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Do you have Unrelenting Standards?

Put another way, is getting anything less than 100% not acceptable to you, and a trigger for uncomfortable feelings of failure, of not being good enough, of self-criticism, self-doubt and shame?

In my experience as a psychotherapist, a personal drive for perfection is often the root cause of distress in many of those seeking therapy. It can be a hard issue to resolve. After all, why would we not try our best?

An illustration of how much pressure unrelenting standards (US) can generate is a client I saw who, for ‘relaxation’ – as she saw it – became a triathlete. Nothing wrong with that, of course, but for this thirty-something woman, who for this blog I will call Caroline, her hobby required a series of log books and electronic aids to record every jog, every swim and every bike ride with painstaking notes about her heart rate, timings and much more (1).

It emerged in therapy that Caroline took any sign that her performance was not improving as a trigger of dismay. Was it because she was getting old? That she was physically too weak? Or that she was simply not good enough? She spoke about her ‘hobby’ almost as if it was a military exercise. The physical benefits were clearly being offset by that the effort involved was itself yet another source of worry. Worry about worry!

So how do unrelenting standards develop as a pattern of behaviour that can have maladaptive and counter-productive overtones? In a previous blog, I wrote about basic human needs, and pointed out that, according to US psychology researcher Caroline Dweck (2), in order to feel safe we need to come to feel that we exist within a secure base. How is this generated? Key elements are that we need to grow up feeling that the world is reasonably predictable, that we are accepted and loved (by those around us) and that we are sufficiently competent.

If that happens and we believe we are indeed broadly secure, the Dweck paper also says that we come to believe we can trust other people, we feel that we have a reasonable degree of agency and control over what happens to us in the world, and we develop a healthy and balanced sense of self-esteem.

Against that background, how do unrelenting standards develop? The current theory is that if we feel we have been abandoned in any way during our lives (for example by bereavement or as a result of divorce), and/or if we have been badly mistreated or abused, and/or if we come to believe we are basically defective, feelings that we are fundamentally unsafe develop. Our secure base is seriously compromised.

Those feelings are triggered in a part of the brain called the limbic system, which exists to monitor danger and to provide the tools for dealing with perceived threats. It is an extremely powerful and fast-acting structural network and if was not, we would soon be dead. Our fight-flight-freeze responses – all there to protect us – originate in the limbic system and they are activated by the five basic emotions: fear (through which we become aware of danger); anger (with which we can deal explosively and rapidly with threats); disgust (which, when triggered, prevents us ingesting poisons); sadness (loss of a loved one is perceived as a threat because we evolved as pack animals); and joy – the one positive emotion, which is an expression of the pleasure and sense of safety we feel when connected with the world and others.

The upshot of this is that if we feel we are in danger, the limbic system goes into overdrive.

We cannot relax. Any signal, however small, of abandonment, or abuse, or of defectiveness has to be countered by effort and that involves making sure that every aspect of what we do is ‘safe’.

How can this be treated? A vital step is to obtain an understanding of the root causes. In Caroline’s case, it gradually emerged that a significant factor was that her father – though otherwise very loving – never seemed satisfied with what she achieved. He regarded a ‘B’ grade in an exam as a failure and even an ‘A’ was not good enough unless she was also top of the class. Caroline often turned to her mum for reassurance, but instead, she sided with dad. The result was that Caroline first came to dread exams and then went into constant
overdrive to make sure she got the highest possible grades and left nothing to chance. She became locked in what felt like a desperate battle to prove she was not defective. A relentless drive towards perfection felt like the only way she could get love and affection from her parents.

Once Caroline became aware of the nature of the pressure involved, she could begin to see that as an adult, she could make her own choices about the amount of effort she wanted to expend on tasks, and could begin to experiment with dealing with day-to-day demands in a less stressful way, including that sometimes- and maybe even often – 70% is not failure.

Further information about unrelenting standards is contained in this You Tube video.

 

David Keighley is a BACP Accredited counsellor/psychotherapist offering short and long term therapy to individuals and couples using a variety of techniques such as EMDR, CBT and Schema Therapy. He is also a trained clinical supervisor.  He is available at our Brighton & Hove Practice.

 

Resources –

(1) Details changed to ensure client cannot be identified.
(2) https://moodle2.units.it/pluginfile.php/358466/mod_resource/content/1/2017%20Dweck%20PR.pdf

 

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Subjective Perception, Shared Experience

Nel Tuo Tempo…….In Your Yime

The artist Olafur Eliasson’s exhibition ‘Nel Tuo Tempo’ was described as addressing the ‘subjective perception and shared experience’ of a Florentine building.

He did this using light, colour and shadow. Some of the twenty exhibits were complex structures, others were more about how we see the building in which the exhibition was staged. In one room, a series of lights outside the building cast shadows of the windows on an adjacent surface, be it a wall, floor or screen. The windows were high on the wall, but the shadow was right there in front of us. Detail that wasn’t possible to see in the window became crisp and clear in the reflection and shadow. The minute particles in the glass were visible in a way that was impossible to see without the artist’s intervention.

Artistic works can resonate with us emotionally in ways that are unexpected. These exhibits not only provoked an emotional response, but also raised question about what we could understand about the fabric of the building.

Moving between detail

Psychotherapy is about how we experience and relate to our emotions and that through our emotional world we can gain insight into the ‘fabric’ of ourselves. We begin thinking about how we feel now, what is going on in our world and how we relate to it. The gentle exploration of emotions, history and our lived experience gives a sense of what makes us who we are. Like the exhibits in the museum, we can be curious about so much more than what we see.

