clinician works out through the therapeutic relationship whether someone is narcissistic. It is a combination of understanding the clinical theory as well as relying on their felt experience. Being in relationship with a narcissistic personality does not feel like an ordinary relationship. They may greatly need you or ‘brush you aside’, or a combination of both but what they cannot do is relate in an equal two-person manner. Their vulnerability and humanness is hidden for fear of shame and abandonment – the narcissistic injury.

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

Client or patient; patient or client – does it matter?

June 19, 2023 by BHP Leave a Comment

The medicalisation of mental distress

The foundation of the paradigm shift in how we now view mental health, or as I prefer to consider to consider my field, emotional distress, is one where the problem is increasingly located in the individual as a disorder, rather than in the environment that the individual finds themselves.

The inception of this paradigm in thinking began with the publication of the third version of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) produced by the American Psychiatric Association (APA) which had a specific focus on meeting the needs of a wider clinical audience in the field of mental health. It was never specifically intended as a guide to clinical treatment and despite the introduction of specific clinical categories, there was an assumption that prior clinical wisdom across the field would endure, however, in practice it was the clinical categories that took precedence.

In no other field of medicine – which is the direction that mental health has taken – is symptomatology clustered together as it becomes fundamentally unreliable and invalid in understanding what may bring about a syndrome, condition, or as the DSM prefers to refer to it – a disorder.

For example, how mental health disorders are clustered is based on symptoms and were this to be replicated in the field of physical medicine, we would have groupings of ‘fever disorders’, ‘limp disorders’ or ‘headache disorders’ – an idea that would be absurd and yet is the basis for psychiatric classification.

The reality is that there is no consensus in psychiatry about what exactly causes ‘disorders’ and yet the list of disorders continues to grow with every revision of the DSM and with it more and more ‘disorders’ become both labels and terms of abuse in popular culture – after all the problem is now firmly located in the individual. We have seen an explosion of disorders from around 106 in the 1970’s through to 365 in the latest incarnation of the DSM (DSM-V)! And, not only has the number of disorders increased exponentially, but in parallel so too has the bar been lowered at which point a patient qualifies for having a particular disorder.

In clinical practice we now see the normalisation of these disorders with patients using disorder terminology to ‘self diagnose’ so rather than presenting for therapy with a statement such as ‘I notice that I feel very shy in social situations’, we are increasingly presented with statements such as ‘I have social phobia’. The problem with this is that it can serve to eradicate curiosity around why a person may feel shy in certain situations and inherently positions them as ‘wrong’ rather than suggesting a position of openness towards how this may be adaptive behaviour learnt during childhood.

Under pressure

The profession of psychotherapy is increasingly under pressure to comply with this new world of diagnostic criteria in that the language has been adopted by general practice in medicine, public health and by insurance companies. The latter meaning effectively that patients cannot get psychotherapy sessions reimbursed without a patient meeting the criteria for a disorder.

Arguably what has underpinned this shift in the field of mental health is how the sector has responded to meeting the needs of the economy, rather than those of the sufferers. The focus of public mental health and overarching classification system for psychiatry has shifted from being patient centred to being directly linked to economic productivity.

An example o this is how in the UK, The NHS’ mental health initiative ‘Improving Access to Psychological Therapies’, now renamed Talking Therapies for Anxiety and Depression has its foundations in getting people back into work. Whilst there is nothing intrinsically wrong with a drive to enable people to return to the workplace, in many instances it is a normal human response to environmental stressors that lead a person to feel anxiety or depression. This is the crux of the schism – are mental health disorders located in the individual and therefore indicative of a failing or are they responses to the external environment?

Suffering has been turned into a commodity

The problem is located in the individual rather than seen as an adaptation to past or present environment. This eliminates both a capacity for curiosity as to cause and blame – a person simply has a disorder. From a macro systemic perspective governments can provide a health service that treats’ the problem in the individual rather than consider how societal issues lead directly to emotional suffering – mental health problems.

Secondly, the industry that benefits from the drive towards specific disorders located in the individual is the pharmaceutical industry, which, despite there being little to no evidence of increased efficacy in psycho-pharmacological treatments over the past 40 odd years, This question pervades all types of emotional suffering and the past well-trodden path of linking emotional suffering with a broader and deeper developmental, social and economic narrative is being cast aside in favour of a diagnostic super-highway with disorders based on symptoms and neat psycho-pharmacological solutions. Essentially the invitation is to disconnect the threat response from the threat; to increasingly shift away from asking ‘what’s happened to you?’ to simply ‘what’s wrong with you?’

Further reading by Mark Vahrmeyer

Client or patient; patient or client – does it matter?

