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What is Psychotherapy?

In this age of jettisoning the past and continually embracing the new, the answer to the question of how psychotherapy works has remained largely unchanged since the days of Freud.  Modern enquiry and comprehension brings the capacity to understand what happens in the brain as a result of effective analysis, psychotherapy, or indeed, good enough parenting.

To use an analogy, Freud worked out how to bake the cake of psychoanalysis and with it, what ingredients to use.  Modern science has the capacity to empirically prove how those ingredients work through neuroscience research.  In this piece, I shall concern myself solely with the main ingredients of what is needed for effective psychotherapy.  Although they are but two, how they are applied marks the difference between an amateur cook and a master chef.

In 1968, Michael Balint, a psychoanalyst in Britain, wrote the following ‘recipe’ for effective analysis which holds true for counselling and psychotherapy to this day:

“Although, as a rule, it is not stated quite so implicitly, we are compelled to recognise that the two most important factors in psychoanalytic therapy are interpretations and object relationship. It should be borne in mind, however, that with the latter we are on comparatively unsafe grounds because psychoanalytic theory knows much less about it.” (p159, The Basic Fault – Therapeutic Aspects of Regression)

Balint is making two important points in this brief paragraph. Firstly, he gives us the key ingredients of what makes psychotherapy work. Secondly, he tells us that while object relationship is an essential ingredient, in 1968, psychoanalysis lacked an understanding of why that is.

A basic cake ingredient remains the same through the generations. No doubt, there are scientific reasons to explain why the chemical constituents of flour and egg make a good cake. This is also true of Balint’s main ingredients; interpretations and object relationship, or, put more simply, understanding ourselves and the importance of the therapeutic relationship.

Understanding, or, Knowing Thyself

Insight and understanding is a key tool in making changes.  If clients can form a compassionate – and that word is key – understanding of how their past relationships (object relationships) and experiences have shaped them, they can develop the capacity to change.  However, this possibility of change is entirely contingent on the therapeutic relationship they form with their therapist.  Insight alone cannot lead to change. This is the fundamental answer as to why the many shelves of self-help books comprising an ever-increasing proportion of high street booksellers, never really lead to any change in their hopeful authors. Change requires a relationship in which loss can be worked through and trust built in a new way of relating; trust that the other person in the relationship (the psychotherapist) will not let the client down. At least not catastrophically.

Object Relationships

Why can change only take place in the capacity of a relationship?  In the past, I have written blogs about the therapeutic relationship and its importance, as well as on the principles of attachment.  However, to recap, psychotherapy is about re-parenting.  On a fundamental level, it is about helping the client to experience a good enough relationship where they are listened to, cared about and held in mind.  Through this, the client can start to develop their own mind, and over time, hold themselves in mind in ways they have not been able to do in the past.

If the therapeutic relationship is so important, why is it not enough?  It can be argued that affective attunement is about offering interpretation, if interpretation is about helping a client to understand why they feel, think or behave in a certain way. Is this not, after all, what a good enough mothering relationship provides, minute by minute, hour by hour and day by day?

To contradict myself, it is also too simplistic to simply suggest that the object relationship with a psychotherapist is akin to re-parenting. It is far more disappointing and frustrating than that. It is, for the client, a coming to terms with the stark reality that they cannot and will not ever have the mothering they needed for the child they once were. It is the working through of this and then, ultimately, the abandoning of infantile objects – unconscious childhood trauma driven states of mind – for adult objects – conscious adult states of mind that can tolerate the limitations of adult life and adult relationships; a tolerance of pain and abandonment of pleasure.

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 on this subject:

How does counselling or psychotherapy work?

What is transference?

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Grief – how to grieve?

Grief is often referred to in the context of intense feelings experienced with the loss of a loved one. The loss we experience is often caused through death. Grief is, therefore, synonymous with bereavement.

This, however, is nowhere near the whole story. In order to know how to grieve, we need to understand grief.

When we are told that someone is grieving, we may assume they are feeling intensely sad. Although this is often true, grief is comprised of a multitude of emotions, and sadness is only one. One of the early pioneers of grief work (yes, there is such a thing), was Elizabeth Kübler-Ross. She suggested grieving was an active process that required a “working through of emotions” broken down into five core groups: denial, anger, bargaining, depression and acceptance. Sadness would fall into the ‘depression’ group in this model.

Since Kübler-Ross, plenty of other models have been proposed. All of these have added something to the field. I will not directly elaborate on these in this blog, but further information can be found on the Internet.

Grief is, therefore, an umbrella term for a whole host of emotions, and it is a verb.  It is something that we must allow ourselves to experience and actively engage with.

 Why should I grieve?

Emotions exist within us, whether we consciously acknowledge them or not.  Where we are unable to feel them (through repression, which is always unconscious) these emotions will often express themselves as a conversion reaction. They will be expressed through the body such as in aches and pains. They may be expressed through even more obscure symptoms, such as a loss of physical movement.

Where we are aware that we are feeling grief, but actively suppress the feeling, emotions are likely to manifest as anxiety or depressive symptoms, which can persist for years.

Thus, there is no escaping it, grief must be felt and ridden out, like a storm. To complicate things further, it is not a linear process. We might have felt anger (perhaps with our loved one for leaving us) and moved onto bargaining (“If only I had done more for them…”) However, this does not mean that we will not return to anger again. And again…

We must grieve because we need to acknowledge what we feel.  If we do not (because we can’t or won’t) things get complicated.

How do I grieve?

Grieving (in the context of bereavement) used to be a socially prescribed activity which was both acknowledged by the wider community and defined as a process. Those who were bereaved would often wear symbols of their grief – black clothes or a black armband. Within their community, it was acknowledged that they would be grieving for a set period of time, often a year. This practice has largely been lost in northern Europe. However, in southern Europe, it remains common in more traditional communities to see widows wearing black for the remainder of their lives.

