Mental Health Archives | Brighton and Hove Psychotherapy

September 3, 2018 by Brighton & Hove Psychotherapy Leave a Comment

What is BDSM and is it a Mental Illness?

Have you ever felt curious about people who engage in BDSM?[i]Possibly interested in trying it out yourself, while at the same time feeling apprehensive. You would not be alone. Many others have similar thoughts. They also worry what this interest signifies; are they weird, unnatural, in need of treatment? This concern is hardly surprising, considering the stigma that has – until recently –accompanied BDSM. A brief historical and cultural review can help provide guidance.

What is BDSM?

The use of physical or mental pain to promote sexual stimulation has not always been perceived in a negative way. Until it became a medical diagnosis it received little attention and was not even classified as a sin. BDSM behaviour has been recorded throughout history, dating back to ancient Egypt. It was generally regarded in a positive light, with painful stimuli being viewed as an acceptable part of a person’s sexual repertoire, (e.g. The Perfumed Garden, The Kama Sutra). Much later, the writing of sadomasochistic activities (e.g. Marquis de Sade) was seen by physicians as a medical curiosity, but not something that required their intervention. However, following on from the work of Krafft-Ebing and later Freud, BDSM practices became seen as examples of sexual pathology, and were diagnosed as such. The belief that people who engaged in BDSM were mentally ill became established and continued for over a hundred years. This view was reflected in the highly influential Diagnostic and Statistical Manual of Mental Disorders (DSM), in which BDSM has been classified as a mental disorder since the DSM’s first publication in 1952. Since the 1980’s a campaign has been waged for a return to a more enlightened understanding of BDSM, including the removal of BDSM from the DSM. This was fully achieved as recently as 2013 when finally, consenting adults were no longer deemed mentally ill for choosing sexual behaviour outside the mainstream.[ii]

So, in these more enlightened times, what could a novice curious about the BDSM scene expect?

The five main categories of BDSM

Dominance and Submission

Dominance is the appearance of rule over one partner by another. The dominant partner is variously called sadist, dominant, top, master, mistress or ‘S.’ The submissive partner gives the appearance of obedience to their partner, and is variously called masochist, submissive, bottom, slave or ‘M.’ BDSM participants are extraordinarily clear about which part they are playing. The experience of physical and/or psychological pain is used to express dominance and submission.

Role Playing

Role playing is about establishing a role primarily to act out sexual fantasies. Some participants like to take turns playing both the dominant and submissive roles (‘duals’) while others have definite preferences. Part of role playing is establishing a ‘scene,’ such as master and slave, teacher and student, mistress/master and servant. Some scenes are simple, some are more specific and can include a ‘script.’ Scenes can be enhanced by various paraphernalia including clothing, chains and restraints.

Consent

Most players in the BDSM scene would agree that one of the most important principles is that of consent. All acts should be safe, sane and consensual. It is assumed that everyone has the ability to mentally, psychologically and socially choose for themselves whether or not to engage in an activity. Everyone will be expected to practice risk awareness. This means that all understand the potential risks and have taken the necessary precautions for their safety. Participants soon learn who will not abide by these rules; word gets out and no one goes near them.

Sexual context

Activities are placed within a sexual context. Even if there is very little sexual contact during the encounter most participants say what they are doing has a sexual meaning and is clearly erotic. Sometimes the main sexual activity takes place when the role play is over.

Mutual definition

Participants have to agree that what has taken place is BDSM. For example, even quite intense physical pain will not always be seen as BDSM, with participants preferring a mutual definition of masculinity and toughness and/or unwillingness to give into pain, explaining that everyone else in their group ‘can take it.’

This description above of the five main categories observed may help to lessen your fears of further exploration of the BDSM community.[iii]It can be seen that BDSM activities usually operate within clear boundaries, with issues such as consent and safety being a primary concern. However, there remain those who advise caution.

Is it a mental illness?

Some of Freud’s successors continue to speak of BDSM in the language of mental illness. Sheldon Bach, Clinical Professor at the New York Freudian Society maintains that some people are ‘addicts’ who use BDSM in an attempt to cope with emotional deficits. They feel compelled to engage in BDSM acts, doing anything that is asked of them. Sheldon claims this is because they are unable to experience love. They are searching for love and BDSM is the only way they can try to find it because they are locked into sado-masochistic interactions they had with a parent.

The BDSM community itself have expressed related concerns, explaining the real danger is that some people have misplaced anger and pain, and are trying to resolve these issues in destructive ways. Instead of confronting their emotional pain they seek physical pain to relieve their distress. The relief is usually short lived and the need for destructive behaviour quickly returns.[iv]Thus, there are both mental health professionals, and members of the BDSM community who acknowledge possible negative effects of BDSM activities. However, most people in BDSM circles are dominant or submissive in very specific situations, while in everyday life they can, and do play a whole range of roles. But if the only way a person can relate to someone else is through sadomasochistic games, there is probably a deeper psychological problem.