You could observe people moving in close and seeing the details of the glass panels, then standing back and looking at the window as a whole felt. This felt like moving between detail in a similar way to how we move between thoughts and feelings during psychotherapy. The detail of daily life, which puts emotional demands on us, alongside a wider view of life and history, shifting between thoughts to build a complete picture. Like the artist does, it’s about creating a space in which we can be curious about what is there and what is less easy to see, moving from what is subjective into something shared. Asking ourselves if it’s possible to not fully understand and remain curious.

Subjective Perception, shared experience

The connections and considerations of psychotherapy and art are numerous and much commented on. This exhibition brought to mind the fact that both art and psychotherapy can give us a much greater insight into our emotional world, by moving beyond what is seen and what is not seen, but is felt. It can also reveal some of how when we engage with certain art works, we also mirror what goes on therapeutically between the practitioner and the client. Shifting between detail, emotions and understanding, the subjective perception becomes the shared experience.

Psychotherapy is about moving from the subjective to the shared. Being heard and seen as a means of gaining a deeper understanding of who we are and our relationship with our selves and those around us.

 

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove . To enquire about psychotherapy sessions with David , please contact him here, or to view our full clinical team, please click here.

Further reading by David Work –

In support of being average

Collective grief

The challenge of change

Thinking about origins

Bridging Political divides

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The Psychological Impact on Children who Grow Up in Cults

I have just watched the latest Netflix docu series “How to Become a Cult Leader?” and was pleased to see that images of the cult I grew up in appear in it with frequency, because it means it is undoubtedly and widely recognised as a cult. Familiar images of the cult leader doing “energy darshans” (so-called transmission of energy) with his disciples, who in turn look utterly blissful, was designed to portray him as someone who holds special powers and cures people’s suffering instantly.

Indoctrination from an Early Age

The indoctrination of children in cults differs from that of adults in that children are extremely vulnerable to adult influence – the people they look up to, especially their parents. Children’s brains are still developing, and they are like sponges, absorbing the world around them, the world of adults who create the environment they exist in. A child will absorb the world view of those around her and accept this as her reality because this is all she has known.

The Cult Leader’s Demands Always Comes First

In cults, the cult leader or doctrine always takes priority over anything else. The child who grows up in a cult will never be the centre of attention in her parent’s world because they will most likely be totally self-absorbed with the cult leader and the cult demands. These demands are usually great and unattainable because the leader is likely to be highly perfectionistic, insatiable, and persecutory of those who do not meet his or her ideals. Moreover, a cult leader will employ fear tactics with their disciples and keep them in a state of perpetual adoration towards him and shame towards themselves. In this state of fear, shame and total preoccupation with another, there is no room for the age-appropriate demands of a child who actually needs their parent’s care and attention.

“Have No Needs”

A child who grows up in a cult learns to have no needs because she quickly learns that they do not matter. To survive in the cult and gain some crumbs of attention from her parents, she will have no choice but conform to the leader’s demands, try to fit in as much as possible and override her natural developmental needs. This means the child will miss out on normal stages of development, if not also on education and normal peer interactions because of the insular and isolated nature of most cults.

Isolation and Abuse

Sending a child to school means interacting with the outside world, which most cults find threatening. Depending on how isolated a cult becomes, they will supply their own schooling, have children interact only with other cult children and make sure there is no outside influence that could lead the child to question her upbringing.

Keeping a child isolated from society also makes her vulnerable to abuse – sexual, physical, spiritual, emotional, and psychological. Isolated groups create their own rules and decide what is right or wrong. In the cult I grew up in for instance, children and teenagers were conveniently seen and treated as adults.  This meant that we were required to work long hours, worship and meditate with the adults. This also meant that schooling was minimal and there was no age-appropriate censorship to adult-only stuff. The cult leader – a self-proclaimed enlightened master – was seen as an expert in raising children, despite him not having any children himself or knowing anything about child development. If the cult leader condones inappropriate, harmful, or even criminal behaviour, then his disciples collude because all that matters is what the leader thinks. His truth matters above all truths, and he/ she is always above societal rules and norms, including the law. Under these circumstances, children are extremely vulnerable to predators.

The Objectification of Children

In cults, children are either seen as an inconvenience or used as means for growing the cult. In both situations, children are seen as objects and not encouraged to develop their own identity. In cults, nothing is in the best interest of a child. Everything is in the best interest of the leader and the organisation. Despite this well-known fact, cult leaders will make it seem that everything they do is for your good and the good of your children, even if there is plenty of evidence to the opposite (see ‘Gaslighting’ below). They will make you quash your doubts, question your sanity, and give up everything you have, including your children, in the service of “the greater good”. This “greater good” has very few winners, which are usually the leader and his inner circle.

Gaslighting

A central feature of cults is gaslighting – a term coined from the movie ‘Gaslight’ where it a young woman is manipulated by her husband into believing that she is descending into insanity. Cults do this on a large scale, which is designed to keep its disciples or followers in a state of perpetual doubt about their opinions and follow the opinions and ideas of the cult leader. It is an exercise in maintaining power over others and abdicating any responsibility for one’s actions. For instance, in the cult I grew up in the self-proclaimed enlightened master would attribute all personal suffering to his disciples and never take any responsibility. This extended to the sexual, financial, and psychological exploitation of ‘his people’ including children. When questioned, he would say that you had not surrendered to him enough and that this was your reason for suffering.

Leaving

When the child grows up and is lucky enough to leave the cult, she or he will have to contend with a long process of rebuilding or recovering her own identity. Everything that she is has been attributed to the cult or exists because of the cult. Sometimes, when a former child choses to leave, her family will want nothing to do with her. Or she may need to cut contact with her family to survive psychologically.

