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May 23, 2016 by Brighton & Hove Psychotherapy 3 Comments

On Affect Regulation

The term ‘affect regulation’ is one that I have written about previously and one that is increasingly used in the world of applied psychology and neuroscience. It can be a very useful term for bringing together psychology, biology and in explaining why good psychotherapy works, so read on!

What is regulation?

We all regulate (manage) the environment around us moment to moment. A good example of this is how we may regulate the temperature in a room by either opening a window or turning up the thermostat.

When we feel overwhelmed by our emotions, we become dysregulated. It is interesting that the language we use often reflects our experience of how we experience nature or bodies when we witness this dysregulation taking place. “She blew her top.” “He became hot and bothered.” “She went weak at the knees.” “She exploded with anger.”

Imagine a sunny warm afternoon, and you are relaxing in a nice safe place. If you don’t like the sun, imagine an environment where you feel contented and calm. There are no worries or stressors and life is good. In this state, you are likely to be regulated and in a state of ‘rest and digest’. However, as we all know, calmness is transitory, and soon a stressor will appear on the horizon. An irate relative calls, we realise we have lost our keys somewhere on our walk, our partner says something we experience as hurtful – the list is endless.

In this moment, our arousal levels increase. Arousal simply refers to the wide range of physiological, emotional and psychological changes that happen when our attention is drawn to a stressor that we perceive as something that needs dealing with. In this moment, we have moved from ‘rest and digest’ into a state of alertness.

Just as a room temperature on a micro level is never static, so our arousal levels are also never static. Whatever we think about, see, hear, smell, taste or imagine creates a change to our physiology on a moment by moment basis.

If our arousal starts to become too heightened, we can shift into a ‘fight or flight state’ (or freeze/fold state) where our thinking brain quite simply goes offline and we feel overwhelmed.

Being in a fight or flight state is useful if we are about to be attacked by a sabre-toothed tiger. However, in most day to day situations and interactions, it is simply unhelpful and can be damaging to ourselves and others.

Affect regulation is therefore the understanding and practical implementation of how we manage our emotions in the face of an ever-changing inner and outer environment.

How do we learn it?

In simplistic terms, we learn to regulate our emotions by our primary caregiver teaching us to do this. They literally help us make sense of our emotions by using their own nervous system to tune into ours and give form, shape and language to our experience. This is often our mother, as she will generally have the strongest and most frequent physical bond with us when we are very young, such as when we are breast-feeding. However, fathers have an equally important role to play in this process.

Time after time, our sense are flooded as infants by strong physiological responses which we have no capacity to make sense of. Time after time, our primary caregiver will soothe us, name the motion, witness our experience and normalise our response. Ideally, anyway.

Why does it matter?

Nobody enjoys living under the feeling of ‘being on edge’ all the time, or the opposite, of feeling bored, apathetic and ‘switched off.’

Both of the above states of being, although seemingly opposite, are in fact highly stressful states of being that put our minds, hormone systems, bodies and immune systems under enormous stress, just like we cannot ‘rest and digest’ when overly aroused.

Ongoing dysregulation does not only occur through poor attunement as a child (emotional neglect). It can also be the result of trauma characterised by PTSD.  However, research has shown that those people who lack the ability to healthily regulate their emotions are more prone to PTSD in later life (van de Kolk)

Types of regulation

Broadly speaking, there are two ways we regulate ourselves: we auto-regulate, and we regulate our emotional state interpersonally.

Auto-regulation is the ability to self-soothe; the ability to hold onto a thinking mind as arousal levels start to increase, to ‘think things through’ and then take action, rather than being at the mercy of our reactions. Examples of self-soothing techniques in the moment include mentalisation (holding onto that all important thinking mind) taking a deep breath, walking away from situations that are not in our best interest, through to engaging with external behaviours and activities such as yoga, going to the gym, meditation and lifestyle choices such as diet and good sleep hygiene.

Auto-regulation can also include a whole host of dysfunctional behaviours which, rather than stemming from taking action as a result of using our thinking minds, fall into the categories of reactions – a flight from emotions – such as addictions or narcolepsy (falling asleep when under emotional stress).

Interpersonal regulation is the most sophisticated forms of regulation and it involves using our thinking mind (from auto-regulation) to seek out other human beings with whom to share our emotions. All humans are wired for connection and while we can, and must, learn to auto-regulate in healthy ways, the fact of the matter is that our nervous system needs the nervous system of others in order to down-regulate our emotional state. Put simply, human beings are hard-wired for relationships and need these relationships in order to feel calm and content. This is arguably the fundamental principle as to why we pair-bond.

Why do some people find mindful auto-regulation and inter-personal regulation hard? Perhaps it is because it becomes very hard to hold ourselves in mind when the one person who should have helped us to learn to regulate our emotions could not do that. This makes auto-regulation hard to do. If that primary carer could not do it for us, why would we trust that anybody else can?

 How does psychotherapy help regulation?

Good psychotherapy starts with helping clients to make healthier choices in auto-regulation. This all helps to bring down chronic stress levels and forms the foundation of bringing that thinking mind online – the beginnings of the process of mentalisation.

However, the real goal of therapy is to help clients to grow their minds and find – perhaps for the first time – safety in a relationship where they can entrust their precious mind and nervous system to be seen, witnessed, validated and ultimately regulated by the mind and nervous system of their psychotherapist.

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

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Filed Under: Mark Vahrmeyer, Mental health, Neuroscience Tagged With: affect regulation, Psychotherapy, PTSD, Trauma

May 16, 2016 by Brighton & Hove Psychotherapy Leave a Comment

Remembering in order to forget

It is not unusual for prospective or current clients in psychotherapy to ask, “What is the point of me remembering that and feeling sad, upset, angry (insert whichever uncomfortable emotion comes to mind)?” And even when not posed directly, the question plays in the unconscious through resistance in the therapy and a quick shift of content or a dissociation from emotions that are coming up.

Remembering to forget lies at the heart of psychotherapy, and it is no coincidence that, like so much in the world of therapy, it is a statement with more than a hint of the paradoxical to it. After all, how can remembering possibly lead to us forgetting? Perhaps the answer, or one of the answers, to how this paradox unfolds lies in why we often seem destined to repeat the past in our lives – a key factor in what often brings clients to therapy.

The past repeats – particularly in our relationship to ourselves and others – until we become conscious of our past; our unconscious drives us until it is brought into consciousness. One way of thinking about this is that as we travel through life, we all collect trauma (with a small ‘t’.) Trauma is shapeless and formless, yet, once again paradoxically, it takes a substantial hold and can exert significant influence over our lives. Trauma, or the effects of it, also reside in the unconscious – the body.