Religion

Love it or hate it, the one thing religion gave (or gives) us is a powerful story of what happens after we die.  From the Vikings with Valhalla to the Christians and Heaven, the concept of an afterlife can bring great solace to loved ones who are left behind.  The loss of socially prescribed ways of mourning, combined with a loss of religious beliefs, has made grieving more difficult.

Meaning making

A universal task in coming to terms with grief is to find some sense of meaning within it, and to weave this together into a narrative. We are no longer provided with cultural narratives in the way that we once were. This then becomes something that we need to do ourselves.

Why is grief hard for some people?

When I embarked on my own professional psychotherapy career, working directly with dying patients and their relatives, I imagined that the loss of the deceased would be felt most acutely where relationships had been close, connected and happy. However, the inverse was true. Where relationships had been difficult, strained, or even devoid of contact for long periods of time, the bereaved would often struggle to process the loss far more. This occurred particularly where the relationship was between a parent and their (adult) child.

The reason for this lies in attachment and in how we learn, through attachment, to feel.  For those of us lucky enough to grow up in homes where there is no abuse or neglect, and no unexpected losses, we find it relatively easy to move in and out of relationship – to say ‘hello’ and ‘goodbye’. With the security of the relationship comes an ability to feel emotions and make sense of what is being felt. Thus, the process of grieving, whilst hard, is something that can be actively undertaken.

In some parent/child relationships, the child has been significantly disappointed by the parent in the past. Parental neglect and/or abuse can lead to an accumulation of unacknowledged earlier losses in the relationship. In these cases, the final physical loss of the parent can make it very hard to come to terms with the enormity of all the losses that person represents. The loss is not only of the relationship and person, but also of hope. If the relationship between parent and child was strained or difficult, it is likely the bereaved will be poor at navigating his or her emotional states. This makes grieving terrifying, at best, or unthinkable, at worst.

Grieving is normal

As a clinician, I get a lot of fulfilment in helping clients to grieve. It is different from any other presenting issue they bring to me. Grief is the universal leveller. We will all experience it at some point in our lives. The way out and through grief is always the same – we have to feel the full range of emotions that our grief brings up.

Grief is not a mental health condition, and yet many people become stuck with their grief. When this happens, the secondary symptoms can mutate into more complex conditions such as anxiety, clinical depression and panic attacks.

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 a personality?

We all use the word ‘personality’ in everyday language. We might use it to describe how we experience another person (“She has a nice personality.”) We use it to describe elements of how a person may behave, in the case of personality traits.  And sometimes we use it interchangeably with the word ‘character’ to describe somebody. But what actually is a personality, and why does it matter – particularly when it comes to psychotherapy?

As the word ‘personality’ refers to the mind of a person, and as no human has ever seen a mind, in essence, the term is an abstraction. It’s an idea, a way of understanding how we tick, not a concrete object.

The dictionary suggests that a personality is a collection of characteristics that make up somebody’s character.  What, then, is character?  According to the dictionary, it is the mental and moral qualities distinctive to a particular individual.  And character is apparently synonymous with personality!  Confused yet?

OK, so this is how we mental health professionals generally understand personality. Personality is made up of two distinct categories – temperament and character (there’s that word again).

Temperament

Temperament is considered to be the traits that we inherit from our parents – either genetically, or through other biological means.  A person’s temperament may be a higher predisposition to anxiety, a genetic predisposition to addiction, or to being quick to anger. We are either born with our temperament. or it is developed in utero or shortly thereafter.

Character

Character, in contrast to temperament, is something that emerges at a slower rate as we grow, explore our world, relate to our caregiver and mature.  For example, we learn how to relate to others (particularly in close relationships) through our own attachment story with our primary carer. This way of relating takes place over a significant period of time.

Nature vs Nurture

We can substitute ‘temperament’ for the word ‘nature’ and ‘character’ for the word ‘nurture’ to keep things simple.  While most forward-thinking counsellors or psychotherapists will acknowledge that nature and nurture both play a significant role in defining our character, the jury remains out as to exactly where the boundary lies between the two. In fact, there may be no boundary at all!  For example, it is now increasingly accepted that what matters is not so much a genetic predisposition, but epigenetics – how our genes interact with our environment.  Therefore, just because someone has a genetic predisposition towards alcoholism, if they are raised in a loving home where they can develop a strong, solid sense of identity, it is unlikely they will become a full-blown alcoholic.

Why it matters

Therefore, personality matters as it is a word that encapsulates a large part of our identity and mind.  And in mental health, it is particularly important, as when clinicians treat clients or patients, the work will be significantly different depending on whether the presenting issue is an isolated issue, such as anxiety, or whether the problem relates more to the structure of a person’s personality. Just to confuse matters further, if a client presents with anxiety and has traits or a diagnosed personality disorder, the work will be lengthy and complex.

In Lay Terms

If who we are – how we experience ourselves and relate to others – is dysfunctional, damaging or harmful, then deep psychotherapy is required to restructure the personality. As personalities have taken a long time to form, it takes time for them to change. And because personalities are made up of temperament and character – nature and nurture – how much change is possible is something the therapy will uncover. The goal of depth psychotherapy is, of course, to change the level of the personality. However, it is also about developing kindness and compassion for one’s personal limitations and accepting these so we may lead a calmer, more fulfilled life.

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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How does counselling or psychotherapy work?

I have written in depth about the differences in counselling and psychotherapy – the work and the training of the clinician.  So, for the sake of this blog, I will treat the terms as interchangeable, even though they employ vastly differing depths of work and skill.

How does counselling work? This question often comes up when we are contacted by people who know they need some help, but are unclear how “talking to a stranger” can help them.

Irrespective of a therapist’s modality of training (how a therapist works) – fundamentally, the success of the work is dependent on the quality of the therapeutic relationship and on how the therapist works within this relationship. The latter is extremely important and is often overlooked by less qualified therapists. More on this shortly.

