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‘Where Should I Start?’ – On the flow of a psychotherapy session

Starting psychotherapy can be a daunting prospect.  Researching the right psychotherapist; making contact; booking the appointment; finding the practice; waiting in the waiting room; and then…. you are invited in.

You enter and sit down.  Water is on the table.  Perhaps you help yourself as you are suddenly unexpectedly thirsty. Or perhaps, unconsciously, the thirst delays the awkwardness of starting the session.  Eventually that moment arrives and you are unsure where to begin and so ask ‘ where should I start?’.

In fact, my experience is that this is a question that, for some clients, will repeat over and over again in the relationship and it becomes a significant part fo the work: how to work out where to begin each week.

On taking space

Whilst it is conceivable that someone with a perfectly good childhood should choose to enter into psychotherapy, it is in practice highly unlikely. Especially if we differentiate between short-term counselling or psychology, and open-ended psychotherapy.

All of us can fall victim to the uncertainties of life and can find ourselves struggling to make sense of a difficult event – perhaps a divorce or an accident.  These would be perfect examples of events that may require a period of focused counselling. However, as troubling as these experiences can be, it is only if they throw our whole existence into doubt or bring down the edifices of our defences, that psychotherapy would be required.

Therefore whilst it is possible that someone with a good childhood would come into psychotherapy, most of those who do are coming (unconsciously or not) to work-through and repair attachment damage, neglect and trauma in their early relationship(s).

And for children who have been neglected, and thus not held in mind, it can then be hard to suddenly find themselves in an environment where the Other (the psychotherapist) is fully holding them in mind and is interested in everything they have to think and say.  Where in the world should they start and how can they learn to feel comfortable taking up the space for themselves?  Being truly seen when one has not been seen can feel very exposing.

Knowing where to start, is all about desire

When a client asks me where they should start a session I will mostly hand this back to them in a gentle manner.  I invite them to be curious about how they might work out where they want to start.

I then quite often get a relaying of the week’s events, if the client is one I have seen before.  Once again I will hand this back and ask them what it is that they want me to know about how they are feeling about their week.  Often this is then met with a blank stare and then we can perhaps address the issue at hand: how can they work out what they want to share with me as someone they are in relationship with?

Knowing where to start is all about desire.  It is about having a relationship with ourselves and working out what we would like to think about in the therapeutic relationship.  It is akin to choosing what to eat off a menu – in order to know what we want to eat, we need to get in touch with what we ‘feel like eating’.  We try the different dishes on in our mind and then choose which we will focus on – which becomes the dish we will order and eat.  Therefore desire tells us about what matters to us – what is important to us.

And yet choosing were to start has a further complexity – we must choose what we want to talk about and then bring this onto the relationship which means acknowledging that our psychotherapist will have thoughts, feeling and perhaps judgements about what we tell them.  That can bet very confronting!

From a duet for one to a dance of two

Psychotherapy is a relationship and as in all relationships, they are not static.  They follow a trajectory of, if the relationship is positive, deepening over time.  It shifts and moves, develops and cements as a relationship, where two people are in dialogue with each other and who matter to each other.

Where we start a session then is about allowing ourselves to accept that we are in a relationship with someone who not only holds us in mind and to whom we matter, but crucially, letting our psychotherapist matter to us.  The question of where to start then simply becomes, ‘what do I want Mark to know about me?’.

Mark Vahrmeyer is a UKCP registered psychotherapist and co-founder of Brighton and Hove Psychotherapy.  He works with couples and individuals using an psychoanalytically informed integrative approach and sees clients in Hove and Lewes.