Therapy is about giving shape, form and language to trauma – whether that is trauma with a small ‘t’, or more substantial trauma in the shape of single incident PTSD or Complex Childhood Developmental Trauma. We give shape, form and language to our trauma by listening to the communication of our unconscious which uses symbolism, repetitive behaviour and the body to communicate to us.

This is why we need to remember.  We remember so that we can bring our emotional being back into contact with the sensations, emotions and feelings that were evoked when the event we are remembering occurred.  Our emotional system is not linear or logical: when we remember, we feel what we felt at the time.

What good is it to feel what we once felt?

It is only though the remembering of the felt sense – the somatic memory – that we can allow our emotions to express themselves in the way they could not at the time of the original event or experience. And unexpressed emotions do not go away, they simply find other ways of telling us that we are hurting.

Psychotherapy is about feeling those unexpressed emotions – giving shape, form and language to them – and allowing ourselves to feel without becoming overwhelmed.

How do we know the outcome will be different this time around?

We may find we are defended against remembering as, after all, it did not make us feel better when we felt the pain the first time around. The art of feeling, whilst staying present with the here and now as well as being attuned to and witnessed by a psychotherapist is where the potential for change resides.

And so it is through a grounded and gentle approach to being witnessed and validated in our process of remembering that we can process our trauma and finally allow ourselves to forget the need for unconscious reminders that dominate our lives. Remembering to forget thus ceases to simply be a paradox and instead becomes a road to freedom.

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

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Filed Under: Mark Vahrmeyer, Psychotherapy Tagged With: memory, PTSD, somatic memory, Trauma

April 25, 2016 by Brighton & Hove Psychotherapy 2 Comments

My approach to psychotherapy

Every psychotherapist has a view on what therapy is and how they practice.  As I write this blog, I am drawn to my bookshelf filled with tomes by both historical and modern clinicians, detailing precisely how to practice this art that is psychotherapy.

Having recently commissioned a set of videos introducing Brighton and Hove Psychotherapy and explaining how my colleague Sam Jahara and I work, I was faced with the daunting prospect of trying to convey just this – how I practice – in a couple of hundred words, no easy task!

However, the process of writing my script and recording my video to camera has brought into focus for me what I believe works in bringing about therapeutic change and it comes down to two fundamentals.  Want to know more? Then read on:

My first guiding principle is on the importance of Mind–Body integration.

What do I mean by this?

therapy chairsWell, our bodies are literally where our emotions originate and where trauma is held.  In Freud’s language, we can say that the unconscious resides in the body.

And it is by using our minds – our conscious – that we can make sense of what we are feeling and can begin to stop emotions driven by past experiences from dominating our present lives.

Healing cannot happen without this mind–body integration.  My job, therefore, is to help you to learn to feel all of your emotions without becoming overwhelmed or needing to cut them off.

This means paying attention to your emotions in your body while holding onto a thinking mind.

The second principle that guides my work is a profound belief in the power of the therapeutic relationship between the client and the therapist.

You see, most of our trauma happens in relationship and I believe that it can therefore only be healed in relationship. The relationship with a psychotherapist is an environment where profound healing can happen through not only learning to make sense of our feelings, but in allowing ourselves to feel emotionally witnessed and validated by another human being.

So there you have it – integration and affect regulation through the therapeutic relationship are, in my view, the key fundamentals leading to change. Keep an eye out for our new videos which will be uploaded to our website in the coming weeks to find out more about me, Sam and our practice!

And if you would like to know more about my approach and how I may be able to help you personally, have a look at my profile on our website and give me a call or drop me an email.Mark Web

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

Photo credit: Sander van der Wel

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Filed Under: Mark Vahrmeyer, Mental health, Psychotherapy Tagged With: Brighton and Hove, Mental Health, Psychotherapy

March 21, 2016 by Brighton & Hove Psychotherapy Leave a Comment

Top tips for breaking a bad habit

We all have bad habits.  Some are fairly innocuous and others, at the extreme, can develop into behavioural addictions.

Many of us try our hardest to break bad habits, but end up failing miserably.  There is a particular time of year – New Year’s – when many of us set out to ‘turn over a new sheet’ and to give up on habits that may not serve us.  And the statistical evidence shows that on average, only around 8% of us manage to stick to our resolutions.  We then generally put this down to us being weak-willed in some way, but the real reasons why breaking a bad habit is so hard are more complex.

Why are bad habits so hard to break?

Neuroscientists are starting to unlock the secrets of how our brain plays a key role in us staying stuck in old habits.  And it has a lot to do with dopamine – a neurotransmitter that helps control the brain’s reward and pleasure centre.

Our brain gets very easily distracted and searches for past rewards that it felt when engaging in an activity – even when the rewards are no longer there or perhaps never were.  Dopamine causes our brains to gravitate towards behaviours and activities that were previously pleasing.  And once a habit gets laid down, we have much less control of our brains than we like to believe.

So, rather than being weak-willed, our brains (or a part of them) are hijacking our behaviour to seek out its dopamine hit.

Top tips

How do we break this cycle?  Well, researchers are now suggesting that instead of focusing on stopping the negative behaviour, we should instead focus on replacing it with a new one that will give our brains some reward.

The first step in this process is to identify what the exact nature of the reward is that we get from the behaviour.  For example, if we find that we snack late at night because we are hungry, then changing meal times; changing food types; moving exercise routines etc. can all help to change our cravings.  It may be, however, that we snack because we are feeling bored, in which case, going for a walk around the block may be a suitable substitute.

In the 12-step program, participants are invited to HALT before engaging with their addiction.  HALT is an acronym that stands for asking the questions: ‘Am I Hungry, Angry, Lonely or Tired’.  Often, it is one of these feelings that is driving the addictive craving.

So, instead of self-critiquing when we once again go down the rabbit hole of a bad habit or addiction, get really interested in the following questions:

  • What am I feeling?
  • What triggered me? – time of day, activity (e.g. drinking correlating to smoking)
  • What would meet my needs in this moment?

By engaging with these questions, you can take control by focusing on putting in place a behaviour or set of behaviours that makes you happier and provides your brain with dopamine for the right reasons.

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

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For more information, click here to download our guide on habits, including top tips on breaking habits.

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Filed Under: Mark Vahrmeyer Tagged With: Brain, habit, Health, self-care

March 14, 2016 by Brighton & Hove Psychotherapy 2 Comments

What is attachment and why does it matter?

Attachment theory is something I draw on a lot in my practice.  However, unlike psycho-analytic theory, the concepts are relatively simple. Simply put, attachment theory describes how we respond to relationships.

There are broadly four different styles (or, as I prefer to think of them – adaptations) of attachment: secure; avoidant, ambivalent; and disorganised.  Briefly, they are defined as follows:

Secure individuals are people who received ‘good enough’ parenting (Winnicott) and feel they are able to navigate life without unnecessarily reacting to emotions and either becoming overwhelmed (fight) or dissociating (freeze).  They are also people who, generally, feel like they can get their needs met in relationships and for whom intimacy is possible.  Bar some later trauma in life, securely attached individuals rarely present for therapy.