The Recovery Process

Cult recovery is a long and challenging process which requires the right support. Finding a group of like-minded individuals who share similar backgrounds is advisable, as well as finding a therapist who is experienced and knowledgeable about this type of work. Explaining to people what you have gone through is never easy. Former cult members and those who grew up in cults can feel a lot of shame about their past and have difficulty articulating what they have been through. Most people lack an appreciation of what it is like to live in a high control group and its effects.

Regaining One’s Mind and Setting Boundaries

Those who were born or grew up in cults will often need to learn or re-learn how to live in society. Although cults range in terms of how isolated and restricted their members are, the indoctrination of children is so deep that it will take a very long time to regain their own mind, learn to think for themself and have their own opinions. This extends to knowing one’s own preferences, wishes and needs. Because having own thoughts and opinions was frowned upon or even dangerous, it takes time to regain a sense of safety in doing normal things, having personal preferences, and even feeling entitled to personal space. Growing up in an environment where nothing belongs to you, all the thinking is done for you and personal space is not a thing, has big implications in later life when it comes to setting personal boundaries.

Sam Jahara is a UKCP Registered Psychotherapist and Clinical Superviser. She is experienced in working with the psychological impact of high-control groups and cults on individuals, families and organisations. She has also spoken about her personal experience of growing up in a cult in recent public interviews.

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What is Narcissism?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

Further reading by Mark Vahrmeyer

The medicalisation of mental distress

Can chatbot companions relieve our loneliness?

What are feelings anyway?

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

The psychological impact of the recession

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Finding Contentment in the Age of Discontent

The official definition of contentment is “freedom from worry or restlessness: peaceful satisfaction”. I would define contentment as a state of inner quiet and peace, and a satisfaction with oneself and with life. This is not linked to material satisfaction, which is usually temporary and unsubstantial, but more of an acceptance of who one is and a coming to terms with choices and situations in one’s life. This is usually linked to how a person perceives themselves, others and the world. One example would be the ageing process. Some people may struggle with getting older, and all the changes that our bodies go through. Others may see ageing as a natural process and one that can be embraced and even enjoyed.

How can we practice contentment in our everyday life?

As said above, contentment is linked to how we perceive ourselves and others. Freedom from worry or restlessness comes by cultivating patience and working on how we perceive things. It is also linked to an ability to trust in oneself and those who are close to us. Building and maintaining good relationships, spending time in nature and engaging in meaningful activities are some ways of achieving contentment.

Can external factors (politics, economy, capitalism etc) affect how we can feel content?

Contentment may sound like a luxury when there are serious external factors affecting our survival. However, if our basic needs are met and there is no imminent threat to our life or livelihood, contentment can be cultivated and maintained despite the ups and downs of political and economic factors. Contentment comes from within, so although external factors impact how we feel about the world and ourselves within it, it is also important to hold the bigger picture in mind and remember that we live in an ever changing world with no ultimate guarantees or certainty. I have seen people who are very content and live with very little under difficult circumstances. I have also seen people who have everything they can wish for materially but live in a contact state of anxiety and worry. This is not to say that environmental factors do not impact the way we feel and I believe that improving social and political factors can and will lead to a better society with is happier generally.

Feeling contentment in a materialistic world

I hope there is a movement towards prioritising contentment over material gain, however the rise in inequality around the world tells a very different story. Maybe there are certain sections of society who are able to make the changes they need in order to live better lives. Mental health has been in focus for a while now, and some people are realising that living a stressful life comes at a high cost.

If you want to cultivate contentment…

Start looking at what causes you discontent. Then look at these feelings in some depth – are these feelings about self-perception or external changes that you need to make? Work towards cultivating qualities and activities that lead to more contentment. And finally, simplify your life.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.
Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading by Sam Jahara

What causes low self esteem?

Online therapy: good for some but not everyone

The psychology of mindful eating

Defining happiness

What are the benefits of counselling and psychotherapy?

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The Medicalisation of Mental Distress

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

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

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

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

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

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

Under pressure

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

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

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

Suffering has been turned into a commodity

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

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

 

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

Further reading by Mark Vahrmeyer

Can chatbot companions relieve our loneliness?

What are feelings anyway?

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

The psychological impact of the recession

Why do people watch horror movies?

 

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What Causes Low Self-Esteem?

Low self-esteem stems from beliefs that we have about ourselves, a negative self-evaluation which is usually rooted in childhood experiences. The way we were spoken to, treated, and made to feel as children has a significant impact on how we see and therefore relate to ourselves later in life. Some of us may also have grown up with parents who were not very confident and had low expectations of themselves and their children. Social class, culture, race, gender, sexuality, and disability are also societal and environmental contributing factors to how we self-evaluate.

Knowing where negative self-belief and low confidence comes from is the first step in effecting change. Feeling things that we don’t understand can be confusing and cause anxiety and depression, further perpetuating negative self-belief. The next step would be to begin challenging these beliefs and check them against the reality of your life and achievements, skills, etc. Many of the beliefs we carry are just that: thoughts about ourselves that do not match reality. This can lead to perpetual feelings of failure, regret or agonising about every small decision for fear of making mistakes. Some of these feelings can be debilitating and hold us back from moving our lives forward with confidence in our decisions.

Awareness of negative self-talk is also useful in that we can choose to gradually replace this self-talk with more positive inner dialogues. Sometimes people are surprised at how much time they spend being self-critical. The way we think has a direct impact on how we feel, therefore it is important to work on these issues.

How Relationships Affects Self-Esteem
Cultivating positive and healthy relationships is essential in gaining more confidence. A sense of belonging and acceptance comes from a variety of places, but the main place that it comes from is relationships. Therefore, being in relationships that don’t make you feel good about yourself, where you are badly treated, taken advantage of, etc is only going to make you feel worst about yourself. This includes both personal and professional relationships.