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What is Integrative Psychotherapy? – An interview with Mark Vahrmeyer (Part 3) – VLOG

Recently Dr Simon Cassar interviewed integrative psychotherapist and co-founder of Brighton and Hove Psychotherapy Mark Vahrmeyer on the question of ‘What is Integrative Psychotherapy.  This is the last in a three-part interview where Mark explains the difference between integration and eclecticism, why integration is about co-building a relationship between therapist and client and how integration is about psyche and body integration.  Check out Part 3 here:

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What is Integrative Psychotherapy? – An interview with Mark Vahrmeyer (Part 2) – VLOG

Recently Dr Simon Cassar interviewed integrative psychotherapist and co-founder of Brighton and Hove Psychotherapy Mark Vahrmeyer on the question of ‘What is Integrative Psychotherapy.  This is the second in a three-part interview where Mark explains the difference between integration and eclecticism, why integration is about co-building a relationship between therapist and client and how integration is about psyche and body integration.  Check out Part 2 here:

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What is Integrative Psychotherapy? – An interview with Mark Vahrmeyer (Part 1) – VLOG

Recently Dr Simon Cassar interviewed integrative psychotherapist and co-founder of Brighton and Hove Psychotherapy Mark Vahrmeyer on the question of ‘What is Integrative Psychotherapy.  This is the first in a three-part interview where Mark explains the difference between integration and eclecticism, why integration is about co-building a relationship between therapist and client and how integration is about psyche and body integration.  Check out Part 1 here:

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What does Integration mean in Psychotherapy?

Psychotherapy is many things, but on a fundamental level it is about the integration of split-off parts of ourselves.

This cannot be achieved without the integration of psyche and soma (body), which is the function of the mind.  We need the mind of another to grow a mind and this is what happens in the relationship children have with their parents, if all goes well.  Emotional and psychological integration cannot happen outside of the context of a secure object relationship and it is this that is the function of psychotherapy.

Far too many ‘modalities’ of psychotherapy operate in ‘silos’, possibly reflecting the medical approach to the body and mind.  This makes them limiting and we end up with ‘infighting’ around “my modality is better than yours”, or “this modality is NICE approved whereas that one isn’t”…. All of this in unhelpful to clients and to the profession.  Without an integrated approach to helping clients to grow and use their minds to form a relationship with their whole being, little change is likely.

Going back to psychoanalysis

The old analysts, from Freud through Winnicott, understood integration and Winnicott wrote extensively about the ‘Mind Object’: where a mind becomes an external ‘object relationship’ for the patient/client, to compensate for a lack of secure primary object, but then persecutes the individual for having an emotional world (as it cannot process and contain emotion).

In the absence of a ‘good enough’ parent, the child projects his or her mind out of the body and uses it to navigate the world, however, this is a precocious mind that cannot help the client process emotion and attacks the client for their emotions.

The function of a mind is to make sense of the psyche and soma and be an ally to the individual.  Integration in psychotherapy involves the client/patient growing a mind; learning to navigate their feelings and making sense of their thoughts, all whilst accepting reality and being in relationship to others.  To do this requires and integration of approaches, not least Object Relations (psychoanalysis), Attachment Theory, Neuroscience, Embodiment and Existential Givens, all held within a relational therapeutic context.

Integration vs eclecticism

Being a potent psychotherapist means therefore being able to adapt our language and thoughts processes to those of the client in order to help them grow their mind and discover how they become integrated.  It relies on the ability to move between languages (therapeutic, class, gender, culture, religious/spiritual) as well as being able to move between the client’s experience and our own.  This is the true meaning of integration and the difference between integration and eclecticism.

 

Mark Vahrmeyer is a UKCP-registered integrative psychotherapist working in private practice in Hove and Lewes.  He is integrates psychotherapeutic approaches with neuroscience and the body in his work.

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How to Stop a Panic Attack. Step-by-step instructions and guidance from Mark Vahrmeyer – VLOG

Panic attacks can be terrifying.  When experiencing a panic attack we feel out of control and at the mercy of what is happening in our bodies.  We are overwhelmed and unable to ‘think our way out’ of what is happening to us; indeed, it is not uncommon to imagine that we may be dying.

As an integrative psychotherapist I have written extensively about the importance of integrating the body into psychotherapeutic work.  The fundamental reason for this is because all of our emotions originate in the body and need to be felt in the body.  We then use a thinking mind to make sense of what we are feeling.  However, if we become overwhelmed we may experience a panic attack which is when the body has physiologically gone into a ‘fight – flight’ response to a perceived threat.  Often, the threat is not actually life threatening – it may not even be ‘real’ in the sense that it is a repeat of trauma.