Avoidant (adapted) individuals are those of us who feel that relationships are inherently unsafe and that they cannot rely on the other.  They have a tendency to keep people at arm’s length, especially when they experience a relational stressor.  To cope, they may make themselves unavailable to their partner (through other commitments) and avoid being vulnerable.

Ambivalent (adapted) individuals struggle with the internal conflict of wanting intimacy and thus moving into relationships quite quickly, only then to slam on the brakes when they perceive an attachment disruption.  They feel trapped (under stress) between wanting closeness but pulling away for fear of being hurt.

Disorganised (adapted) individuals are people who have experienced significant childhood developmental trauma and have more than likely been born to mothers who have also been traumatised at a relatively young age.  They are people who struggle enormously to contain (in the body) their feelings and to make sense of them (mentalise).  Relationships for people with a disorganised attachment adaptation are fraught with threats, intensity and chaos.  It is likely that individuals presenting with this attachment adaptation as their predominant style may have a personality disorder.  And, yet, personality disorders can be treated too, under the right clinical conditions.

Misconceptions

As is often the case with models and classifications, people can believe that they have one attachment style and that this is fixed. Whilst we may have developed a default adaptation in relating, this adaptation only surfaces when we are under stress. Let me explain:

Imagine you are with another with whom a budding relationship is developing. You are both relaxed and sitting in the sun in a place that both makes you feel safe and comfortable.  There are no stressors present – alcohol, drugs, conflicting conversations, other people who may threaten your relationship, etc. In this context, irrespective of what your default adaptation may be, you will most probably be in a state of secure attachment.  That is, in a secure relationship with yourself and the other.  This is really critical to understand, as it means that even in those of us who have experienced significant childhood developmental trauma and attachment disruption, the propensity to feel securely attached resides in us all and can be built upon in the therapeutic work.

Neuroscience and neuroendocrinology

What makes attachment particularly interesting is that it requires a focus on mind–body integration, as all emotions originate in the body (see my blog on the pyramid of change) and we need a mind to help us make sense of what we are feeling.

Theoretically, attachment principles can be applied to any psychotherapy ‘model’. as long as the emphasis is on helping the client understand what they are sensing in their body; what this feeling is telling them; how to contain it; how to make sense of it.

However, attachment theory is coming to the fore of psychotherapy thinking around change that happens as the principles of healthy attachment are being evidenced through neuroscience findings.

Neuroscience is showing that when we are securely attached, we are able to feel our emotions without becoming overwhelmed and reacting.  And it is showing how our fear centre of the brains (the limbic system) can become primed to react at the slightest perceived danger.

Neuroendocrinology – the study of brain and body (hormone system) integration is showing us that secure attachment is a state of optimal health in both the brain and the body. In brief, to be in a state of insecure attachment leads to higher stress hormones being present in the body; lower immunity; higher anxiety; and less ability to mentalise.

Mind-body integration in attachment reparation

How do attachment adaptations come about? Why would one child generally be considered securely attached and another a variant of insecure? The answer to this is complex. However, two variables stand out above all others, and those are how much the child was attuned to as an infant (particularly pre-verbal) and how much the child was encouraged to be themselves in the relationship with their primary caregivers.

It is these two variables that stand relational psychotherapy is a very strong position to repair attachment trauma – to re-parent the client.

The role of the therapist is therefore to help the client understand what they are sensing and feeling in their body and what feeling that translates to: a variant of the five core emotions of joy; anger; fear; sadness; and disgust.

The therapist is then there to work with the client in remaining present to the feelings in their body – avoiding overwhelming or dissociation – so that little by little the client learns to navigate their universe of emotions.  And how does all of the above happen?  Through careful attunement – nervous system to nervous system; body to body; mind to mind – and through validation of what the client discovers they feel.

Secure attachment is the goal of therapy for a healthy mind; healthy emotional system; healthy immune and endocrinology system; and healthy relationship patterns (intimacy with self and other).  Sounds like a good goal to me!

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

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Click here to download our guide on attachment for more information.

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Filed Under: Attachment, Mark Vahrmeyer, Psychotherapy Tagged With: Attachment Styles, Neuroscience, Psychotherapy, Trauma

February 22, 2016 by Brighton & Hove Psychotherapy Leave a Comment

Anger Management: Often Mismanaged

Anger management is a common term used in working with clients with anger issues.  Even Hollywood has capitalised on the term as a title for a movie, which unsurprisingly was directed at a largely male audience.

At Brighton and Hove Psychotherapy we offer work on ‘anger management’, however, what this actually comprises may well be quite different to other clinicians, so read on:

What is anger?

Anger is one of the most important emotions we can feel.  It gets a bad rap with nobody wanting to be labelled as ‘angry’ – it is much more endearing to be sees as a ‘happy’ or ‘content’ person.  However, it is impossible to feel happy or content without feeling anger.

Before we get into what anger is, it may be useful to revisit the basics of how feelings like anger come about.  In an earlier blog entitled ‘The Pyramid of Change in Psychotherapy’, I described just this.  In brief, we are all ‘embodied’ being, meaning we are one with our bodies and our bodies are constantly feeding us data through sensations, changes in our physiology, changes in sensation, right down to the tiniest change in cellular structure.  Our physiology translates to our emotions, which is literally our physiology ‘in-motion’.  Groups or clusters of emotions are feelings which in turn lead to the generation of our thoughts, in turn embodied in our behaviour which gives us the external results we experience.

So, anger is a physiological response to a real or perceived external stimuli.  Most of us experience anger as tension or tightness in our core.  Anger in its most profound and pure form is our body saying ‘no’ and is a response to a boundary violation (real or perceived).  The greater the boundary violation, the greater the anger.

Therefore, anger is vital to us in knowing what is right or wrong for us moment by moment.  It enables us to define, communicate, protect and if necessary, fight for our boundaries.

I don’t want to be an angry person!

Nobody is any one kind of person.  Folks who are labelled as ‘angry people’ and generally hyper-vigilant and feel unsafe in the world.  They are either enraged, or waiting to be.

‘Angry people’ have generally learnt that they are not allowed to relate is a healthy way and to communicate their boundaries knowing that their wishes will be respected.

The healthy expression of anger became dangerous to ‘angry people’ growing up and they either had to swallow their anger (hold it in their body) or use rage to have some sense of safety.

Where we have had to protect our caregivers from anger – where it has been unsafe to say ‘no’ – we often end up holding a lot of anger.

Anger vs rage

Anger, like all other emotions, is a feeling that tells us something is not OK for us.  It may be a request by somebody, it may be someone trying to break into our house or it may be something as subtle as somebody standing too close to us.  Thus anger can be broken down into subtle nuances of frustration, irritation, annoyance through to feeling livid.