The definition of a healthy relationship is one where there is mutuality and exchange of support, ideas, validation, trust and honesty. The more we base our relationships on these principles, the stronger they will grow. Sometimes low self-confidence can get in the way of building relationships or seeking career opportunities for fear that others will think that we have little to offer. Again, challenging these beliefs and checking them against reality can help us to start to behave differently, take more risks and challenge ourselves in a good way.

In Psychotherapy we work with the root causes of low self- confidence, for instance how early relationships have contributed to the beliefs that we have about ourselves today, and then gradually replacing these with more helpful and realistic beliefs about who we are and what we are capable of. This usually leads to making better choices in life in the areas of work,  relationships and health.On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

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Is Spirituality an Escape from Reality?

Spirituality is an important part of our existence. It can provide meaning and purpose, give us a sense of well-being and peace, and provide a philosophical way of being that gives us an ethical code and a way of dealing with adversity. Additionally, it is an important part of personal development that enables us to be more authentic in the world, and to connect with a transcendental dimension that is greater than ourselves.

But can spirituality also be an escape from reality? At times, our spiritual practice and our spiritual philosophy can become a way to avoid reality, and this is called ‘Spiritual Bypassing’.

The term spiritual bypassing describes when we use our spiritual beliefs or practices to avoid or escape from dealing with difficult emotions or personal problems. This could be when we use spirituality as a way to rationalise or justify an avoidance of emotional pain, as well as using spiritual practices as a means of avoiding responsibility or accountability for our actions.

For example, we might use affirmations to deny our feelings of sadness or anger by saying such phrases as “I am happy and content” when we really don’t feel it. While this does have a use in terms of positive psychology, it can also deny and suppress our feelings. As another example, we might believe that everything happens for a reason, and because of this belief not take any action to rectify a problem or take responsibility for our part in a situation. At times, these sorts of ideas can hinder our progress on the spiritual path and also become problematic for our emotional development.

In terms of spiritual practice, this also can become a way of avoiding our emotions and the reality of life. For example, if we are able to get into blissful meditative states, then we might try to spend as much time as possible in such states and deny other experiences. This could then lead to a withdrawal from the world as we attempt to be fully occupied with meditative bliss. While mediation and other practices can lead to a more permanent feeling of bliss and contentment, resolving our underlying emotional issues needs to come first.

While spiritual bypassing can take many forms depending on the person and their practice, below is a list of the more common manifestations.

Denying emotions: This involves using spiritual beliefs to suppress or deny difficult emotions, rather than fully experiencing and processing them.

Overemphasising positivity: This is where we focus exclusively on positive thoughts and feelings, and dismissing or denying negative emotions or experiences.

Avoiding conflict: This involves using spirituality to avoid or minimise conflict, rather than addressing it directly.

Disregard for the physical world: This involves using spirituality to detach from or minimise the importance of the physical world and material concerns.

All of the above, (and this list is not exhaustive) are examples where the underlying thinking is rooted in spiritual philosophy, but that philosophy is taken out of context in order to serve the individual. As such, it can end up being harmful both for the individual and others around them.

It can be quite easy to fall into spiritual bypassing as most spiritual philosophies are beautifully simple and can lead us to thinking that it is an easy task to evolve spiritually as well as emotionally.

However, such development takes a lot of time, practice and self reflection. Working honestly with a good spiritual friend can help us to understand how we are applying spirituality to our lives, and if this is in a healthy manner. But at times we need to take this a step further and work with a therapist to help us resolve our underlying emotional patterns so we can truly bring our spiritual life into reality.

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

 

Further reading by Dr Simon Cassar

Sleep and Mental Health

Spirituality and mental health

Living with borderline personality disorder

Online Therapy

Student mental health – how to stay healthy at university

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What are the Benefits of a Twice Weekly Therapy Group?

Most therapy groups run once a week. In our practice at Brighton and Hove Psychotherapy, we also offer a twice weekly group, but how does having a second session in the week help?

Emotional bonds
An essential aspect of any group therapy is building emotional relationships between group members, enabling strong attachments to form. This creates an enhanced sense of belonging which, in and of itself, is therapeutic.

In addition, because psychological difficulties tend to originate in some form of breakdown in early childhood relationships, group psychotherapy also emphasises the relationships in the group as an essential means of understanding oneself and others.

These relationships are both real and transferential (the latter, meaning other members and the conductor can ‘stand in’ for important relationships, especially in the original family). In this way, therapy groups offer all kinds of opportunities to explore the complexity of relationship dynamics, both past and present. This helps the individual to develop insight into their patterns of relating and what ‘went wrong’ early on, as well as the potential to find resolution and transformation in ongoing relationship problems.

Any functioning therapy group will enable these emotional bonds and dynamics to grow between members but in a twice weekly group these relationships are likely to be particularly intensified and strengthened.

Depth
Group analytic psychotherapy is concerned not only with reaching depth in relationship to others but also in relationship to oneself. In this approach, we are interested in what is known and conscious but also, and arguably more importantly, what is unknown and unconscious.

It has long been assumed and agreed, in the analytic professional field, that greater frequency of sessions will reach greater depths in the psyche. When the gaps between sessions are shorter there is less time for defences to build up. This is as true for group work as it is for individual work.

Continuity
It is perhaps obvious to say that a more frequent therapy model will provide greater sense of continuity from session to session. Shorter gaps means that threads and conversations can be picked up, carried forward and explored. This facilitates the emotional intensity and the depth outlined above but can make the group also feel more containing.

This helps because therapy work can be anxiety-inducing. To be successful, therapy will always touch parts of ourselves that we don’t see, or don’t want to see, or don’t want others to see.

The more frequent contact also reduces anxieties that inevitably arise in making any close relationships. On the occasions friction or conflict in the group arises, the opportunity to return and repair is only a short time away.