Panic attacks can be controlled.  But only through the body.  I have produced an embodied guide that literally walks you through becoming aware of a panic attack and managing it. This guide has been produced as a series of interviews and VLOGS into the topic of psychotherapy generally.  So, please check out the interview and we would welcome any feedback or suggestions for future VLOGS.

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.

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What is Existential Psychotherapy? An interview with Dr. Simon Cassar – VLOG

 

Recently Mark Vahrmeyer interviewed Dr. Simon Cassar on the topic of Existential Psychotherapy.  This is the first in a series of interviews and VLOGS into the topic of psychotherapy generally.  So, please check out the interview and we would welcome any feedback or suggestions for future VLOGS.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy.  He works from our Hove and Lewes practice.

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Can Mindfulness Replace Psychotherapy?

There is a lot of hype surrounding mindfulness at present. The NHS now sees it as a psychological intervention, and large corporations recognise that calm, happy  employees are more productive. But how realistic is mindfulness, a secularised and stripped-down version of the Buddhist practice of meditation, as a long-term psychological intervention?

What is Mindfulness?

Mindfulness is essentially ‘awareness’; being able to remain aware of what we are experiencing without becoming attached to the thoughts, feelings and sensations that come and go.

What are Some of the Touted Psychological Benefits?

Few in-depth academic studies have been carried out into the effects of mindfulness on psychological health. Even fewer have approached the question critically with a willingness to consider adverse effects.  However, early indications from pilot studies are that mindfulness can be beneficial (more on this word shortly) for alleviating the symptoms of mild depression and anxiety.

And the Drawbacks?

Dr Bessel Van Der Kolk is one of the world’s leading authorities on PTSD (Post-Traumatic Stress Disorder) and CPTSD (Complex Post-Traumatic Stress Disorder, also known as Childhood Developmental Trauma.) He states that mindfulness does not work for these patients, as they cannot feel.

What he means with this statement is that for traumatised people, the capacity to feel emotions has become compromised. This could be because their childhood experiences prohibited them developing a healthy relationship with their emotional world. Alternatively, this inability to feel emotions derives from massive emotional trauma in adulthood that the person has not been able to process.  Traumatised people, in lieu of feeling, become overwhelmed and then dissociate. They split off their emotions from their experience in the ‘here-and-now’.

Clinically, early studies have shown that mindfulness, when not integrated into psychotherapy, can exacerbate symptoms in psychological illnesses such as Bipolar Disorder and in people with (C)PTSD. Further research strongly indicates that engaging in any practice of mindfulness can lead to a psychotic breakdown in patients with a history of psychotic episodes.  Furthermore, particularly for children living under abusive conditions, mindfulness can strip them of their coping strategies and leave them more traumatised. This is a consideration that schools using this technique would do well to hold in mind.

Impermanence, Suffering and Not Self

These three experiences are what mindfulness can bring us into contact with.  Located away from any spiritual context (Buddhism) and without adequate psychological holding, the silence and emptiness that so many crave through mindfulness can cause a psychological break in others.

What is Change?

In the world of psychotherapy, we look at two levels or orders of change – first and second order change.

First level change is about clients and patients accessing behaviours that enable them to stabilise emotionally. However, this level of change does nothing to resolve the underlying conflict and trauma that drives the lack of stability.  First order change is a critical step to assisting clients and patients in stopping or managing damaging behaviour. This is an important step and can literally be life-changing for people. It is not, however, the goal of psychotherapy, as it does not address the problem.  Managing symptoms is useful but it negates the critical fact that symptoms are already a way of the client/patient managing the problem. They are a form of self-coping, however malign they may seem.

Mindfulness works to bring about first order change but cannot address the underlying problem. Additionally, as traumatised people cannot feel, they may in fact be dissociated during their ‘practice.’ While they may appear calmer, they are unable to use their emotions and ego to make clear informed decisions for themselves.

Early studies have shown that first order change is only sustained as long as the practice is maintained. This kind of change is not structural on a psychological and emotional level.