Anger always holds the other person in mind.  It is a feeling where we are able to state ‘no’ empathically.  We do not need to be abusive or defensive in stating no, and we don’t need to be responsible for the other.

Rage, on the other hand, whilst unpleasant to be on the receiving end of, comes from a place of powerlessness.  It is anger that could not be expressed healthily.  There may be times when rage is appropriate but in a relatively safe world, these times are rare.

Anger is a guy thing

Hopefully it is now clear that anger is vital to all of us for good emotional, psychological and physical health.

Both genders can carry unhealthy anger, however, how it manifests may be different and lead to the misnomer that men struggle with anger management.  Whilst I have come across plenty of ‘angry women’ and ‘depressed men’, it is not uncommon for men to express rage externally and for women to internalise it and take it out on themselves.  They are both experiencing anger and ‘mismanaging it’.

Anger: The Therapy Room Taboo

Too many counsellors and psychotherapists are scared of anger.  Particularly that of men.  This is in part because men can at times express their anger inappropriately and may in part be because many therapists are women who may not wish to be on the receiving end of a man’s anger.  Many male therapists don’t either for that matter.

Too often anger gets ‘misdiagnosed’ as either covering up sadness, or simply presents as dissociation (cut-offness) or depression.  Working with sadness and depression is important but through working with the anger, the client can start to feel empowered in a healthy way.

Good counsellors and psychotherapists are able to attune to clients and work in the therapeutic alliance through establishing a safe relationship and calming the clients fear system.  This is great, but it is only half the work.

Anger stemming from childhood developmental trauma (complex trauma) or PTSD, must be felt and worked through.  Clients need to first learn what physical sensations are their anger embodied and then learn to feel them in their body and stay present with them.

Pendulating through anger

All our emotions either increase or decrease our arousal levels.  Anger increases our arousal; calm decreases our arousal level.  Alongside this, every emotion is either moving us towards producing growth hormone and having healthy immunity or towards pumping stress hormones such as cortisol into our system (low immunity).

We also experience a journey with each emotion.  We feel an activation: so with anger a slight tension, an increase in heart-rate; some shallower breathing and a narrowing of our field of vision.  The challenge is for the therapist to teach the client to remain connected and curious about how they ‘do’ anger in their body and to stay present with the feeling until it subsides (and it will).  This is called pendulation.  More on this in another blog.

So, rather than anger management being about disconnecting from feelings of anger through dissociation or forcing a change in emotion through the body, anger management is learning to work in recognising anger as it manifests; to work through unexpressed anger relating to past trauma and to develop a healthy relationship with anger going forward.

Mark Vahrmeyer

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Click here to download our guide on Anger Management for more information.

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Filed Under: Mark Vahrmeyer, Psychotherapy Tagged With: anger, Psychotherapy, Trauma

February 8, 2016 by Brighton & Hove Psychotherapy Leave a Comment

What doesn’t kill us makes us weaker: Developmental trauma and attachment styles

There is a lot of wisdom in sayings that have been part of our language and culture for as long as we can remember.  For example, being ‘on the back foot’, meaning to be at a disadvantage or on the defensive, is a perfect expression of how our relationship to our body influences how we relate to ourselves and the world around us.  Likewise, to have a ‘gut feeling’ about someone or something, is really very profound as our emotional system (our unconscious) resides in the body and expresses itself somatically through, amongst other parts of our body, the gut.

However, one expression I come across quite often that is not only incorrect but also harmful is ‘what doesn’t kill us, makes us stronger’.  It is an expression which is frequently accompanied by a disavowal of any felt emotion in relation to the event being described and suggests that somehow we grow stronger and more resilient through trauma.  The latter is particularly true of childhood developmental trauma where an individual has been regularly misattuned to, neglected or abused.  In the case of developmental trauma, what doesn’t kill us makes us weaker and less adaptable to the realities of life.

Developmental trauma, also known as complex trauma, arises ‘when caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief’ – Dr. Bessel van de Kolk (2014).  Developmental trauma directly impacts on cognitive, neurological, psychological and immunological development of infants and maps onto our attachment patterns in later life.  In other words, we grow our brains and minds from our early experiences with our primary caregivers which lays down a belief system about ourselves, about those around us and about the world in general.

A little about attachment

OK, so developmental trauma correlates to attachment patterns.  What are attachment patterns and why do they matter?  It is generally accepted that there are four types of attachment: secure; avoidant; anxious-ambivalent; insecure-disorganised.

If a parent has been available to their infant and able to attune to their child’s needs, the child learns that it is safe to turn to that parent in order to seek soothing and reassurance, and then safe to turn away and carry on exploring the world when they feel calm again.  This child is securely attached and will likely carry this attachment style into his or her adult relationships.

The other three attachment styles are all classed as insecure and arise from childhood developmental trauma.  Avoidant infants learn that they need to be self-reliant despite their anxiety; Anxious-ambivalent children seek out their caregiver but fail to be soothed through a lack of attunement – they pick up their mother’s anxiety; children with disorganised attachment feel enormous conflict in their main attachment relationship wanting to approach for security and feeling frightened of doing so.

Attachment patterns matter for a whole host of reasons, however, on the most fundamental level, attachment patterns dictate whether we are able to use relationships (with ourselves and others) to regulate our emotions, arousal and anxiety.  An inability to regulate our arousal state means it is more likely that we will suffer with higher levels of anxiety and be predisposed to emotional, mental and physical illness.

Thus, in the context of trauma, attachment and our relationship to self and other, what doesn’t kill us progressively makes us weaker.

The role of psychotherapy is to help individuals process trauma and through the therapeutic relationship start to challenge attachment styles and patterns.  It is possible to shift over time from an insecure- to secure attachment pattern.

 

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

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Filed Under: Attachment, Mark Vahrmeyer, Mental health Tagged With: Attachment Styles, Bessel Van der Kolk, childhood developmental trauma, complex trauma

October 8, 2015 by Brighton & Hove Psychotherapy 1 Comment

Working with The Pyramid of Change

In our last blog, entitled ‘The Pyramid of Change’, we introduced the concept (and paradox) that in order to achieve results (change) the locus of attention needs to begin not with change but with the felt sense in the body.  How can we facilitate this?

Counsellors and psychotherapists are taught to ask one particular question, in many different guises.  It goes kind of like this: ‘And how do you feel about that?’.  But, this question is based on a very unrealistic and dangerous assumption: that the client can feel, knows what a feeling really is, and then how to distinguish between feelings.

The ability to feel, requires an attunement with our bodies.  The development of a moment to moment sensitivity to our physiology – the orchestra playing in our body – that brings forth our emotions, and enables us to define our feelings.