Who would benefit from twice weekly group therapy?
Returning to my original title/question, you may be wondering if you are someone who might benefit from twice weekly group therapy?

Finances and Time
Of course, there can be practical considerations. A twice weekly group essentially involves greater time and financial commitment than once weekly groups. Currently, for example, the twice weekly group I run works out at £60 a week (2 sessions of £30 twice a week). This is £20 a week more that my once weekly groups.

However, it is worth noting that in relationship to individual work, £60 a week is a lower fee than that charged by many psychotherapy practices, including my own and those at BHP, for individual therapy.

In addition, if you feel you would benefit from working in a more frequent way, doing this in a group is financially far more cost effective than in individual work.

The time commitment is also something that some people find they need to think about. My experience is usually once people have made connections in the group, it becomes a part of their life and network and so easier to accommodate.

There is also a good argument that the intensity of the work speeds up the process and that, in the long term, more frequent psychotherapy tends to achieve results more quickly and more lastingly than once weekly. There are, of course, exceptions to this in both ways but my experience has certainly been that changes tend to come about more quickly and with greater tenacity in twice weekly groups.

Who might benefit?
So, who might benefit from this more intensive, in-depth, group work? Well, this is much the same as for any group therapy – see Is a Therapy Group Right for Me? Am I Right for a Therapy Group? – Brighton and Hove Psychotherapy
And, beyond that, I would say anyone and everyone!

It seems to me that the advantages, as outlined in this article, will have a special appeal to some people. This may be for different reasons; according to individual struggles, where people are in their lives, and what they feel drawn to. But ultimately, if you are looking for an in-depth and impactful psychotherapy with an emphasis on exploring your relationship dynamics and patterns, that is also cost effective, then this may well be a good option for you.

Additional note
My focus here is on the ‘twice weekly’ element of this question, but if you are interested in reading more about group therapy, and its benefits, below are some links to some blogs and webpages.

(Further reading can also be found under ‘blog’ and then ‘groups’ on our homepage)

Group Analytic Psychotherapy

What is it like being in a Psychotherapy Group? Case study – Joe

How psychotherapy groups can help change our internalised family systems

 

Claire Barnes is a group analyst and training group analyst. She runs 3 groups at the practice,
Twice weekly: Mondays 4.15-6.45pm, Wednesdays 7.15-8.45pm
Once weekly: Thursday mornings 10.15-11.45am
Once weekly: Thursday evenings 6.15pm-7.45pm

If you are interested in exploring the possibility of joining any of her groups, please contact through the enquiry form.

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Practical Examples for ‘Food and Mood’

This blog follows on from my previous one called ‘Food and Mood‘ and provides you with food examples.

Wholegrain cereals, peas, beans, lentils, nuts, seeds, fruits and vegetables are rich in a range of vitamins and minerals that your body needs to function well. They also digest slowly, helping to provide a slow and steady glucose supply to your brain and body.

Start the day with breakfast, such as wholegrain cereal with milk and fruit, multigrain toast with a poached egg, or fruit with yoghurt. Have no more than 150ml of fresh fruit juice or smoothie to drink.

Include some starchy food (such as boiled potatoes, rice, pasta, and granary or multigrain breads) at lunch and dinner. If you are short of time, then go for a sandwich or jacket potato (filled with fish or low fat cheese and salad) or even a bowl of cereal and some fruit.

Between meals include snacks such as fruit, vegetables, nuts, yoghurts, and oatcakes or crackers with low fat cheese, meat or fish.

Caffeinated drinks, such as coffee, cola, energy drinks, tea and chocolate, should be limited.

Other non-caffeinated drinks, such as fruit squash, lemonade or herbal teas are good alternatives.

Limit your intake to no more than two to three drinks on no more than five days per week. It is however important to remember that alcohol itself is a depressant and may contribute towards depression or make your symptoms worse.

Eat regularly throughout the day to make sure your brain has a steady supply of energy.

Include starchy carbohydrates, protein and vegetables or salad at each meal.

Choose wholegrains, pulses, beans, lentils, and fruit and vegetables.

Minimise processed/packaged foods and instead eat a variety of the items listed above to get a range of different vitamins and minerals.

Eat a good balance of healthy fats to maintain the cell structure of your brain. Include oily fish (omega 3 fatty acids) and unsaturated fats in your diet.

Drink plenty of fluid (six to eight glasses non-caffeinated drinks) to keep hydrated and allow your brain to work as best as it can.

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults.  Rebecca is available at our Brighton and Hove Practice.

 

Further reading by Rebecca Mead –

Online vs in-person therapy

Loneliness and CBT

Is that a fact or an opinion?  
As we come out of lockdown, will a number of us be feeling socially anxious?

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Food and Mood

The links between mood, mental health, sleep quality and nutrition are areas of research interest. Associations between the type and quality of a person’s diet and risk of anxiety and depression are increasingly described in literature. Complexities around the multidirectional relationship between diet and mental health are becoming more understood (Firth et al 2020) and it has been long established that poor sleep increases inflammation and stress hormones in the body.

Brain function requires a steady supply of glucose as its primary fuel which comes mostly from starchy carbohydrates. Energy which is slowly released, such as low glycaemic index carbohydrates, provide the optimal energy release for use by the body https://glycemicindex.com/. The brain also requires dietary fats as it is made up of 50 per cent fat, with brain cells needing fats to maintain their structure. Data supports unsaturated fats and omega-3 helps to ensure the brain is well nourished. Whereas trans-fats found in processed and packaged foods (meats, cakes, biscuits) seem to be harmful to brain structure and function.