In spite of the above, the idea that BDSM is pathological has been largely dismissed by those who work in the field of mental health. BDSM is increasingly being seen as one part of the continuum of sexuality and sexual behaviour. The ingredients in good S&M play – communication, respect and trust – are claimed to be the same ingredients found in good traditional sex. The outcome is the same too; a feeling of connection to the body and the self. With regard to communication, the BDSM community may have something to teach others. For example, when setting the scene for BDSM activity, there is discussion ahead of time about what everyone wants to do and also their limitations. There is usually far less discussion between those who engage in ‘vanilla’[v]sex. If there were better communication we might avoid many misunderstandings, from awkwardness between couples to accusations of sexual assault. We need to get more comfortable with these conversations. Presently we are poorly equipped to have honest dialogue about sex. BDSM are one of the few communities who elevate/prioritise sexual/erotic communication in this way. Perhaps we have a lot to learn from them

Hopefully, this brief exploration will help to clarity your thoughts and feelings about whether to further explore BDSM.

[i]In recent years the term S&M, has given way to BDSM. BDSM has become an all-encompassing term for sexual activities between consenting parties. Within BDSM there are several subcategories including bondage and discipline, dominance and submission, and sadism and masochism.

[ii]This was similar to the removal of Homosexuality from the DSM in 1987

[iii]These categories were derived from interviews and observations conducted over an eight-year period.

[iv]Yasuko Thanh, blogger and member of the BDSM community.

[v]Vanilla sex is the BDSM community’s description of conventional sexual practice.

Jane Craig is an experienced chartered clinical psychologist and supervisor working in the NHS and in private practice at The Barn, Lewes, where she sees individuals, couples and groups.

June 18, 2018 by Brighton & Hove Psychotherapy Leave a Comment

How do Psychotherapists work with Anxiety? – Trio of Blogs – Part 2

In this trio of blogs, three of our therapists – a psychologist and two psychotherapists – of differing modalities will be sharing their views on how to work with a fictitious client. The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.

Client background

James comes from an upper-middle class background where there was a family culture of not talking about feelings and difficulties. He was sent to boarding school ages 6 – 13. He is eldest of 3 children and his parents divorced when he was 13. There’s has been other traumatic childhood incidents that he is yet to disclose.

He presents well dressed, competent, practical and wants quick solutions. He is very busy and wants to know what therapy can do for him and how long it will take.

A gestalt psychotherapy approach

There is meaning in the way that James relates to the prospect of therapy. I imagine that if I were sitting with James, I would experience a sense of pressure – in fact I experience this when reading the paragraphs above.

The desire for quick solutions manifesting as demands on himself and the process, wanting to “get rid of” the problem. Herein may lie the clue as to the “how” of James’ anxiety.

Anxiety conceptualised from a gestalt perspective

In gestalt therapy we talk of anxiety as “excitation without breathing”. Simply put, this means that as a way of blocking emotions unwelcome to us or others around us, we physically hold our breath. For example if a child’s anger was deemed unacceptable by her parents, she may hold her breath to block this emotion. Although successful in one respect, the original anger becomes stuck in the body, trapped by the rigidity of the held breath.

This is a complex psychological-body process that, in severe anxiety, is kept out of awareness. The holding of breath has become chronic and unconscious and is no longer a pragmatic response to a given situation.

Therefore James’ present experience could be thought of as an expression of an outdated solution to events in the past. In a family environment that did not support certain experiences or expressions of vulnerability it is possible that James found ways of being that were acceptable to his family.

The importance of families

As families are vital for children to survive, this response, psychologically speaking, is a matter of life or death, and in gestalt therapy is called a creative adjustment. This adjustment contains three things: the original emotion felt in the past (i.e. fear), the unfavorable environment (the message that you should not be vulnerable) and the mechanism of holding the breath (felt as tightness in the chest, pain in the throat or a general unpleasant feeling in the core of the body). This is all kept out of awareness and the result is anxiety.

Then you have the subsequent events of boarding school, divorce and another trauma yet to be named. These possibly difficult and distressing experiences were likely more difficult to live through with the already well developed habit of non-expression of vulnerability.

Why now?

The current beginning of an intimate relationship is likely to trigger early attachment wounds which would cause James to feel vulnerable, thus increasing his anxiety.

Giving time and space to his current experience may well be a challenge for James, but would be the principal task of therapy. This could support greater understanding and awareness of the processes involved in anxiety.

Julia Wright is a UKCP-registered psychotherapist with more than 15 years of experience in psychotherapy and mental health. She works from our Hove and Lewes practices with individuals, couples and groups and she also offers clinical supervision.

June 4, 2018 by Brighton & Hove Psychotherapy Leave a Comment

‘Hello, what do you do?’ Women and the Family Life Cycle

When women are asked the this simple question I often sense a slight hesitation; I wonder if the pause is connected to the many different roles and contexts within the family life cycle.

Even in 2018 there is still a sense of women juggling many different roles within family which change with external demands, in addition to working building a career and staying in a very competitive job market.

The Sandwich Generation

The sandwich generation accurately describes one of the many transitions women make over the course of the family life cycle.