Most people presenting for counselling or psychotherapy have experienced some sort of relational trauma in childhood, the severity of which correlates to their pathology, or current relationship to self and others.  In attachment theory language, they are insecurely attached.  And remaining in attachment theory language, the role of therapy is to change that attachment style to one of secure attachment.  We re-parent our clients.  At least, that’s the idea.

When we assume that a client knows what they are feeling, we assume that there was enough attunement – bodily, psychically, emotionally and mentally – from their primary carer, for this developmental process to have been completed.  Sadly, this is very unlikely to have been the case.

The role of culture and gender

In the Western world, ‘feeling’ is not seen as helpful.  In fact, most corporate and political structures reward a lack of feeling.  Thought is prized above all else, yet few of us stop to think about why we are thinking a certain way.

Add into this generations of subscribing culturally to a patriarchal model that dictates that ‘boys should be strong’ and you have a recipe for disaster when it comes to people working out how they feel.  Most men have profound trouble defining a feeling and when they can, the feelings tend to be somewhere in the region of ‘OK’ or ‘shit’, with little in between.  Women may generally be slightly better at this than men, but their sensitivity to their emotional state remains curtailed by the mind-body split and social conditioning.

If, as is increasingly being evidenced through research in the fields of neuroscience and neuroendocrinology, results (change) are driven by an attunement to our physiology ,as the first step, and then the regulation of affect (physiology and emotions) through directly influencing our physiology, as the second step, I would suggest that as counsellors and psychotherapists our job is two-fold.

Firstly we are responsible for using our own physiology, emotions, psyche and mind – to help clients understand what they may be sensing in their bodies, how these sensations are travelling (emotions), how clusters of emotions comprise feeling states, how these feeling states influence their thoughts, how their thoughts influence their behaviour and how all of this ultimately contributes to how they experience themselves and others in the world (results).

The second step is to help clients tolerate their uncomfortable feeling states and whilst remaining connected to the here-and-now.  This is in part and initially achieved through the relationship in the therapeutic dyad, and subsequently in part through helping clients’ access tools (internal and external) that enable them to regulate their own emotional state (which we have blogged about before).

It is these two steps, that we believe, comprise results driven Functional Psychotherapy and should lie at the core of any treatment plan.  To quote Dr Allan Shore, psychotherapy is ‘an affect-communicating and affect-regulating cure’.

And, of course, there is a process preceding steps one and two that clinicians can come to overlook:  if we want to be able to offer this to our clients, we need to be able to do it for ourselves.  It can’t be learnt from a book, or in expensive training courses.  It is the cultivation and development of our own felt sense and emotional landscape.  Otherwise we are offering our clients mere insights, at best, which can only lead to short-term behaviour changes.  And behaviour changes, as we now know, lead to failure, as long-term change starts in the body and not in the behaviour.

So, to end, I would suggest that we all need to reconsider our intentions in asking our stock question of ‘so how do you feel’ and follow it up with variations on the following:

‘And how do you know you are feeling that?’; ‘What is happening in your body that tells you that?’; Notice that and hang out with it, how is that?’; and ‘What happens next?’.

Mark Vahrmeyer

Image Credit: Brighton and Hove Psychotherapy Copyright

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Filed Under: Mark Vahrmeyer, Psychotherapy

October 1, 2015 by Brighton & Hove Psychotherapy 2 Comments

The Pyramid of Change in Psychotherapy

Counselling and psychotherapy is about change. Whether that is a fundamental change in how we experience ourselves in the world, or in working through a difficult emotion and changing how we are feeling. Everybody who enters into a process of therapy is seeking change of some kind.

There are a myriad of books written about applied psychology, counselling and psychotherapy. These books use different psychological methods (theories) to explain people’s problems and how change can happen. However, whilst these thoughts, theories and models all talk about the process differently, what they all have in common is helping the client to change.

Whilst the process of change is difficult, understanding the fundamentals of what drives change and how we change can be really useful. At Brighton and Hove Psychotherapy we call this The Pyramid of Change.

What is the Pyramid of Change?

Humans are embodied beings (as are all living creatures). We reside in our bodies and are constantly receiving data from our bodies. The problem is that most of us have either never learnt to listen to our bodies, or have ‘tuned out’ the body’s messages. Why does this matter? Because all of our emotions, leading to feelings, leading to thoughts, leading to behaviours and, finally, leading to change or results, originate in the body – our physiology.

The base of the pyramid refers to ‘Physiology’ and can best be described the orchestra the body plays moment to moment. It comprises all our biological and emotional systems. For example, we all take for granted we are breathing and generally pay little attention to this process. However, through bringing our attention to our breath we can both get valuable feedback – am I breathing deeply or shallowly?; is my breathing fast or slow? – and we can then influence our breath. The same goes for our heartbeat – with some concentration we can become aware of our heart beat and feel it beating in our bodies and calm our heartbeat down (or speed it up).

Our physiology – the data stream from our body – is both influenced by our internal and external environment. For example, we may feel some discomfort in our legs after sitting for a long time informing us that we need to move position (internal) and our heartbeat will likely speed up if we hear a loud explosion or noise nearby (external).

This orchestra of the body, whether an itch on the top of our head, to a sensation in our big toe, provides us with a constant stream of data. And it is this data that comprises our emotions.

Emotions are data streams ‘in-motion’: the data being fed from all the systems in our bodies dictates what emotions we are experiencing. Emotions are synonymous with pieces of music – data from our body – that have a unique composition. They are felt states of arousal. And there are a lot of them. 34,000 have been identified!

Feelings, the next level up the pyramid, are the labels we apply to emotions. It is common in our language to say ‘I am angry’ or ‘I feel angry’. A more accurate expression would be ‘I am doing anger in my body’.

Feelings and thoughts are intricately linked. Through neuroscience we now know that whilst some thoughts can impact on our emotional state, generally the process works the other way around – feelings dictate our thoughts. The problem lies in the fact that as most of us are so cut off from our bodies, and thus cut off from the felt state in our bodies, we don’t know from one moment to the next what we are actually feeling and so go on the thoughts that seem to randomly appear in our minds.

Hopefully by now it may be clear that rather than being random, our thoughts are often driven by of feelings which are ultimately driven by our physiology. However, very few of us stop to ‘think about what we are thinking’ – to ask ourselves ‘how is my felt sense (physiology in-motion leading to feelings) influencing how I am thinking right now. If we did, we would discover the answer is in fact, quite a lot!

Our behaviour is driven by our thoughts. If we think we are enjoying something, we move towards it and vice versa if we are fearing something. There are plenty of studies that the human thought process can be influenced without our awareness leading to changes in behaviour. And these changes are driven by our physiology changing in response to the stimulus.

As a society we tend to focus on behaviour changes to change results. Examples are numerous from how children are schooled, how the judicial system functions through to how we try and create different results in our own lives through pure behaviour focused strategies that tend to fail. A good example most of us can relate to are New Year’s resolutions.