What is the Therapeutic Relationship?

A relationship with your counsellor or psychotherapist is a unique relationship. In the early stages, it may feel a little odd. It is a relationship based on clear boundaries. You know when and where you will meet. You know where you will be sitting. You know that you will not go for a coffee with your therapist after the session. It is also a very intimate relationship where you will, in time, risk sharing thoughts, feelings and memories that are painful and difficult. You might not have shared these thoughts with anyone else before. Paradoxically, it is the boundaried nature of the therapeutic relationship that makes intimacy safe and possible, at least, with time.

So talking with a counsellor or psychotherapist is safe?

Yes and no. Safety in the shape of boundaries is important, indeed, it is vital. However, therapy should not be too safe.  For therapy to be effective, it needs to feel safe enough (which is part of building that therapeutic relationship), meaning that the therapist’s role is to  challenge appropriately from within the relationship.

Is it Simply Talking?

It may look like that at first glance, but significantly more is going on.  Therapists listen to the content of what the client brings, but perhaps more importantly they listen for the feelings behind the content. This is what makes therapy an intimate process, as we allow our vulnerability to be seen by another and validated.

Grieving

Talking is a way of giving shape, form and understanding to experiences. Through language, previous unprocessed experiences can be processed. I often think of the example of Eskimos and their 50 words for snow.  Leaving aside whether this is completely accurate, the principle stands; the Inuit people of North America have far more words for the different types of snow than the average British person. These differentiations in the types of snow enable the Inuit people to make sense of their surroundings and navigate safely.

By giving shape and form to our losses through language, we can start to process them and grieve.

Working in the Relationship

Returning to the concept of working in the relationship, this is where the skill of a good counsellor or psychotherapist comes into its own.  It means to form an authentic relationship with the client; to experience our own emotions in relation to the client and pick through what is theirs, what they are evoking in us and what is simply ours.  This is often summed up as working in the transference (see blog on transference).  It is a subtle, complex and ultimately transformative way of working whereby the therapist helps the client give shape, form and language to their losses which are played out in the relationship between the therapist and client: what remains unresolved in us is destined to be repeated.

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 transference?

I am sometimes asked, “What is transference?” Some patients are strongly negative towards the idea (of how they understand) the concept. A blog seems like a good opportunity to de-mystify this term and emphasise its importance to psychotherapy and to psychodynamic and psychoanalytic counselling.

Freud Again!

The notion of transference dates back to Freud. He used the term to describe how patients will project, or quite literally, transfer their feelings from a significant childhood relationship onto their psychotherapist.

The notion of transference is not limited to the therapy relationship. It’s something that is happening all the time in our lives, we simply are not aware of it. For instance, we may respond with anger or frustration if we ‘hear’ our partner use a tone of voice or phrase that a parent once used with us. Conversely, we may be drawn to someone because somehow they remind us of a family member with whom we enjoyed a close relationship.

We constantly invent stories about others with whom we interact. Some of these stories may be accurate based on non-verbal cues, but others are examples of transference.

What’s Wrong With That?

The underlying principle of transference is that it is an unconscious process and therefore, we are unaware of it. While we are engaged in unconscious processes, the conscious part of us is always playing ‘catch-up’ by inventing reasons for why we behave in a certain way or for the way we feel about another person.

In the therapeutic relationship, the patient starts to transfer ideas, fantasies, and feelings onto their therapist. This occurs because the patient knows relatively little about the life of their therapist. What is transferred by the patient onto the therapist becomes the basis of the collaboration in understanding the patient’s relational patterns, childhood traumas and unresolved conflict. In essence, transference becomes a window into the patient’s past.

Counter-Transference

Counter-transference is the term used to describe what the therapist feels in relation to their patient. It is the therapist’s part of the entanglement of the relationship. It enables the therapist to become aware of what the patient may be feeling towards them or eliciting in them. Counter-transference shows why it is so essential for psychotherapists to be well trained and to have undergone their own rigorous analysis or psychotherapy. This enables therapists to distinguish which feelings come from their own unconscious process, and which are counter-transferential.

So transference matters?

Transference is the foundation of the work in psychoanalytical psychotherapy where the unconscious forms the basis of understanding a patient’s struggles.

Is transference risky, or something to be scared of?

In a word, no, providing your psychotherapist is experienced enough to work in the transference and to be aware of unconscious processes. A psychotherapy process should never be dangerous, but nor should it be too safe. It is a daring adventure into the unconscious inner world that can be painful and difficult. Ultimately, however, it carries the goal of relieving suffering and trauma. And delivering freedom from the shackles of the past.

In other words

British analyst Harry Guntrip summarised the purpose and role of transference thus:

“Transference analysis is the slow and painful experience of clearing the ground of left-overs of past experience, both in transference and in counter-transference, so that the patient and therapist can meet “mentally face to face” and know that they know each other as two human beings. This is without doubt the most important kind of relationship of which human beings are capable and is not to be confused with erotic “falling in love”.

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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Learning to be dependent in the pursuit of independence

When learning to be dependent is necessary

‘Dependence’ is a term that can carry negative connotations. To be ‘dependent’ might imply that we are unable to function alone and that we are unable to be the agent of our own life. It can also be interpreted as subscribing to outdated ideologies of male/female gender roles – the belief that women should be dependent, and men independent.

However, as is often the case in psychotherapy, learning to be dependent can be exactly what a person needs to do. As is always the case in psychotherapy, this dependence is with a view to enabling the client to become genuinely independent. In this sense, dependence is, therefore, a paradox.

Pseudo-independence and emotional neglect

I have previously written about the false sense of independence that some people have, which is born out of emotional neglect – a type of pseudo-independence. In a former blog, I referred to Boarding School Syndrome, in which the illusion of privilege masks emotional neglect and serious attachment disruption.