Why do some Meditators Die Young?

This is a question (riddle) I was posed a few years ago when attending a conference snappily entitled ‘Neuroendocrinology for Psychotherapists’. What was lacking in the title was made up for in the content. A significant number of meditators with a traumatic past think they are meditating when they are, in fact, dissociating. Their emotional and endocrine systems are under immense stress. Long-term, this impacts on their immune system, leading to chronic illness and death.

Second Order Change, or Dealing with the Problem

Psychotherapy is about mind-body integration. It is about providing a therapeutic relationship with the traumatised, split-off, vacant parts of the client/patient which can be seen and related to by the psychotherapist.

Emotions are our compass.  They tell us, moment by moment, whether we want more or less of something; whether we feel safe or a situation is dangerous. Where clients lack the ability to navigate using their emotional compass, they first need to learn to reside in their body – to become embodied. This is achieved through an ongoing stable and in-depth relationship with a psychotherapist who can give shape and form to our trauma through words. Language development is a social process, and so is becoming embodied.

Second order change impacts on our emotions, structure and personality and assists in resolving the problem. Our traumas have happened to us in relationship (with our caregivers or ourselves) and can therefore only be resolved in relationship.

Some Final Thoughts

I work extensively with trauma and actively integrate the body into my work. This, however, means first and foremost to teach a client to remain in the ‘here-and-now’ so that they do not become overwhelmed and dissociated.  The first step in this is that any trauma work is processed with our eyes open, unlike most mindfulness practice.  After all, we cannot be in relationship if we cannot see the other person.

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

How psychotherapy works

How to grow a mind

Remembering in order to forget

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How body stability creates psychic stability

There is No Such Thing as a Baby

I frequently blog about the importance about including the body in the process of psychotherapy and how the unconscious resides in the body.  However, unlike many ‘body psychotherapists,’ I believe that the involvement of the body is more profound than identifying the presence of the body in the process. Let me explain using one of Donald Winnicott’s most famous quotes, “There is no such thing as a baby.”

Winnicott famously made this statement in 1947. On face value, it may seem somewhat absurd. After all, we have all seen babies and know they exist. However, the reality is far more complicated, because every baby that any one of us has ever seen is only visible because it is in a relationship with its primary carer (which for simplicity, I shall refer to as its mother).

A baby cannot exist alone but is essentially part of a relationship.  Babies exist in an absolute state of dependence, such that the infant (the word is taken from the Latin – ‘infans’ – not able to speak) has no knowledge of maternal care, as this would require the knowledge of ‘an other’ providing the care.  The baby therefore is essentially indivisible from its mother and thus cannot exist in its own right.  The infant’s experience relies on the mother’s ability to merge with, and adapt to, her baby.  Therefore, whenever we see a baby, we actually see a baby, its mother, the relationship between the two and also the wider social context within which that baby lives and has come to be.

There is No Such Thing as a Body

The same principle can be applied to a body.  There is no such thing as a body in its own right.  A body is created, shaped, moulded and exists within the relationship that the mother of the owner of the body has had with it.  In other words, the body and how it is experienced by the person in the body is contingent on the relationship that the baby has with the mother and the wider environment. This then dictates the relationship that the owner of said body, has with him or herself (if any.)

Why Does the Body Matter?

Psychotherapy is about many things, but one of the primary tenets is that it is a relationship within which the client/patient can, through relating to the therapist, establish a relationship with themselves. Having a relationship with ourselves includes having a relationship with our body. However, I believe that too many psychotherapists assume that such a relationship is necessarily experienced as helpful by the client at the outset of therapy, or even possible.

The Body as an Enemy

If we come to inhabit, or embody, our bodies through the relationship with our mothers and the wider social context, and our mothers were abusive to us, then the experience of our body can be one of ambivalence (‘I don’t really care about my body”) through to experiencing the body as dangerous, attacking or not our own.

Examples of where internalised abuse/hatred is expressed towards the body include cutting and burning the skin through to anorexia and bulimia, to name a few.