Change therefore, needs to be driven through an attunement with our physiology – by our psychotherapists and ourselves.

Our next blog focuses on the clinical implications of therapy in the context of The Pyramid of Change.

Mark Vahrmeyer

Image Credit: Brighton and Hove Psychotherapy Copyright

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Filed Under: Mark Vahrmeyer, Psychotherapy

August 27, 2015 by Brighton & Hove Psychotherapy Leave a Comment

A Plane Falls From The Sky

After some well earned time off over August, it had been my intention to write a blog on self care for psychotherapists.  However, as with all best laid plans, a more pressing topic has come to the forefront our of minds with the recent Shoreham air crash which resulted in the tragic deaths of (at present) at least 11 people.

Reflecting on my clinical work with fellow psychotherapist colleagues over the past week, we have each felt affected by this terrible tragedy and it has been notable how the theme has dominated our client sessions (with clients who, thankfully, have for the most part been only indirectly impacted).

This, ‘secondary trauma’ – the indirect exposure to trauma through the first-hand account or narrative of trauma – has been very present in the collective unconscious of those of us living in the Brighton & Hove vicinity (and particularly Shoreham) and it is this that I would like to spend some time reflecting upon.

For myself, the experience of the crash resonated with me as the location is a section of road I travel on twice weekly to my role as a psychotherapist in a palliative care capacity.  What has caught my attention is that the emotional and psychic impact of this particular tragedy seems to have been greater on myself, my colleagues and our clients than other tragic events that are sadly a frequent occurrence on this, and other busy roads – such as fatal road crashes.  Why might this be?

Like any good psychotherapist, I am not going to offer up one stock answer, as there will be different reasons and factors playing out for all of us.  However, I do wonder about how the nature of this tragic event has exacerbated the levels of felt death anxiety in all of us for one specific reason – the illusion of control.

Whenever I step into my car, I have some awareness of taking a calculated risk.  I can exercise some control over the level of risk through how I drive, how alert I am, my own levels of emotional awareness, all the way through to ensuring my tyres are correctly inflated and my car is road-worthy.  In other words, I use a combination of internal and external control mechanisms to reduce my risk levels and thus my death anxiety levels; some of these tangibly reduce my risk and others are illusory.  Where I can exercise no control – such as with how other drivers behave on the road – I need to surrender to trust and a belief that they, like I do, will obey the collective rules we have established as a society, that dictate how we behave whilst hurtling along at speed in small metal boxes called cars.

What happened on Saturday the 22nd of August was simply inconceivable.  It was a warm sunny day, people were going about their business – most of whom would have been on the way to or from undertaking some leisure of relational activity.  A plane falls out of the sky and a typical and familiar scene (to many of us) is instantly transformed to the equivalent of a war zone.  This is the perfect storm for laying down the root causes of a trauma response: we feel utterly out of control and what has happened lies beyond the range of expectations we carry in our consciousness.

I think it is perhaps the latter that has led to this crash manifesting in the collective unconscious much more than say a large and fatal multiple car crash.  The absurdity of it; the inability for the victims to exercise any control over their destiny (or feel that they could); the shock of the disruption of a perfect day; the randomness.

Being a human being is a tough business.  As far as we know we are the only animals on the planet whose brains have developed to the degree that we have sufficient consciousness of self to know that we are going to die; and with this knowledge we are supposed to live every day.  The only way we can cope with this horrific knowledge is to block it out to varying degrees and to do so we use many different ‘vehicles’ – religion; having children; hobbies; tyre kicking before we set off on a car journey; etc.  A plane falling out of the sky is unthinkable and brings up a universal anxiety in all of us – the thin veil of illusion falls away and we all face the prospect of our own mortality, or, as has been present in many of our clients’ lives, that of our loved ones.

11 people have died – a terrible and senseless loss of life; countless families have been directly affected and will need to come to terms with their loss and grief and even more have been traumatised by the possibility it could have been them, and this has rippled through the collective conscious and our unconscious death anxiety has been triggered.

But then something beautiful has happened which helps us once again put a psychic bulwark in place against the onrush of our death terror and express our humanness in the face of death – people have started to share stories of courage and kindness; communities have come together; grief is being expressed through cards, flowers and gifts – ritual as the antidote to the randomness of the falling plane; and most importantly of all, humans who feel affected are talking to other humans about what this has meant for them.  It is through this ritualisation of death and the emotional processing that only a relational context can provide, through constructing a narrative and shared experience, that we can start to work through the unthinkable, give shape to the trauma and feel that we can venture back out into the world, without feeling overwhelmed by our collective death anxiety.

Our condolences go out to the victims who lost their lives in this terrible tragedy and all those families who have been directly affected.

Mark Vahrmeyer and Sam Jahara

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Filed Under: Mark Vahrmeyer, Sam Jahara

July 13, 2015 by Brighton & Hove Psychotherapy 7 Comments

What is the purpose of counselling or psychotherapy?

Were you to ask a group of clinicians (counsellors or psychotherapists) to define the purpose of therapy , you will likely get a set of quite different answers based in a large part on the lens (modality) through which each clinician views mental health and their approach.  One would hope to find some degree of similarity between them, but ultimately, there seems to be no agreed upon objective apart from somehow ‘helping’ the client to feel better.  I see this as profoundly problematic.

It is a question that in my view is enormously ethical as surely, as psychotherapists, we have a duty to firstly do no harm, and secondly, to be of service to our patients?  If so, then what is the purpose of psychotherapy?

As psychotherapists, I would suggest we have to walk a line between holding a clinical diagnosis and being present with the patient’s experience; too much of a shift in either direction, and the ability to hold both the individual and their underlying psychic structure becomes lost.  We therefore need to have a clinical understanding of what is happening in the mind of the patient and to be able to work with this, whilst also remaining present with the patient’s moment-to-moment experience in the room – no mean feat!

Like any other clinician, I have my own lens – broadly psychoanalytic – through which I think about a patient’s mental state.  I am trained to work with the unconscious and thus believe in how past experiences and relational patterns repeat in the client’s experience of their lived experience in the present. Secondly, I believe that what has been damaged in relationship, can only be healed in relationship.

I am also heavily influenced by object relations theory, meaning the study of how a patient has internalised the relationship(s) with their primary caregiver(s) and then how this manifests in their relationship to themselves and their significant others.  However, not all clinicians believe in the unconscious (notably person-centred therapists) and not all work relationally.

Too much time and energy is taken up with the ongoing debate and argument about which approach and method is best.  Approaches to understanding a patient’s internal world are like languages – they often say something similar and in some cases can be literally translated but nonetheless, they also contain with them ‘cultural’ expressions and understandings that simply cannot be translated.  And where these cultural expressions form the bedrock of an approach, they can end up diverging significantly.  However, at their core they all seek to help patients make sense of their experience and aim to ‘help’, so where is the commonality?