Protein is essential for the growth, maintenance, and repair of all body cells, including the brain. Total protein intake and the quality of protein intake is important to ensure the body receives all the essential amino acids required for health. Good sources of protein include fish, chicken, lean red meat, meat substitutes, beans, quinoa, and nuts. Furthermore, protein contains tryptophan, an essential amino acid which is a precursor of serotonin synthesis and is thought to help with less depressive symptoms and anxiety. Tryptophan sources include fish, poultry, eggs and game, some green leafy vegetables such as spinach, pulses and seeds.

Specific evidence looking at nutrients directly linked to mental health include B vitamins (including folate) and zinc with research suggesting that these nutrients are important in managing depression. Vitamin D has also received attention as to whether vitamin D deficiency causes depression. There is no evidence that this is the case, however there is a correlation between people who have depression and low levels of vitamin D. This is likely to be a causal effect from the social withdrawal and isolation from feeling depressed. There is evidence that not having enough vitamin D leads to depression symptoms. Eating a colourful variety of fruit and vegetables at least 5 portions per day (1portion = 80g), consuming foods fortified with vitamin D and getting safe sun exposure helps provides a wide range of vitamins and minerals sufficient for health and well-being. In addition, some researchers think that omega-3 oils, found in oily fish, may also help with depression. Oily fish twice per week such as salmon, sardines, mackerel, and trout is recommended.

A healthy brain contains up to 78 per cent water, therefore dehydration may also affect mood. Caffeine can lead to dehydration, withdrawal headaches and to low or irritable mood when the effects wear off. Drinking too much alcohol causes dehydration and can lead to B vitamin deficiencies, which increases depressive feelings or anxiety. Alcohol should be limited to within safe limits of units per week along with at least two alcohol free days per week.

Eating and drinking pattern is also important. Regular eating ensures optimal blood sugar control and as described above, links to our body’s functions, including brain health.

Avoiding over-eating and eating a main meal by 7.30pm encourages better sleep quality, which in turn supports our body’s natural circadian rhythm or body clock. Lack of good sleep also affects how much we eat. Research at King’s College, London, found that even partial sleep deprivation increased daily calorie intake of the equivalent of four slices of bread.

A recent area of interest is the link between our gut microbiome and mental health. As well as supporting our gut health, the microbiome is linked to stress and sleep quality and conversely sleep deprivation is known to negatively affect the gut microbiome after only two days of reduced sleep quantity and quality.

Such preventative measures to help with optimising mental health, gut health and overall well-being is key to maintaining a long-term positive lifestyle and will pay dividends in your overall health and happiness.

For further food examples, please refer to my blog called ‘Practical Examples for Food and Mood‘.

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults.  Rebecca is available at our Brighton and Hove Practice.

 

Further reading by Rebecca Mead –

Online vs in-person therapy

Loneliness and CBT

Is that a fact or an opinion? 

As we come out of lockdown, will a number of us be feeling socially anxious?

 

Resources:
• https://www.bda.uk.com/resource/fat.html
• https://www.bda.uk.com/resource/omega-3.html
• https://www.bda.uk.com/resource/fruit-and-vegetables-how-to-get-five-a-day.html
• https://www.bda.uk.com/resource/vitamin-d.html
• https://www.bda.uk.com/resource/probiotics.html
• https://www.bda.uk.com/resource/the-importance-of-hydration.html
• https://www.bda.uk.com/resource/depression-diet.html
• https://www.bda.uk.com/news-campaigns/campaigns/one-blue-dot/sustainable-
september/nutritional-considerations-for-dietitians.html
• https://www.nhs.uk/live-well/alcohol-advice/the-risks-of-drinking-too-much/

References

Al Khatib HK, Harding SV, Darzi J, Pot GK (2017) The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr;71(5):614-624. DOI: https://doi.org/10.1038/ejcn.2016.201

Appleton KM, Rogers PJ, Ness AR (2010) Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. American Journal of Clinical Nutrition. 91(3):757-70.

Arens U (2018) Authorised EU health claims for carbohydrates and maintenance of normal brain function. In: Foods, Nutrients and food Ingredients with Authorised EU Health Claims – volume 3. Woodhead Publishing.

Cuomo A et al (2017) Depression and Vitamin D Deficiency: Causality, Assessment, and Clinical Practice Implications. Neuropsychiatry. 7(5) 606-614.

Firth J, et al (2020). Food and mood: how do diet and nutrition affect mental wellbeing? BMJ; 369;m2382 doi:10.1136/bmj.m2382.

Gomez-Pinilla, F (2008) Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci 9 (7) 568-578.

Kraguljac NV, et al (2009) Efficacy of omega3 Fatty acids in mood disorders – a systematic review and meta analysis. Psychopharmacology Bulletin. 42(3):39-54.

Lespérance F, et al (2011). The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry. 2011 Aug;72(8):1054-62. doi: https://doi.org/10.4088/jcp.10m05966blu

Letchumanan V, Thye AY, Tan LT, et al (2021) Gut feelings in depression: microbiota dysbiosis in response to antidepressants. Gut;70:A49-A50.

Lin PY, Huang SY, Su KP (2010) A meta-analytic review of polyunsaturated fatty acid compositions inpatients with depression. Biological Psychiatry. (68(2):140-7.

Lindseth G, Helland B, Caspers J (2015) The effects of dietary tryptophan on affective disorders. Arch Psychiatr Nurs. 29(2):102-7. doi: https://doi.org/10.1016%2Fj.apnu.2014.11.008

Martins JG. (2009) EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. Journal of the American College of Nutrition. 28(5):525-42.

Mischoulon D et al. (2009) A double-blind, randomized controlled trial of ethyl-eicosapentaenoate for major depressive disorder. Journal of Clinical Psychiatry 70(12):1636-44.