Risk of Trauma

Assuming a pre-existing, or even conceptually possible positive relationship between a client and their body on the part of the psychotherapist is naive. At worst, it risks re-traumatising the client.

If, for the client, all that is bad resides in their body, then they need to slowly find a way to ‘meet’ their body in a different context and to tentatively form a different relationship with their body – to reclaim it from the ‘bad’ parent. The therapeutic process involves creating a different relationship with ourselves, one in which we are able to leave the echoes of past formative relationships behind. At the very least, we need to learn to think about ourselves as players in those stories in a different way. In the same way, we need to learn to relate to our body as our own and as our friend, guide and an integral part of us.

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

Body psychotherapy

What is attachment and why does it matter?

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Come and Join our Team

We Need You!

Brighton and Hove Psychotherapy is expanding thanks to consistently increasing demand across our Hove and Lewes practices.

We are seeking an experienced and motivated psychotherapist who has the clinical training and experiential background to work with individuals and couples, ideally splitting their practice between our clinics in Hove and Lewes.

This is an excellent opportunity for the right person to join our strong team of clinicians and to contribute to a cohesive practice whilst growing a vibrant private practice.

We are interested in hearing from UKCP registered psychotherapists or equivalent (BPS/BPC), who can bring additional skills to our practice.

This position would be on a self-employed, part-time basis.

If you are looking to be part of a clinical team, to contribute to blogs, reflective practice meetings and work as part of an integrated talking therapies clinic then please email mark@www.brightonandhovepsychotherapy.com.

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The Truth of the Myth of Anti-Depressants

The Truth of The Myth of Anti-Depressants A Response to Johann Hari’s Book  – Lost Connections

As a psychotherapist, I welcome honest debates about mental health, as they can help reduce the stigma and isolation of many sufferers experience.  Recently, a book has been published by controversial author Johann Hari, that has created a bit of a storm,  in which he claims to dispel the myth of anti-depressants and provides us with the Nine Factors that lie at the root of anxiety and depression.  Here is my two-cents worth:

Do anti-depressants work for some people?

Yes they do.  And furthermore, they can be essential ‘life rafts’ for clients who simply cannot cope.

They are compatible with psychotherapy in as much that clients need to be thinking about and taking responsibility for choosing healthier ways of coping.

Are there ‘Nine Factors’ contributing to Anxiety and Depression?

This idea really concerns me.  It is less about whether Hari’s ideas or suggestions are valid (some are), but rather seems to be reminiscent of a reductionist trend of identifying and listing the problems of the human condition, with a view to us being fixed if we address the list.  The many causes of depression include biological, social, economic, genetic, epi-genetic, existential and more beyond.  And they are all interconnected.

The Problem of Being Human

Since the dawn of time, man and womankind have pondered the purpose of life.  Existential thought and theory has much to teach us on this matter and the many tomes published on the topic have never identified a specific number of causes.

Perhaps what we are ultimately left with is that anxiety and depression are part of the human condition.  Whether this is a random fluke of evolution, or brought about by us being (as far as we know) the only species who must live life knowing we shall die – existentially an unbearable proposition – or a combination of the two, I do not know.

My view is that being a successful human being is about learning to come to terms with the past and to learn to tolerate our feelings and then navigate by them.  If anti-depressants help us bear the unbearable for a while, they have a place and a role which can be lifesaving.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes.  He is existentially informed and has a background of working in palliative care.

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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

Holiday blues

After the break: Christmas after separation or divorce

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Four Simple Steps to Stop a Panic Attack

Remember when I told you that panic attacks originate in the body and can therefore only be controlled through our relationship with the body? It is called Soft Belly – Soft Throat – Soft Tongue.  This is how you do it:

You can do this process any time, anywhere. While it is ideal to do it standing, you can do it sitting if you prefer/need to, or even lying down. However you do it, keep your eyes open throughout.  This is not a meditation; it is a physiological process of calming your autonomic nervous system.

  • Bring your focus to your belly – the region immediately above your belt. Tell your belly to relax, or be soft. It is your belly – a part of your body – so you can instruct it to let go of tension. With a soft belly, breathe into your belly.