Pseudo-independence is an extreme reaction against dependence rather than true independence. If, as children, clients have been let down emotionally, or worse, neglected, they learn that nobody can be relied upon. It doesn’t matter whether this neglect came from an upbringing in the social care system or from within the gilded prestige of a boarding school education. These individuals might seem very capable and strong. However, this apparent strength is a mask to protect them from connection, relationships and dependence in the ordinary sense of the word.

Beneath the highly developed outer mask (in the case of neglect couched as privilege) lies a fragile interior. These clients crave connection. They want to be seen and validated for who they are and how they feel. But they find this terrifying. So, instead, they will often throw themselves into high-powered jobs, extreme hobbies or anaesthetise their inner voice with fine wine or expensive drugs.

In the case of someone who has experienced a more outwardly evident neglectful childhood (such as being raised in the social care system) the exterior shell of pseudo-independence is generally less polished and socially acceptable. Instead, their pseudo-independence may be shown through a turning away from society in the form of criminality and a “don’t mess with me” exterior.

How does learning to be dependent lead to healthy independence?

Well, psychotherapy is about learning to have a relationship with both our therapist and with ourselves. It is a process of giving voice to parts of ourselves that we have had to repress, split off or even kill off to survive. It is a relationship in which, week after week, the client learns to be seen and heard, to be accepted and validated. Little by little, if the client allows themselves to really feel seen and heard, and believes it, then it must mean that the other person in the room matters to them. Thus, it is through the psychotherapist mattering to the client that they can finally learn to rely on another emotionally.  Then, a collaboration can begin, with the psychotherapist coming alongside the client to help them make sense of their world.

In every psychotherapeutic relationship, the end is always in sight. It may be a very distant sense of an ending on the horizon, which may be many years away. Nonetheless, it is there. Therefore, the willingness of the client to allow the psychotherapist to matter to them, though this relationship will, one day, come to an end, is courageous. The process of becoming dependent and then becoming independent marks a shift in the relational quality of the client. If they can do this with a psychotherapist, maybe they can allow someone else to matter to them in an ordinary way.

Through learning ordinary dependence, which they never learned in the first place, clients can learn to navigate the ordinary ebb and flow of relationships. They will then discover that dependence on another is not terrifying, after all.  Even when we eventually have to say goodbye.

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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Boarding School Syndrome

The term ‘Boarding School Syndrome’ is one that was brought to public consciousness by Jungian analyst Professor Joy Schaverian around a decade ago. Since then, it has gained significant traction as a model for explaining the often seen experiences and symptoms of adults who were sent away to boarding school as children. Specifically, it is a term used to explain and understand the experience of a child who loses the consistency of their primary attachment figures which constitutes a significant trauma that can shape this child’s life throughout adulthood.

Like all mental health conditions, with the exception of a tiny minority, such as schizophrenia, boarding school syndrome (BSS) refers to a cluster of symptoms. When enough people present with similar clusters of experiences, behaviours or traits, and there is a clear correlation in their experiences, then a diagnostic category can be applied.  Officially, this is not yet the case with BSS, although more and more analysts and psychotherapists (as well as journalists) are using the term. Irrespective of whether the term has been formalised as a distinct diagnostic category, what is clear is the trauma that is frequently caused to children as a result of being sent to boarding school and how this impacts on their ability to form attachments as adults – intimate and connected relationships.

What is Boarding School Syndrome and why does it matter?

Psychotherapy is about helping people to grow a mind and better relate to themselves and those around them.  In order to do this, the clinician will often work with the client’s past experiences, either directly through dialogue, or in the relationship between the client and themselves.  The latter certainly constitutes the ‘relational approach’ which has been evidenced to be highly effective, irrespective of the underlying ‘approach’ to psychotherapy.

Schaverian (and others) suggest that BSS can be identified through disrupted relationship patterns, which with adults are generally found in romantic relationships. One of the characteristics of BSS is that what appears to be a strong sense of independence in the adult proves to be, in fact, a shell or mask, covering emotional vulnerability, depression, anger management problems and in more serious cases, substance misuse or abuse problems.

BSS affects both genders. However, as statistically, boys are sent away to boarding schools in higher numbers than girls, boys and thus men are disproportionately affected.  Add the social expectations on male middle-class and upper-middle class former boarders to adopt a ‘stiff-upper lip’ and the problems they face can become further entrenched and emphasised.

In my experience, former boarders will only present for psychotherapy once they hit a wall. This generally happens when addictive behaviours get out of control or when significant relationships fail.  Once the veneer of privilege and entitlement has been stripped away, the presentation of symptoms is akin to children who have been taken into care and raised institutionally. This results in a catastrophic attachment trauma that makes any form of genuine, close, intimate relationship extremely difficult.

All of the above would matter little, at least from the perspective of the individual in question, if they were to grow up comfortably inhabiting their own skin and needing a close relationships. Human beings are born into and shaped by relationship. We are relational to the core and this cannot be bypassed.

Boarding schools espouse entitlement, (pseudo)-independence and academic rigour. Once a child has been abandoned by his or her parents to this system, the best they can expect to develop is a ‘more-or-less’ robust shell that reflects back to the world the message that they are perfectly fine.  Deep down, they simply are not.

Neglect breeds a false sense of independence irrespective of financial privilege. Whether a child is abandoned to the social care system as a result of an outwardly chaotic family life, or the abandonment is couched in the traditions of boarding school, the attachment disruption and damage remains the same. The result is a false self-reliance with a deep wariness of their own vulnerability and a fear of relationships.  At least children who survived social care have a place to locate their problems – the neglect and abandonment is clearly visible and readily acknowledged by society.