Murakami K, Sasaki S. (2010) Dietary intake and depressive symptoms: a systematic review of observational studies. Molecular Nutrition & Food Research 54(4):471-88.

Penckofer S, et al. (2010) Vitamin D and depression: where is all the sunshine? Issues Ment Health Nurs. 31(6):385-93. doi: https://doi.org/10.3109%2F01612840903437657

Pouwer F, et al (2005) Fat food for a bad mood. Could we treat and prevent depression in Type 2 diabetes by means of omega-3 polyunsaturated fatty acids? A review of the evidence. Diabet Med. 2005 Nov;22(11):1465-75. doi: 10.1111/j.1464-5491.2005.01661.x

Rocha Araujo DM, Vilarim MM, Nardi A (2010) What is the effectiveness of the use of polyunsaturated fatty acid omega-3 in the treatment of depression? Expert Review of Neurotherapeutics 10(7):1117-29.

Rogers, PJ. (2007) Review: Caffeine, mood and mental performance in everyday life. Nutrition Bulletin 32, pp.84-89

Rondanelli M, et al. (2010) Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr 29(1):55-64.

Royal College of Psychiatrists (2019) Alcohol and depression. [online] Available at: https://www.rcpsych.ac.uk/mental-health/problems-disorders/alcohol-and-depression [Accessed 27 March 2023]

Somer E (2000). Food & Mood: The Complete Guide to Eating Well and Feeling Your Best, Second Edition

Walker JG, et al (2010) Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial. Br J Psychiatry Jul;197(1):45-54

Wurtman, RJ., et al (2003) Effects of normal meals rich in carbohydrate or protein on plasma tryptophan and tyrosine ratios. American Journal of Clinical Nutrition 77 (1) pp.128-32

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Can Chatbot Companions Relieve our Loneliness?

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

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

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

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

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

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

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

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

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

Narcissism by another name

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

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

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

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

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

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

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

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

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

 

Further reading by Mark Vahrmeyer –

What are feelings anyway?

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

The psychological impact of the recession

Why do people watch horror movies?

How to minimise Christmas stress if you are hosting

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The End

Just as what goes up must come down, so whatever begins must end.

Each of us comes to deal with this existential reality imposed on our own lives and all the living beings that we care for. As truly relational creatures we humans encounter the inescapable fact of death in those who die before us and we experience the pain of loss and bereavement.

And grief work itself is a common reason for people to seek therapeutic support. But whether it is through debilitating loss, or one of the many other reasons that spur people to commit to regular therapy, it is a fact that once therapy has begun, an ending of some sort will surely follow in the fullness of time.

Indeed the business of deciding when and how to end therapy is not straightforward.

Aspects that might make it easier to recognise when work is coming to an end can sit within the very beginnings of the work. Sometimes we go to therapy with a higher level of self knowledge about where our difficulties lie. With the help of our chosen therapist we can identify a working goal that will help us to recognise desirable change and a means of measuring how we will know when this has been achieved.

Through this means an ending may well present itself. In some senses this work might be likened to sailing whilst keeping the shoreline always in view.

Perhaps more often than not though, we can approach therapy with a less clear picture of who we are in our lives at that particular point in time, maybe even feeling unsure about quite what is ailing us or why.

In this case the beginnings of therapy can require a willingness to tolerate uncertainty. To deepen our self awareness, we might contract with our therapist to explore more deeply how we are in the world and this might come with a commitment to developing skills for new ways of being. We might compare this approach with setting sail beyond coastal waters to the open sea in search of new horizons.

When client and therapist first meet one question swirls for each of them: how is this for me to meet in relationship with this new person? And when the time comes to end therapy the question’s twin will arrive: how is this for me to end my relationship with this person I have known? An attuning therapist will process both these questions in the service of her client. For the client these valuable questions offer a way to better understand themselves and to evaluate any differences they experience in who they were back then at the beginning and who they feel they are now, at ‘the end’.

Much has been written about endings in therapy in terms of how this might relate to the ways in which both client and therapist have processed loss and bereavement in their own lives. Some family systems therapists have proposed that we can conceive other contexts to finishing therapeutic work than (1) ‘ending as loss’. Their framings suggest to me some useful additional questions for both client and therapist to consider:

• Ending as cure: does the client feel ‘better’ in relation to the way they originally felt ‘bad’?
• Ending as transition: how has this therapy supported the client to grow developmentally?
• Ending as release: does either client or therapist feel relief in this ending and if so, what might this mean?
• Ending as metamorphosis: how have both client and therapist changed through this relationship?

Reviewing these questions here reminds me of the vital importance of beginnings and endings in shaping the content of therapy and the emerging relationship between practitioner and client. Thus therapeutic beginnings and endings always invite our special attention.

As it is ultimately the client who decides to finish in therapy one final question becomes theirs alone: having begun, how much time and space will I allow myself to end?

To enquire about psychotherapy sessions with Chris Horton, please contact him here, or to view our full clinical team, please click here.

Chris Horton is a registered member of the British Association for Counselling & Psychotherapy (BACP) and a psychotherapeutic counsellor with experience in a diverse range of occupational settings. He works with individuals (young people/adults) in private practice.  He is available at our Lewes and Brighton & Hove Practice.

 

Further reading by Chris Horton –

I’m the problem – It’s me!

Making sense of our multiple selves

Let’s not go round again – how we repeat ourselves!

How are you?

Out of Sight, Out of Mind

 

Resources –

Fredman G. & Dalal C. (1998) Ending discourses: implications for relationships and action in therapy. 1
Human Systems: The Journal of Systemic Consultation & Management. Vol 9 (Issue 1)

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Some Existential Musings on Love, Generosity, and the Relation Between Self and Other

(Adapted from a presentation given at the SEA conference November 2022) – (Part one)

Anne Carson (1998) wrote,

“‘Now’ is a gift from the gods and an access onto reality. To address yourself to the moment when Eros glances into your life and to grasp what is happening in your soul at that moment is to begin to understand how to live.” (p.153).