May 15, 2023 by BHP Leave a Comment

What is belonging and why does it matter?

I was recently invited onto the Podcast ‘Conversations with Annalisa Barbieri’ to talk about the topic of ‘Belonging’.

The discussion centred around our mutual experience of growing up in cultures that were not of our families of origin. Annalisa is technically a ‘second culture kid’, and I am a ‘third culture kid’ – the latter meaning I spent my formative years in a country other that that of my parents or where I was born.

The focus of our conversation was on belonging and whilst a rich discussion, we were limited by time and the need to keep the discussion relevant to a broad audience.

In this blog I am going to (briefly) explain why I believe how ‘belonging’ is absolutely essential to not only our emotional and psychological health, but beyond that, critical to our very existence. And how it is under threat.

I have in previous blogs written about primary belonging which we refer to as attachment, and so I am now primarily approaching the topic from a more anthropological perspective.

My premise is that if we do not have a strong sense of belonging then there is an inverse correlation with the amount of (death) anxiety we are exposed to. At the extreme, this anxiety is unbearable and is the primary source of neurosis (and psychosis).

What is belonging?

Our first sense of belonging is derived from our family of origin. Belonging and attachment are inextricably linked for children and the main role of belonging in our family is, beyond immediate safety, as a means of deriving self-esteem.

As children we want to please our parents. We learn ‘right’ from ‘wrong’ and bit-by-bit form an understanding of the culture of the family – the rules and ways of being in that family. Through satisfying those rules, we derive self-esteem. So what is self-esteem?

Self-esteem is a combination of feelings whereby we feel valued and appreciated alongside feeling a sense of belonging. It is linked to meaning in that if we are embedded in a culture (a family) and are able to fulfil the expectations of that family – the cultural expectations – then we derive a sense of meaning from the process.

However, self esteem does not only come from ‘fitting in’. Healthy and psychologically robust children grow up in environments where the culture both supports them to derive self esteem from meeting expectations but also from forging their own path – expressing who they are.

As humans we are all somehow trying to find our personal balance between ‘standing out’ and ‘fitting in’, whether that be in the culture of our family of origin or later, in society.

What is Culture?

When I use the term Culture, I am referring to it on a macro level – in the context of society. If society is made up of the people with whom we share commonality, then culture is an expression of the values of that society.

Culture has two functions – it enables people to find mechanisms for generating self esteem (work, social groups, interests etc.) and secondly, and this part is entirely unconscious, it has an enormous symbolic function in assuaging death anxiety. Every culture on the planet provides its constituents with answers to cosmological questions, the four primary being:

Where do we come from (the story of our origin);
How to behave whilst we are alive (and derive self esteem);
What happens when we die (funeral rites etc.);
A myth of some sort of afterlife.

Culture is therefore in essence religious, and so are all human beings. However, as powerful as culture is, it remains symbolic and therefore cannot compete with the realities of death and so there remains residual death anxiety that we contend with. This in part gets expressed by an intolerance towards others who have a different culture as when we encounter difference it unconsciously increases our own anxiety as our cultural values are undermined and thus death anxiety encroaches upon us.

A currently example of the above is the war in Ukraine. The West thinks it can win on firepower – which it can technically – but what they fail to realise is that Putin is fighting a religious war – a war to restore the ‘myth’ – the culture – of Russia. Ergo, the war is unwinnable.

The role of myth

When we hear the word ‘myth’ many of us think of stories of old, perhaps extending back to the Ancient Greeks who had many a myth to tell. The truth, however, is that all cultures are comprised of myths. The answers to the aforementioned cosmological questions that each and every culture answers for its constituents are in essence myths. They are myths because they are stories rather than empirically provable.

Myths are stories that are held by the collective – by all, or at least most, constituents of a culture.

They may just be stories, but they are stories that hold great power in anchoring us to an identity and providing us with a sense of belonging.

Technology and the loss of myth

Joseph Campbell, the American writer and mythologist suggested that the world is changing too fast for us to cultivate and sustain myth. This matters significantly as, if myth forms the basis of culture, and culture functions as both a vehicle of deriving self esteem and in assuaging death anxiety, then the loss of myth renders us more anxious and less able to derive self esteem from our culture.

The deconstruction of Western Culture

We are living through a period of mass social change, much of which has been brought on my technology and some brought on by unexpected, but seismic events, such as The Pandemic.

In The West we are seeing long-standing cultural institutions and social structures being torn down at an alarming rate. The issue is not a moral one – some of these institutions and structures represent oppression and inequality and need to be challenged. However, we are at the stage of challenging virtually every construct that defines us right down to sex and gender. And yet have nothing collectively held to replace it with. There is nothing left to collectively believe in.