There is no doubt that emotional cruelty has an enormous greatest impact on the developing mind.  And a mind is what we use to understand ourselves – our emotional world and our vulnerability. We also use it to understand the mind of others. Without a developed mind, we may be left adrift in a flood of emotion, which is more often seen with children who have come through the social care system. Alternatively, we become rigid and emotionally stunted, incapable of connection, which is conversely what we see with adult survivors of boarding school.

How to treat Boarding School Syndrome

As I have already suggested, the defence from emotional neglect is the development of a false and rigid sense of independence. This is established by having no attachment figure to soothe them and help them make sense of their inner and outer emotional world. The vulnerable child is still there, but many former boarders will deny its existence, mirroring the attitude of their caregivers. Alternatively, they may treat their vulnerability with disdain, saying things like, “I just need to pull myself together”, “All this wallowing is a waste of time”, and “I am sure you have more deserving patients to see, I really am fine.”

The work of the therapist, like any we do, is in establishing a close, supportive relationship with the patient. This enables them to start to make some tentative contact with his or her vulnerability.

Helping these patients imagine that they experienced neglect (and at times, abuse) can be an enormous piece of the work. For the patient this is hard to do, as it relies on a complete dismantling of a belief system – in their parents, in their privilege, in the institution, and lastly, in their false self.

Despite what former boarders have been taught, finding their way out of their suffering is not something they can do alone or with the help of a book. It relies on the very thing they find hardest; establishing a secure attachment with their psychotherapist.

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 narcissism?

Narcissism is a Freudian term that has become perhaps more ubiquitous in the social lexicon than any other derived from psychoanalysis.

It is a term that seems to define a generation in the eyes of the media – the Millennials, and one that we use disparagingly to describe celebrities before following them via social media, emulating them or electing them to the highest public office.

Narcissism in psychotherapy

In psychotherapy, narcissism is on a continuum from healthy to pathological. For example, it is entirely possible for a client or patient to lack enough healthy narcissism, in which case, the work is to strengthen their ego accordingly.

The sort of folk who get labelled as ‘narcissists’ – those who crave celebrity status, fame and live up to legend in seeking their reflection in the mirror that is society – rarely presents themselves for therapy. After all, why would they? They don’t have a problem – the problem is everyone else!

When we psychotherapists talk about narcissism and narcissistic defences and structures, it is rarely these people we are referring to. So how can we better understand narcissism as it presents in psychotherapy treatment?

What causes unhealthy narcissism?

Unhealthy narcissism is a defence.  Generally, it comes about through the young infant learning through relational patterns with his or her caregivers that he or she cannot rely on them, leading to a ‘turning away’. This turning away marks the beginning of a defensive structure built around self-sufficiency. However, this is not a self-sufficiency born out of healthy confidence, but one born out of emotional neglect.

Narcissistic structures are often well hidden in clients and patients and difficult to treat. Narcissistic patients and clients tend to treat all relationships, the therapeutic one included, as things that are there to be used and thus discarded when no longer of use. Relationships (in the truest sense of the word) are threatening at a core level to people who rely on narcissistic defences, as any true relating will open them up to a whole host of unbearable feelings and mental pain. The latter lies at the crux of the function of the narcissistic defence; the inability to cope with, endure and make sense of mental pain.

Is working with clients and patients exhibiting narcissistic defences a lost cause? Not if they willingly enter the therapy room and not if they are able to think about their vulnerable side and how they needed to develop a disdain for this part of themselves in order to survive. Without a doubt though, it will be a lively journey, because as the charming, likeable and self-sufficient façade starts to crack, rage, envy and mental pain will emerge and present themselves in the therapeutic relationship. This is often where the therapy can end, as the therapist is unable or unwilling to engage with the enactments that invariably will play out. If, however, these can be worked through, then there is genuine hope.

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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Mutual Disappointment – Surviving a Long Term Relationship

At a recent clinical supervision session in Lewes, my supervisor and I were discussing the realities of being in a long-term relationship. By long-term, we were thinking about decades, rather than months or years, and in this context, we were together considering what individuals must accept about a long-term relationship and thus about themselves.

It is a relatively recent phenomenon in social and human development that we pair-bond for reasons of love (rather than status, wealth or lineage) and thanks to modern medicine and increased living standards, we live much longer than our recent ancestors. The former brings great expectations around what our relationship should offer us; the latter means that long-term relationships can last for many decades.

In working with couples, I often invite them to think about the purpose of their relationship. This may not sound romantic and idealistic. However, every human needs a purpose (generally multiple purposes) and every relationship requires a mutually held sense of purpose to bind the couple together. And with longevity and changes to social structure now meaning that the sole purpose has ceased to be to raise children, the objective of a romantic relationship is likely to change throughout the time the couple spend together. I will write more about the purpose of a relationship in the future. However, for now, let us return to the cheery topic of mutual disappointment.

There comes a point in most relationships where there is a realisation that the person we have chosen, the person we lusted after and loved – were willing to change the direction of our life for –  is simply not who we thought they were going to be. I don’t mean that we are struck, as is so often the case, with the shattering of a delusion when we see our idealised partner do something human for the first time; we must all go through that shift where lust wanes, and we accept our partner is a fellow human with his or her faults. No, mutual disappointment is something deeper. Perhaps it strikes when we realise on a more profound level that the person we picked, with whom we built a life and chose to have children, has not delivered us the life we had imagined. Thus, mutual disappointment is not about discovering that our newly acquired lover snores, or leaves the cap off the toothpaste. It is a reflection of our disappointment and mourning of how our imagined shared life with our partner simply is not the reality.

It all sounds terribly negative. However, I would suggest that mutual disappointment in a relationship need not necessarily lead to rupture and conflict, as it is, in fact, less about our partner and more about ourselves. We must come to terms with the reality of our lives and accept that many of our youthful dreams for ourselves, and the partner who would perhaps rescue us from mundanity, cannot be fulfilled. Nor should they.