I believe that perhaps it can at least in part be encapsulated by the following bullet points:

  • To assist patients in becoming aware of their emotional state, so they can know when they are experiencing emotions;
  • To assist patients in learning to express their emotions safely (to themselves and to others) using language (feelings), so they can become aware of and protect their personal boundaries;
  • To work with patients in separating the past from the present on an emotional level, so that they can experience their emotional response to the world based on their present needs, rather than on past trauma being re-triggered and replayed;
  • To teach patients to address their present and genuine needs – which will involve in turn them feeling satisfaction; frustration; and negotiating – as opposed to repressing –  their needs to protect an attachment.

Whilst I technically work within the realm of mental health, very little of my work is genuinely about any sort of psychiatric disorder; most of my patients are stuck in some way and have no learnt through adequate parenting how to feel, consider, contain and express their emotions in a healthy way.

Successful talking therapy depends on the patient-therapist relationship.  Relational trauma and damage occurred in their relationship(s) in early life and so it is only through relationship that this can be worked through.  The function of the relationship with our primary caregiver is firstly, once we step beyond the obvious physical needs, one in which we learn how to feel and navigate our emotions, and secondly, one in which we become aware of the emotions and mind of another – relationship.

Counseling and Therapy Help People Feel and Understand Themselves

Unless people are able to navigate their emotions, establishing any kind of genuine relationship that is stable and fulfilling becomes nigh on impossible.  The role of the therapist and thus therapy is, therefore, to help the patient become aware of what they are feeling, help them to differentiate between the past and the present (on an emotional/affect level) and to pendulate through their states of arousal without becoming overwhelmed.

Creating a Relationship the Patient Never Had

So perhaps ultimately the purpose of cpsychotherapy does go back to creating a relationship with the patient that they never had, so that through the therapeutic relationship they can learn to regulate their emotions in healthy ways.  From the therapist’s perspective, this is contingent on a careful and precise attunement to the patient’s emotional and nervous system, teaching them to know themselves first, so that it then becomes safe and thus possible to know themselves and the other in the capacity of a relationship.

Mark Vahrmeyer

Image credit: Sam Jahara

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Filed Under: Mark Vahrmeyer, Psychotherapy, Sam Jahara

July 6, 2015 by Brighton & Hove Psychotherapy Leave a Comment

Making the Most of Therapy

Starting a process of counselling or psychotherapy can be daunting.  It is also a significant commitment.   And just as we are paradoxical in other areas of our lives, we are paradoxical when it comes to therapy; part of us wants to embrace change and another part doesn’t.  So how can you get the most from your therapy?  Here are five top tips which are less about doing and more about your relationship with yourself and your therapist, which will help you in your therapeutic journey:

Be Curious

In my view, a spirit of curiosity and openness to exploration on the part of client and therapist allows for a deeper and more interesting process.  The reason I love what I do is because I never cease to be amazed by the richness of the human experience.  Therapy facilitates self-knowledge.  Therefore, there is no better way of knowing oneself other than being curious about your own experience.

Engage Honestly

This includes being honest about not being honest.  Therapy can only benefit you if you are fully honest with yourself and your therapist.  Being honest does not mean a full detailed confession of what is going on in your life.  It is more about not leaving out vital material, which is holding you back in life.  It’s totally okay to say to your therapist: “This is difficult for me to talk about, but I think it’s important that I do.”

Build a Meaningful Relationship with Your Therapist

Research shows that the success of therapy is linked with the quality of the therapeutic relationship.  It is important that you feel safe and are able to trust your therapist.  This is not to say that things won’t feel difficult or wobbly at times.  However, basic trust between therapist and client is an important component of the work of therapy.  It may take sometime to build trust in the relationship, and when mistrust arises it is important that you feel able to discuss this with your therapist.

 Pay More Attention

One of the many benefits of therapy is an increased level of self-awareness.  You will gain more from your weekly or twice weekly sessions by paying more attention to your thoughts, feelings and interactions in and outside of therapy.  This includes observing familiar patterns of behaviour and negative self-talk.

Prioritise Your Sessions

You have come to therapy to feel better and get better. However, your wellbeing and recovery can only take place when you value it and prioritize it. Come to your sessions on time and attend weekly, no matter how resistant you are feeling. It’s okay to say to your therapist: “I really didn’t feel like coming here today…”

Lastly, if you are in any doubt as to the value of therapy, then check out this blog which will help you quantify how valuable therapy can be.

Sam Jahara

Image credit: Mark Vahrmeyer

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Filed Under: Mark Vahrmeyer, Psychotherapy, Sam Jahara

June 29, 2015 by Brighton & Hove Psychotherapy Leave a Comment

Make me happy…

When clients first present for counselling or psychotherapy, I generally always ask them what they would like to get from our work; how will they know that what we have done has been worthwhile for them?  The answer to this can give the work important clinical perspective, but can also provide an insight into the client’s way of seeing the world, particularly when the answer is ‘I want to be happy’.

Nowadays, there is a lot of pressure on all of us to be happy.  We are told that buying certain products and experiences will make us happier; the government (ours and others) attempt to measure happiness and rank us against other more and less ‘happy’ countries; and all our social media friends seem to post selfie after selfie showing how happy they are in their lives.

Recently I came across an article by Gruber, Mauss and Tamir entitled ‘The Dark Side of Happiness? How, When and Why Happiness is Not Always Good’ which poses four philosophical questions about happiness:

Is there a wrong degree of happiness?

The researchers focus was on whether an over emphasis on happiness can come at the cost of other emotions which they labelled ‘negative’ such as anger or sadness.  Such a focus may then lead to suppression of other authentic emotional states and behaviour associated with chasing happiness (dopamine chase) such as risk taking.

Is there a wrong time for happiness?

The researchers suggested that our emotional state should reflect the circumstances and thus that affect regulation is suited to the environment.  Their suggestion was that when we are happy we tend to seek out social bonds and increase our resources which could be inappropriate or downright dangerous in some situations such as when we are under threat and our energy should be directed to protecting ourselves.

Are there wrong ways to pursue happiness?

It seems to be the zeitgeist to pursue happiness whenever and wherever but there is some evidence that the focus on achieving happiness can get in the way of actually obtaining it.  Furthermore the researchers concluded that an unhealthy focus on happiness can lower our resilience in dealing with disappointment.

Are there wrong types of happiness?

With this question the focus seemed to be on an authentic expression of happiness versus hubris and pride.

From the perspective of therapy and I would argue an emotional healthy way of being in the world, happiness is no more important than any other authentic emotional state.  Of course, humans, like all animals, are primed to avoid pain and discomfort and maximise pleasure,  However, this is perhaps not the same as trying to be constantly happy.