Many of us, especially when anxious, breathe into our chest. This is a shallow breath and actually increases our anxiety levels. To breathe into our belly, we imagine drawing the breath right down to our belt line.  Our belly extends, and lastly, our chest extends.

Focus on your breath. Whenever your thoughts drift off, come back to simply telling yourself that all you need to do is breathe. Focus on getting into a natural rhythm dictated by your body. You will find your breathing slows over time and becomes effortless. Allow the body to naturally exhale rather than pushing the out-breath out.

  • Bring your attention up through your body as you continue to breathe into your belly, and stop with your throat. Tell your throat to relax. This is not the same as asking your shoulders to relax. When you tell your throat to relax, you may notice a softening in the neck muscles and a slight drop of the shoulders. Sometimes you may feel a desire to yawn. Allow this to happen. It is one of the ways the autonomic nervous system drops into a calmer state (rest and digest vs flight/flight).
  • Now bring your attention to your tongue. Often, we create tension in our body and our emotions simply through holding tension in our tongue. We push our tongue against the roof of our mouth or against our front teeth. Tell your tongue to relax and let it simply lie in your mouth. You may notice a further softening of your jaw muscle and a slight opening of the mouth.
  • Breathe like this for a while with your eyes open and allow your senses to pick up sounds, sights and smells in the here-and-now. For example, you may notice a car pass; a rustle of a tree; a dog barking, and so on. Just notice without becoming attached to any of these stimulants. Continue to tell your body that you are safe through creating a soft belly – soft throat – soft tongue.

In this state of being, it is simply not possible to experience a panic attack.

What else can help?

Any embodied practice – a practice where you are mindfully in your body – will help with controlling anxiety and panic attacks. Examples include yoga, dancing and martial arts but it can be as simple as walking barefoot on sand, grass or even a floor.

And then, of course, there is counselling or psychotherapy.

The relationship with yourself

Counselling and psychotherapy are about developing a relationship with yourself. That includes with your body. Through talking therapy, the triggers and causes of anxiety and panic attacks can be gently uncovered, understood, relationally processed and expressed in words and emotions rather than as the body being overwhelmed.

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

A Daily Practice to Manage Emotions

On Having a Daily Practice

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What are panic attacks?

Panic attacks can be terrifying and debilitating. They can feel as if you are going to die and like you have lost control of your body.  While nobody has literally died from a panic attack, feeling out of control and overcome by fear and anxiety can be one of the most unpleasant experiences. It causes some people to limit their lives, which can, in turn, lead to more panic attacks through hypervigilance.

What is a panic attack?

I have previously written blogs about how all of our emotions originate in our body.  Our emotional system (autonomic nervous system) is constantly scanning its surroundings for signs of threat. Some of us have systems that are primed to be more hypervigilant. This can be useful in dangerous situations, but not so helpful in normal everyday life.

There may be genetically inherited reasons why some people are more prone to anxiety, and thus panic attacks. However, other reasons relate to what we learned about emotions and how to feel them from our primary carer and family of origin.  Put simply, an anxious mother will most likely raise an anxious child. When the child becomes a parent, they become an anxious mother who raises an anxious child, and so on.

Why do panic attacks happen?

Panic attacks happen when we become overwhelmed with fear and anxiety.  We cannot simply feel and make sense of our experience and our emotional system goes into overdrive. The fast heart rate and shallow breathing that accompanies a panic attack exacerbates the experience and we can feel stuck in a nightmarish loop.

It is important to understand that a panic attack originates in the body.  It can therefore only be controlled through the body. We cannot think ourselves out of a panic attack. This is why it is so unhelpful when well-meaning loved ones tell us to “calm down!”

Panic attacks are generally unrelated to the immediacy of our environment in that we are generally not confronting a deadly situation. However, there will generally be something about what we are experiencing that is triggering anxiety and/or fear.

In my next blog, I will give you four simple steps to stop a panic attack.

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:

Managing conflict for emotional and physical health

What is attachment and why does it matter?

Click here to download a PDF version of this post.

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