If all systemic meaning is removed and annihilated we will be left with nothing from which to derive our identity, sense of meaning and self-esteem. Perhaps this is already afoot as traditional ‘pillars’ of meaning collapse and people have little to replace them with, and certainly little of symbolic (religious) value, death anxiety comes rushing forward and manifests as both intolerance towards others (increasing culture wars), tribalism and ‘mental health problems’.

Further reading by Mark Vahrmeyer

Client or patient; patient or client – does it matter?

April 17, 2023 by BHP Leave a Comment

Can chatbot companions relieve our loneliness?

In recent weeks I have seen various articles espousing the virtues of having an ‘AI companion’ or chatbot friend. Apparently these are particularly popular with the younger demographic. One of these is ‘Replika’ – a prophetic name if there ever was one.

Chatbot ‘friends’ are touted as being helpful in alleviating loneliness through to functioning as some sort of antidote to mild mental health problems. Reading through the ‘testimonial’s’ on Replika’s website the interaction is linguistically framed as a relationship, with reference to the duration the AI avatar and human have ‘been together’ and, based on the published testimonials alone (which are undoubtably biased), some people seem to get something from this encounter.

As a psychotherapist it is not my role dismantle another person’s way of being in the world. This would be arrogant at best and dangerous at worst. However, psychotherapy, at least in the way I practice it, is all about relationship and one of the foundational belies is that what has gone wrong in relationship can only be healed through relationship. This is because human beings, like all mammals, are relational but we are the most relational of all if relational refers to our psychological, emotional and cognitive development being contingent on the consistency of a caregiver. Other mammals, once weaned, can fend for themselves. Humans remain dependent for longer than any other mammal.

We are shaped and defined by the relationship with our primary caregivers and, with the risk of providing an opening for the historical and clichéd attacks on psychoanalysis, we are most shaped by the relationship with our primary carer, who is our mother.

These early relationships are what help us to understand our emotions and grow a mind. If satisfactory enough, we learn that whilst others can and will disappoint us, we need relationships with others throughout our lives. It is true that some people have more need for contact with others, but contact is needed nonetheless.

In my clinical practice I am always thinking about whom my patient is having a relationship with – even if they are single and isolated, in fact especially so in such cases. As children we internalise important relationships with others, starting with our mothers and then broadening out as we grow older. In the British school of psychoanalysis we refer to such internalised relationships as ‘object relations’. Therefore, when I am thinking about whom someone is having a relationship with, I am referring to their object relations – whom have they internalised and therefore whom are they projecting onto other relationships?

If we have ‘good enough’ parenting, we are likely to feel fairly secure in relationships and are able to operate in a world populated by others. These others have minds that are different to our own and by extension are having different experiences moment to moment. We have internalised a ‘good object’ (good parent) and can tolerate frustrations and difference in others without becoming unduly affected.

An indication of someone who has healthy relational dynamics is someone who is able to tolerate difference in others and hold onto the good of what the relationship offers. One of the (many) frustrations about being a grown up, or rather having a psychologically mature mind, is that we learn that relationships with others are inherently frustrating alongside being rewarding.

Returning to Replika and systems like it, I can well see why, by applying enough denial to the encounter, it can, on the surface, seem satisfying as despite the illusion, we are not having to content with thew mind of another and thus the difference of another. The system ‘pretends’ to be different but in fact mirrors back to us what we want to see and hear.

Narcissism by another name

In the myth of Narcissus and Echo, Narcissus is a young man who finds relationships with others confronting. Through happenstance, or what we might call fate, Narcissus finds himself isolated in the woods and discovers the most beautiful ‘Other’ he has ever seen in a still pool of water. This is of course his own reflection and yet Narcissus falls hopelessly in love and even when part of him knows that he is deluding himself, he cannot bear to tear himself away from this ‘perfect Other’. The story of Narcissus is ultimately a tragic one as he wastes his life away yearning for something he cannot have – the perfect relationship.

A character whom is rarely referenced in relation to Narcissus is Echo, the river nymph who loves Narcissus and has been condemned by a Goddess to only be able to repeat the last words anyone says. In other words, she is an echo. She too sacrifices her life waiting for Narcissus to notice her but, of course, as she is ‘different’ he cannot allow himself to notice her other than to drive her away.

I see the rise of these artificial ‘friends’ and the ‘relationships’ that ensue to be modern versions of the myth of Narcissus and Echo. ‘Replika’, or replica, when spelled correctly, quite literally means ‘clone’ or ‘copy’ but one can just as easily translate this to ‘reflection’. Chatbots reflect back to the user what they want to see and hear – from literally dictating how the AI avatar looks, through to receiving the expected responses. The user is turned into Narcissus and an echo is all they receive in return. Of course since Echo in this modern myth is but a machine, ‘she’ will never die.