We are all bombarded by celebrity lifestyles on a daily basis. Programmes abound promising instant stardom, wealth and fame, which judging by viewer ratings, have an almost manic appeal as vehicles that offer us a chance of being rescued from our lives, and thus death. But the vast majority of us slowly, often unconsciously, let go of many of the unrealistic dreams we once held for ourselves that protected us against the harshness of life. With that, have to accept our partners as fellow humans who have disappointed us, whom we have disappointed, and who themselves are disappointed with who they turned out to be.

Framed like this, holding mutual disappointment in a relationship, making sense of it and mourning it potentially offers an opportunity for a deepening of the reality of what the relationship actually is – a mirror through which to experience ourselves and a system in which we can be understood. That, or we can have a ‘mid-life crisis’, buy a Porsche, divorce our partner and keep on running from the inevitable –  how the passage of time and the knowledge of our own mortality brings with it disappointment of what could have been, but what was not.

If you would like support in navigating the complexities of your relationship in our modern world, please contact us to arrange a consultation with one of our Couple Psychotherapists in either Hove or Lewes.

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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How to grow a mind?

The word ‘mind’ is one that most folks use quite regularly and comfortably. Us psychotherapists use it more often than most. However, to the best of my knowledge, nobody has actually seen a mind. So, what is a mind, and why should we grow one?

Those of you who follow us know that at Brighton and Hove Psychotherapy we believe in mind-body integration and espouse a range of approaches in order to facilitate this. Furthermore, our approach is also in keeping with the latest neuroscience findings on why therapy works So, back to the mind. While there are differing definitions, we believe that a mind is that part of a person that enables them to make sense of their world (inner and outer) and can navigate and mediate between feelings and intellect. If the brain is in the head (no disputing this fact) and emotions originate in the body as sensations, then the mind is what enables us to connect the two up (counter-intuitively, neuroscientists are now suggesting that rather than residing in the brain, the mind is in the body – just like the unconscious).

In psychotherapy, the mind is very different to intellect. We can all probably bring to mind folks who have academically brilliant intellects, but struggle to apply a rational, wise mind to how they relate to themselves and the world around them. It could be argued that some of these people even hold quite powerful positions in government and business, so sometimes having a limited mind does not hinder performance, at least in certain parts of our lives.

We grow our minds from the moment we are born, perhaps even in utero. A mind is grown from the mind of our parents (or caregivers) and thus, the quality of our mind is generally directly correlated to that of our parents. They are the ones who use their auxiliary mind to build ours, hour after hour, day after day, and throughout our young lives.

They begin by helping us make sense of the turmoil of the sensations we feel in our bodies as tiny infants and give shape and form to our emotions through naming them and normalising them. With time, they help us understand that we are not alone in the world, and so, while our own emotional experience really matters, so does that of those around us. Finally, they guide us in developing wisdom in using our minds to navigate a complex arbitrary world. That’s if it all goes to plan, anyway, and often it doesn’t.

If our parents’ minds are limited because their parents didn’t enable them to grow their minds, they won’t have so much input to give us. This is one example of inter-generational trauma. Or, if our mother was depressed after we were born, she won’t have the capacity to attune – to be fully present – to us. In fact, any form of abuse or neglect will have a detrimental impact on our minds.

To emphasise the difference between the intellect and the mind, consider the impact of boarding school, particularly where children are young. This is traditionally an environment where the development of the mind is forsaken in lieu of intellectual prowess.

Why does all this matter? Well, because psychotherapy is about helping clients grow and develop their minds where, for whatever reason, this did not fully happen when they were young. It is precisely why therapy cannot be rushed and needs to be consistent and regular. One cannot fast-track the growing of a mind.

Let’s move on to another word we use a lot and consider how this all fits together – trauma. Again, this is a word with many definitions, and it is very much the zeitgeist at present. Essentially, trauma in an emotional sense is shock that has not been processed. There are broadly two types of psychological trauma: single-incident trauma, known as PTSD, or Post-Traumatic Shock Syndrome, and complex trauma, also known as Childhood Developmental Trauma. They are fundamentally different and require different approaches. We can treat PTSD with a range of approaches including counselling, brief psychotherapy, Cognitive Analytic Therapy (CAT), EMDR and energy psychotherapy, to name a few. All of these can be very effective. None of them grow a mind.

Childhood developmental trauma, or, as I prefer to think about it in most cases, a lack of parental attunement, requires a slow consistent methodical relational approach to enable the development of the client’s mind. This is what depth psychotherapy offers and the research – back to neuroscience – evidences that the relational approach does this best.

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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Being in therapy is the most normal thing

While stigma around mental health issues remains an issue, there is an increasing willingness to talk about mental health issues both in the media and in society as a whole. Even if much of that talk centres around the woefully inadequate state provisions for mental health support and treatment, to some extent, the debate is being had. This can only be a good thing. For counselling and psychotherapy, the knock-on effect is that more people are willing to enter into therapy, prompted often by some crisis in their inner or outer world. Again, this is a good thing. However, to limit thinking about counselling and specifically therapy to a support or treatment for mental health problems or as something that is to be accessed only during times of crises misses much of the point.

Recently, a client of mine told me about a trip to the cinema at the weekend. As he was sitting in his comfy chair enjoying the prelude to the main feature, the screen flashed with three words: ‘Amazing. Awesome. Astounding.’ What transpired next was not God revealing himself/herself from the heavens (or insert whatever experience that would, quite literally, bowl you over with awe.) What came next was a preview of the films being released this summer. My client relayed this story, remarking on how nowadays everything seems to have to be somehow awe-inspiring. It no longer seems to be enough to simply state, albeit with a small degree of marketing spin, ‘Here are our new releases this summer, which we really think you will enjoy.’