A healthy emotional system depends, quite simply, on being able to do two things at once:  feel whatever emotion we are feeling in response to a situation (and that that emotion is broadly one that others can comprehend – empathy) and secondly, that the emotion we feel can be felt without us becoming overwhelmed.

How is this achieved?  Internally this is achieved by us learning to feel all our emotions and connect our emotional experience to our mind.  If we feel without being able to think and process, we become overwhelmed and reactive.  And if all we do is think, we fail to feel.  Externally, I would suggest that we can be fully in the world and feeling our emotions by making our lives meaningful, which is not the same as happy (though it would be nice to feel happiness at times).

So, whilst I broadly agree with the research findings in an academic sense, I wonder whether the real world focus should be on meaning making and creating contentment, together with the ability to experience the full range of human emotions without becoming overwhelmed.

Mark Vahrmeyer

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Filed Under: Mark Vahrmeyer, Psychotherapy, Relationships Tagged With: Emotions, happiness

May 26, 2015 by Brighton & Hove Psychotherapy Leave a Comment

The Value of Therapy Quantified

We live in an age where increasingly our value of anything comes down to money.  Even environmentalists are needing to show the value of ecosystems and specific species of animals, in order to put forward a robust case for conservation.  Little wonder then that the question of the value of counselling and psychotherapy in monetary terms raises its head from NHS commissioners through to money-conscious clients.

Until recently this has not been a simple question to answer.  Therapists know that therapy is valuable – whether directed towards specific behavioural change or as a process of self-enquiry and self-reflection.  However, quantifying the benefits in monetary terms has not always been that simple.  Sure, if a compulsive gambler stops gambling, the financial pay-off can be immediately visible, however, I would suggest that the benefits (financial and emotional) go much further than the savings made from avoiding the betting shop and breaking an addiction.

Well, research undertaken at the University of Warwick seems to be getting closer to quantifying the value of therapy, at least versus receiving direct financial reward and it turns out that psychological therapy is 32 times more valuable than money in increasing our well-being!

We all need money to meet our basic needs such as food, shelter, water etc. in order to survive – cue Maslow’s Hierarchy of Needs.  However, once our more basic needs have been met, additional money seems to have little to no correlation to happiness and well-being.  The research paper entitled ‘Money and Mental Health: The Cost of Alleviating Psychological Distress with Monetary Compensation versus Psychological Therapy’ suggests that in the developed world, despite huge economic gains and a political focus on economic growth during the past 50 years, national happiness has not increased.  In fact, quite the opposite: mental health seems to be deteriorating across the globe.

Through comparing 1,000’s of data sets of participants reporting on their happiness, the researchers looked into how happiness changed due to therapy compared to sudden increases in income such as through lottery wins or a jump in salary.  The results showed that a four-month course of therapy, equating to an investment of £800, led to an overall increase in well-being equivalent to a pay rise or windfall of £25,000.  In purely financial terms, therapy could be 32 times more effective at improving well-being pound-per-pound than money.

Interestingly, an additional point raised by the paper discusses how ineffective financial compensation is when dealing with trauma – e.g. the court system – and that psychological therapy could be a significantly more effective way of supporting people in overcoming their traumas.

So there we have it.  Therapy works.  Us therapists always knew this but now we are starting to get a grasp of how much it works in financial terms.

Link to research paper: http://www2.warwick.ac.uk/alumni/services/eportfolios/psrfbb/boycewood_hep_website_copy.pdf

Mark Vahrmeyer

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Filed Under: Mark Vahrmeyer, Mental health, Psychotherapy, Sam Jahara Tagged With: Counselling, Psychotherapy

March 23, 2015 by Brighton & Hove Psychotherapy Leave a Comment

Suicide: A Largely Male Solution

In February of this year, The Guardian newspaper published two articles on the dramatic rise in male suicide figures in the UK over the past 30 years.  I should imagine that this makes sad and disturbing reading for many, but it particularly spoke to me as I am a man.  And a psychotherapist.

The statistics are grim: suicide is the leading cause of death amongst males between 20 and 34 years of age; male suicide rates that in 1981 made up 63% of all such deaths, now account for 78% across the UK; and whilst female suicide rates have halved since 1981, male rates have increased.

As a relatively young male psychotherapist in private practice I work with a fair few men who pluck up the courage and present for therapy.  The numbers are more or less evenly split between male and female clients, yet I find that there are some fundamental differences between the two genders.  Men tend to present for therapy when they are in a pretty deep crisis – often a relationship will be on the rocks, a career will be hanging in the balance or an addiction has brought them to their knees.  Or they have been sent to therapy by a well-wishing friend or an exasperated spouse or partner.  Either way, coming to therapy for men can often be something that they undertake when all other options have been exhausted.  And it can feel deeply shameful.

Working with clients from diverse backgrounds and cultures, it would also seem that men from British backgrounds, or culturally influenced by Britain, such as Australia, can find coming to talk to someone about their problems tantamount to betrayal of their gender.  Men in the UK are still culturally expected to ‘suck it up’, get on with it, provide for the family and not have feelings.

But as well as the cultural and social influencers on men, the therapy profession also has a role to play in how it has failed to reach men over the past 30 years.  Most therapists are women.  That is not to say women cannot work with men – on the contrary – but for some men it does seem to create a further barrier to entry.  Furthermore, the language of counselling and psychotherapy is often centred around feelings and many men in crisis have spent a lifetime escaping their feelings to the extent that they are not really sure what feelings are and whether or not they have them.  By this I am not suggesting that men are emotionally stunted, however, therapy can and should be tailored to help people process loss and trauma in other ways than through the ubiquitously common question ‘so, how does that make you feel?’.  Body-work, functional psychotherapy, sensing, posture work, and meditation are all routes that I have found successful in enabling men to return to their bodies and thus their felt experience.

Going into a process of psychotherapy is hard for everyone, but especially so for a man who carries round a belief that he needs to manage alone.  It is a courageous choice and one that can make a life or death difference to men who feel desperate.  But, in order for this to happen, psychotherapy needs to lose its stigma – men need to know that whilst a safe environment, psychotherapy can bring them alive and make life rich and meaningful.  And a rich and meaningful life is one peppered with disappointments, pain, loss, grief and every other human emotion possible.  Rather than being the shameful choice, it is the courageous one – the warrior’s choice.

 Mark Vahrmeyer

 References:

 Number of suicides in UK increases, with male rate highest since 2001

Britain’s male suicide rate is a national tragedy

Image credit: Mark Vahrmeyer

 

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Filed Under: Brighton and Hove Psychotherapy, Gender, Mark Vahrmeyer, Mental health Tagged With: Mental Health, suicide

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49 Church Road, Hove, East Sussex, BN3 2BE

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Star Brewery, Studio 22, 1 Castle Ditch Lane, Lewes, BN7 1YJ

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