Was it Merleau-Ponty (2012) who showed us that, without you, I do not know who I am. I cannot see the back of my head. I need you, the other, to tell me so I can build a picture of it. Yes, it seems we are made in the social.  But that means there will be ruptures too. Losses and suffering will prevail without our control. Can we transform in them? Do I need your help for that too?

Sal Renshaw (2009) describes the relation between self and other as a continual movement intrinsic to our becoming. Not only does the relation between self and other reveal the movement of becoming. It also signifies the impossibility and impermanence of the unified subject or absolute being. Encountering self and other reveals difference, perceived “somewhere in the space between that which returns to us that which we recognize as the same, and that which escapes us” (Ibid, p. 2).

Sometimes difference is felt as a conflict, sometimes as a threat, sometimes as an interest and an opportunity. But difference can be, and is, an opening into our becoming.

It may entail a complex exploration: maintaining positive regard for the other without being implicated in a kind of sacrificial logic rooted in Christian morality and its derivatives and without being caught in the web of patriarchal narratives. As Renshaw states (2009) writers such as Helene Cixous inform us of the extent to which “women have traditionally borne the brunt of sacrificial logic in a patriarchal structure” (p. 7).

How can we hold a space for a version of selflessness that is generous, alive, affirmative and does not fall into self-abnegation? A difficult task, no doubt. But an important one: “loving the other as other, allowing them and oneself to be born into the present in love” (Renshaw, 2009, p. 176). Perhaps they have forgotten or never knew that difference is the astonishing source of their love.

Isn’t there always more to the story, yes, more to come, more to become?

Is not life itself a movement of becoming …

Part two of this blog can be found here.

To enquire about psychotherapy sessions with Susanna, please contact her here, or to view our full clinical team, please click here.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

 

Further reading by Susanna Petitpierre –

On living as becoming (part two)

On living as becoming (part one)

Some thoughts on becoming (part two)

Some thoughts on becoming (part one)

What is the Menopause? (part one)

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Online Therapy: Good for Some, but not Everyone

Therapy over the phone and in more recent years on video has been around for a long time, but since the recent pandemic it has become normalised with lots of online therapy platforms emerging and an abundance of “mental health” apps.

At Brighton and Hove Psychotherapy we offer both face-to-face and online therapy, and whilst many people can benefit from the latter, this option is certainly not advisable for everyone. I would like to share some of what I have observed about psychotherapy conducted online from my own clinical experience, from supervising clinicians who work with clients online and from many exchanges with colleagues in the field, especially since the beginning of the Covid-19 pandemic. Here are some considerations:

Doing therapy from the comfort of your own home x travelling to see your therapist

The journey to a therapist’s office is a part of the work itself, as long as it isn’t so arduous and exhausting that it becomes unsustainable. The intention and commitment to make the journey each week, the space to reflect, the checking in with self before entering the therapist’s office, arriving at a physical room and being greeted in, or waiting for your appointment, all are rituals that are a part of the process itself. There is also the journey after the appointment, which hopefully is long enough to allow some space to be with yourself before engaging in any other activity. Time poor people will argue that they can fit therapy into their day more easily if it’s done online, however one of the goals of therapy for some individuals could be to look at difficulties in prioritising personal needs, including making time for therapy appointments.

Choosing from a larger pool of therapists x choosing someone locally

Depending on where you live it may be easy or difficult to choose someone to work with. However, the very process of choosing is an important one. I compare some online directories or platforms to fast food. We live in a consumer-led culture where convenience is highly sought after. We want quick results because many of us are time poor, but consider that this is probably on of the most important choices you will make. Therefore, it is worth spending some time and effort choosing a therapist as it might determine the future state of your mental health and even your life.

People who are socially anxious can access help at home

Unless someone has a debilitating condition that keeps them housebound, in which case psychiatric care would be advised, colluding with or perpetuating the existing issue might be counter productive. Encouraging someone with social anxiety to venture out and travel to see a clinician face to face is a small step towards creating a relationship that is safe and manageable for the client, before they risk other forms of social engagements that go beyond the therapy room.

“ The therapist’s office is intimidating ”

Here is another great reason to explore why it is more difficult or intimidating to talk about yourself when faced with a therapist – a real person in the real world. Psychotherapy should enable and encourage people to have better relationships that are real. If the ease of talking more about yourself when you’re meeting someone online could be linked to difficulties forming and sustaining real relationships. Just as we see brilliant poets and writers who can barely utter a word when faced with a social situation, someone who is seemingly confident and capable of relating on the screen, can be very different in person.

Having said all the above, I remain an advocate of virtual sessions depending on the person and type of work. For instance, more cognitive and solution-focused approaches can work well online. Whereas in-depth psychotherapy which draws on unconscious processes is undoubtedly much better done in person. I would not recommend online therapy to those who struggle to maintain clear boundaries, feel easily emotionally overwhelmed, or are dealing with a range of complex psychological issues. People leading chaotic lives usually find it more containing to have the predictability of their therapist’s office environment. I also would not advise anyone training to become a psychotherapist to have their therapy online, and couples work can be difficult virtually, especially if the couple is in the middle of a lot of conflict.

This is not to say that good work can’t take place virtually, but we have to accept that there will always be a missing component and that the therapy will probably not achieve it’s full potential.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading –

The Psychology of Mindful Eating

Defining Happiness

What are the benefits of counselling and psychotherapy?

Why is mental health important?

What makes us choose our career paths?

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