This brings me back to psychotherapy and how being in therapy is the most normal thing in the world when the world seems to propel us to feeling and expecting a life of extremes. Therapy is not extreme. It is a weekly dialogue, often on the same day and time, that continues. It is a space and within that, a relationship where we can learn to be ‘normal,’ if normal means becoming curious about the subtle nuances of experience, understanding why we may react a certain way and how our past subtly but continuously influences our present until we shine the light of consciousness upon it.  And it is about how a relationship develops over time without needing the extreme highs and lows of excitement and chaos to make it meaningful; the relationship to our psychotherapist and to ourselves.

So, paradoxically, if being in therapy is about being normal and finding a way to be normal in the world outside of therapy, this is then perhaps exactly what makes it if not abnormal, then quite unique in a world where nothing ever seems enough. Being in therapy during a crisis can be very holding, supportive and important, but it is not really psychotherapy. Psychotherapy is the very normal process of being in a contained, meaningful, ongoing dialogue with another human being through whom we can get to know ourselves and recognise that we are simply normal after all, and that that is a good thing.

If you would like to explore the ‘normalness’ of an ongoing therapeutic dialogue with one of us in either Hove or Lewes, please get in touch.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice.

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Managing conflict for emotional and physical health

In our last blog, I discussed the correlation between expressed anger and cardiac problems and repressed emotion and back/muscle pain in warring couples.

The article gave some interesting insights into the correlation between couples who cannot fight healthily and the poor health they experience as a consequence. So should we avoid fighting? No, we need to be able to disagree with our partners and express our emotions. So how do we do this healthily?

Couples who manage conflict well are able to undertake four key tasks:

  • Listen
  • Accept difference
  • Validate
  • Repair

The idea of listening to our partner sounds like the easiest thing in the world. After all, we do it all the time. However, truly listening means hearing how they are feeling rather than focusing on the content or facts. The facts matter as context, but your partner’s feelings are what is key.

Accepting difference in our partner can be really hard, especially when we have learnt that difference threatens a relationship. For example, we may have learned that we were not allowed to have our own subjective experience of the world when we were growing up. Perhaps our parent(s) expected us to enjoy what they enjoyed or they simply told us we were wrong when we expressed a negative or strong emotion. If this is the case, then it is likely that we will experience a difference in opinion with a partner as threatening.

Validation is a behaviour and state of being requiring empathy. To validate our partner means seeing them as separate to us and letting them know that we can accept their experience. It does not mean making them right and us wrong. This is often where couples stumble as they subscribe to the idea that there can only be one correct perspective.

Lastly, healthy and happy couples are really good at repairing their relationship and nurturing themselves and their partner after a fight. The health of the couple unit can often be gauged by how soon a couple moves through the four tasks, ending in repair. Couples who do this within an hour or two of a fight generally have better communication and are emotionally healthier than those who take days or weeks to repair their relationship.

These four tasks may seem simple, but the reality is that many couples simply never master them without support and guidance.

To discuss how couple therapy could benefit your relationship, please contact us for an initial consultation in Hove or Lewes.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice.

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How fights with our partner influence our health

I write a lot about how the mind and body are connected and that our emotions originate in our bodies. I also write about how change happens through learning to be aware of our emotions and being able to feel them without becoming overwhelmed or needing to suppress them.

Recently I came across a blog in the New York Times which considered a study conducted in the 1980s at the University of California, Berkeley, which aimed to show the impact that how we fight with our partners has on our health. It makes for interesting reading.

The researchers took a group of married heterosexual couples and asked them to first talk about their day together for 15 minutes (the control conversation) and then to shift to discussing a contentious issue between them. The study participants were filmed and their bodily cues were studied to establish the emotions they were feeling. As all emotions are embodied and many of us are unaware of what we are actually feeling moment to moment, this was a very accurate way of establishing what emotion the participants’ bodies were experiencing. For example, anger is expressed in the body with a lowering of the eyebrows, a widening of the eyes, flushing of the skin and an increase in the pitch of the voice.

The researchers then focused on two defence strategies that participants seemed to adopt when they were fighting – anger and stonewalling. The latter would be termed suppression or repression in the language of psychotherapy.

The results showed that those who expressed their anger had a predisposition to developing cardiac problems, while those who stonewalled (repressed their feelings) were more likely to experience back and muscular problems. What’s more, the study participants who reacted angrily seemed to never experience the muscular and back pains of the stonewallers, and vice-versa.

The finding makes sense in that uncontained anger will manifest in higher blood pressure, leading to possible cardiac problems, and what we repress is ‘held’ in the body.

The conclusion seems to be that poor relationships are literally bad for your health.

What the study and blog did not discuss is how to fight healthily, as all couples fight (and conflict can be healthy, not only in ensuring we are getting our needs met, but also in keeping the relationship alive). It also implies that anger is detrimental to our health, which it most definitely is not, provided we can experience and communicate it healthily.

In our next blog we will discuss some tools for managing healthy conflict in relationships. Or if you want help with your relationship or managing your emotions, please contact us for either individual or couple therapy in Lewes or Hove.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice.

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On Brexit and the Psychological Defence of Splitting

On Friday, everybody in the UK awoke to a new world. The dust has yet to settle and the repercussions of the vote to be enacted; we live in interesting times.

Whilst I have a view on whether we should or should not leave the EU, this blog is not about that. It is about how as a population we have literally been split down the middle and how this process – splitting – can be seen as a psychic defence process of the same namesake. If it does, what does it say about all of us?

Splitting is the technical term for ‘black and white’ or ‘all or nothing’ thinking. We can all be guilty of this at certain times – particularly when put under pressure and feeling fear (more about this shortly.)

Splitting is therefore an inability of a person to mentally hold the positive and negative qualities of self and others: it a failure to mentalise – to hold an integrated self and other in mind. It is described as a primitive defence (primitive referring to a defence we learn early in life) and stems (or so the theory goes) from the infant’s inability to see both the satisfying aspects and frustrating aspects of their caregiver’s attention to them as being from one and the same person. The infant therefore ‘splits’ the parent (or object) into a ‘good Mummy’ and a ‘bad Mummy’.