We all secretly, or not so secretly, hold fantasies of the perfect Other. This fantasy forms the basis of all modern romcoms all the way back through our collective history. It is epitomised in the idea of a ‘soulmate’ and fuels our drive for the perfect partner – something that in itself is driven through technology in the shape of dating apps; we have the illusion of infinite choice but choose nobody as once we do, they become real and thus disappoint.

Growing up psychologically, maturing and individuating, means letting go of fantasies. It means recognising that relationships are essential to us and that in order to have something real and fulfilling, we must tolerate the frustration and sense of difference.

Rather than difference needing to be threatening, as it increasingly seems to have become in modern society, difference between people is evidence of reality – the very fact that we are encountering a different mind.

Real relationships are about expressing our thoughts and feelings – our experience of the world – and knowing that someone is there to receive them and us, irrespective of whether they ‘mirror’ those exact thoughts and feelings. It is through and via this process that we get a sense of ourselves in the world and with others.

Narcissus was in a clinical sense deluded and descended into psychosis, withering away on the bank of that fateful pool. Chatbot friends encourage this same delusion. I am not suggesting it will lead to psychosis, but reality it is not. There is no relationship to be had and there is no thinking mind alongside you. You are just as alone as Narcissus and cannot grow from a reflection – for that a real relationship is required.

Further reading by Mark Vahrmeyer –

Client or patient; patient or client – does it matter?

How to minimise Christmas stress if you are hosting

March 13, 2023 by BHP Leave a Comment

What are feelings anyway?

Everyone knows what a feeling is, right? Well, it turns out that this is not the case and many of us are either unable to experience feelings at all, or get thoughts and feelings mixed up.

Early on in my training I had a tutor who would tell us ‘when in doubt, hunt the feeling’. It is arguable that this is the purpose of the therapeutic interaction that enables both empathy and relational understanding to take place.

So what is a feeling?

Feelings are emotional responses that we experience which can then be thought about and communicated using language. Let’s delve deeper and understand how feelings operate.

When we have a physiological response to stimuli – this can be external or a thought process – the cluster of physical responses are called ‘affect’. Affect is primal and is something we find across all mammals. Broadly, affect is a proto-emotion and expresses itself through what we would describe in words as:

Seeking;
Rage;
Fear;
Panic;
Play;
Lust
Care.

Affect is not relational, meaning it neither functions nor is used to communicate feelings to another.

Above affect we have our emotions, which are more sophisticated and nuanced and whose function is to let both us and those with whom we are in relationship know about what is going on for us. Emotion is the link between mind and body, and, affect and feeling. Our primary emotions are:

Fear;
Anger;
Sadness;
Joy;
Disgust;
Surprise.

Emotion defies language in that it can be felt and communicated through relationship and experience. However, effect is communicated using projection and projective identification – the ‘putting’ of feelings into another.

Feelings sit at the highest level and are behavioural and cognitive. They can be thought about and defined in language and conceptualised by another.

How can things go wrong?

Infants do not have the ability to use language and nor do they think using words. They experience affect in their body and communicate their emotions to their primary carer using projection. With early trauma where the primary carer (the mother) has not been adequately internalised, the infant projects their affect out into the universe, rather than into the other. They can neither make sense and soothe themselves nor locate soothing in another and are adrift with overwhelming emotions.

In psychotherapy

In relational psychotherapy, feelings are communicated through verbal and non-verbal cues but are also present in the transference in the shape of emotion. By receiving the patient’s projections and giving shape and form to them in the therapy, the therapist assists the patient in digesting their emotions and converting them into feelings.

When is a feeling not a feeling?

Often people will talk about feelings when these are actually thoughts. In language this is expressed as ‘I feel that…’. As soon as the word ‘that’ follows the word ‘feeling’, you know you are dealing with a thought.

Why does all this matter?

Integrating thinking and feeling lies at the heart of the therapeutic process. If unexpressed and crucially, unexpressed in a relationship, then a person is likely to remain stuck experiencing the world and their current relationships clouded by past experiences. In the words of Freud: “Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”

Further reading by Mark Vahrmeyer –

Client or patient; patient or client – does it matter?

How to minimise Christmas stress if you are hosting

How to minimise Christmas stress if you are hosting

January 30, 2023 by BHP 3 Comments

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.

Further reading by Mark Vahrmeyer

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

January 23, 2023 by BHP 1 Comment

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.

Further reading by Mark Vahrmeyer –

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

How do I find the right psychotherapist?

January 9, 2023 by BHP Leave a Comment

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.

Further reading by Mark Vahrmeyer