How does splitting work in relationship? Well with relationship to others, it creates enormous instability, as the other is experienced as either good or bad, loving or hating, black or white, British or foreign. And this split is experienced in the relationship to self too, so that undesirable, unthinkable or unacceptable aspects of the self are ‘split off’ and projected onto others, further fuelling the relational instability. Interestingly, splitting is one of the defences most associated with Borderline Personality Disorder.

The campaign for the EU or for the UK – as it was presented to us – has left the population with little ability to hold their splits by virtue of it culminating in base choice of ‘Remain’ or ‘Leave’. Add to the mix the fear and hate-based rhetoric by politicians and the media, and it becomes a challenge for any one of us to not become aroused (impassioned) about our positions by denigrating the views of the other camp.

I would suggest that the reality for all of us is that how we feel about the EU and Britain’s identity and role in Europe – and therefore by extension our own role and identity – is conflicted. Again, whilst remaining unbiased in my views, factual evidence would suggest that being a member of the EU has brought benefits and challenges and idea of leaving promised, at least in phantasy, much the same (again, phantasy as much of what was promised stirred unconscious desires of identity and safety without us as yet having an evidence that this will be the outcome).

So now, in the aftermath of the vote, where the political establishment is in turmoil and the media in overdrive, how do we reflect and hold our splits? Perhaps we can recognise that in every Remain voter, there is a part that would vote Leave, and that in every Leave voter, a part that would vote Remain. To accept this means accepting that ‘the other’ is not inherently evil, stupid, or self-centred, but has felt obliged to split off their conflict and ambivalence.

Being honest with ourselves about our own splits and how fear, stress and the political system forced a split is the first step, the second is perhaps in noticing that nothing has as yet changed. We are all feeling stress and worry, which raises our arousal levels and drives us to seek a sense of knowing and security – this is human nature. But pausing, breathing, switching off the constant manic newsfeeds and slowing down will create significantly more of a felt sense of safety and security than continuing to allow the chaos to create psychic splits in us that cause us to react rather than act.

For some tips and guidance on developing a daily practice that can help bring about a felt sense of stability and calm, please see our blog on mindfulness.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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Does psychotherapy cure addiction?

Does psychotherapy cure addiction?

The answer to this question depends very much on whether addiction is seen as a disease in the medical sense of the word, and secondly, on whether it is indeed the goal of therapy to cure.

In response to these questions, I would suggest that rather than being a disease (as the 12-Step programmes are so fond of framing it) addiction is in fact a maladaptive way of managing uncomfortable feelings in lieu of more functional methods. Good affect regulation – the art of navigating our constantly changing emotional states – depends on our ability to use our mind to self-soothe and seek out other humans who will be available to witness and validate our experience. For some, reaching out to others is simply too frightening, and it becomes safer to use a substance or behaviour as a pseudo-other.

I would further suggest that the role of good psychotherapy is to help clients to build their minds so that they can use their minds to regulate their emotional state (see my previous blog on affect regulation.) It is not to cure. That does not mean that psychotherapy is not useful or an effective treatment, but it is a treatment to build the capacity to both process unprocessed experience and to help regulate affect.

What is addiction?

Addiction is a fascinating arena and one in which research is continuing, with conflicting ideas, views and theories competing for attention. However, some things have been established.

Addiction is a repeated behaviour that is used as a way of changing our experience and as a result changes our brain; the more we engage with the behaviour to change our experience, the more it changes our brain, making it more likely we then resort to the behaviour again. For many, it is a painful loop – especially where their addiction is socially unacceptable – drug addiction vs. being a workaholic – and has a higher cost of their relationship to self and others.

All addiction is chemical

Some researchers continue to try and draw a fundamental distinction between substance and behavioural addiction.  All addiction, I would argue, contains elements of both.  For example, someone who has an addiction to the most socially acceptable drug – alcohol – may find that their body goes through alcohol withdrawal when they stop drinking.  However, the success of their sobriety also involves letting go of significant behavioural aspects to their addiction such as socialising with certain friends; frequenting certain establishments; and even letting go of the pleasure of the ritual of pouring that 20-year old whisky from the decanter into a crystal tumbler at a specific time in the evening.  At the point of engaging in the ritual – moving to pour that drink – the addiction has taken over.

And behavioural addictions such as compulsive gambling; sex and pornography addiction and gaming addiction, to name a few, may on the surface seem to be simply behaviours without any substance influence, however, this is simply not the case.  Brain scans have shown that the brains of addicts light up in just the same way as those of substance abusers when that individual thinks about their addiction of choice.

Therefore ALL addictions change the brain and it can be argued that all addictions, irrespective of the substance or behaviour, are in reality an addiction to the chemicals and hormones released in the brain when engaging with that addiction – most notably, dopamine.

Addiction as an attachment disorder

Rather than viewing addiction as a weakness, disease or label for a person’s behaviour, it is far more helpful from both a compassion and treatment perspective to view the addiction as a way that that person regulates their emotional state, and to recognise that this has come about through a lack of emotional witnessing, validating and normalising behaviour (emotional neglect) on the part of their primary caregiver.  The behaviour and/or substance functions as a pseudo-relationship for the addict – one that feels far more consistent, safe and trustworthy than their experience of other close relationships has been.  This is also why despite loving their partners, families and children, some addicts simply cannot face letting go of their most important relationship – the addiction – and will forsake all others to protect it.

Who can heal the addict?

Psychotherapy is often critical in helping people with addictions to learn to adopt more functional ways of self-soothing and getting their needs met in relationship.  However all of this depends on being able to hold onto that thinking mind – the ability to mentalise – first and foremost and this can only happen through a prolonged and attuned therapeutic relationship.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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