It can be couples juggling demands of aging parents and young children alongside jobs and careers, or couples in their 50’s and 60’s caring for elderly parents, supporting adult children and acting in a caring role with grandchildren.

Pressures of housing, money and health also add to the squeeze. There are several key transitional points , relationship breakdown, job loss, ill health –physical and mental, moving house, birth of children, death of parents etc.

The mental agility needed to hold the family diary and it’s numerous interactions in your consciousness is immense. However much roles are shared and divided, this is usually held by one person – often the mother – who may also be working in a paid job that requires significant commitment.

On the Role of Men

Of course men are part of the sandwich too and often couples come to therapy needing extra support during one of the many transitional points in the family life cycle. These may be the birth of a child, illness-physical and mental , death of a loved one , redundancy etc.

It can be hard to maintain a couple relationships in the face of so many pressures. Thinking about the present and future, voicing and hearing priorities and hopes are really important.

In families members may be invested with a role or responsibility which no longer fits and needs reviewing. Likewise members can get stuck with outdated perceptions about themselves by other family members. In family therapy how these ‘stories’ evolve and dissolve can be explored bringing new understanding and meaning to the next stage.

Systemic Family Therapy

Systemic family therapy thinks about how systems (in this case family) can change when it no longer works so well. All the different voices can be heard and positive change explored in a safe non blaming way.

Angela Betteridge is a couple and family therapist working at The Barn in Lewes. She works with any combination of family, including adult sibling groups and different generations. Family is whoever you define as such.

April 29, 2018 by Brighton & Hove Psychotherapy Leave a Comment

On the Importance of Using Empathy with Children

What is Empathy?

It can be so hard to be along-side distressed loved ones. So often we want to take the distress away and offer solution as the uncomfortable and difficult emotions become too hard to bear. When we meet with others in distress it can be painful and we can turn to offering guidance, try to lessen the experiences, blame someone or do something to make it all better.

Our capacity to be with someone, to hold a silence if needed and to give attention to some of the difficult feelings and sensations can reveal our abilities to empathise with those we care for. Empathy is our ability to be with another’s emotions and sensations. It is our wish to understand someone’s experiences from their point of view and it is at the heart of connection. When working with children in therapy, empathy is fundamental and within empathic interactions, children get to see that they can be both the light and shade in another’s eyes.

In psychotherapy, the therapist gets to know their clients and in turn the client gets to know that they are known – this is empathy in action. We cannot undervalue this as an experience and it is core to why therapy works.

From a Child’s Perspective

The following example can be helpful to reflect upon when we want to consider a child’s perspective and how, as parents, we can easily miss empathic connection. Misconnection for children can be so difficult to experience and, as psychiatrist Daniel Stern points out in the extract below, it can leave young children feeling alone.

An imagined one-year old’s experience of touching a pool of light on the floor:

Mother: Just sunshine

Child: but it was my pool, a special pool

Mother: it’s just to look at

Child: I heard it, I felt it too

Mother: only light on the floor

Child: how?

Mother: its dirty

Child: I was in it

Child: when she stops, the pieces lie all around. That world is gone. I feel sad. I am all by myself.

(Stern, 1990)

On Bring Validated

Without empathy children can feel deeply alone. Empathy encourages children to invest in themselves and can help them to find the right words and tone to let someone know how they feel. Repetition of empathic experiences can bring so much into our lives and we may create new feelings, images and thoughts that influence how we see ourselves and others. Being along-side another’s experiences, imagining into their experiences can be both rich and fulfilling, and will undoubtedly encourage the development of healthy and happy relationships.

Gemma Hurley is an an Integrative Child Psychotherapist who works alongside families, young adults and children from our Lewes and Hove Practices. To find out more or to arrange an appointment, please contact us here.

April 3, 2018 by Brighton & Hove Psychotherapy Leave a Comment

Managing Work Stress

Most of us have to work in order to live. For many, work can take up a large proportion of our waking lives with up to a third of our lives being spent at work.

While the primary reason for working is to make money, our work life can (and should) be much more than that. Working and having a career can become an intrinsic part of our identity and can indeed give us meaning and purpose in the world.

When we meet a new person, one of the first questions we often ask them is: “What do you do?” We can identify ourselves by our work and the position we hold within it, and our work can become one of the most important aspects of our life.

When our work life becomes stressful, our emotional response to it can become out of proportion to the actual situation. We can feel that our livelihood is jeopardized and at a deeper level it may feel like the very core of our being is threatened. Stressful situations at work can soon spiral out of control as we lose our clarity and our ability to stay objective in the face of these perceived threats.

What is stress?

There is no clear medical definition of stress, but generally speaking we can say that stress is our body’s natural response to demands or threats that are put upon it. The stress response is usually the ‘fight or flight’ response that can help protect us in dangerous situations.

Under normal circumstances, stress is healthy and can help us stay alert, focussed and be more energetic. It can give us the motivation to get up in the morning and get on with our day.

However, if we have a demanding job or there are conflicts at work we can end up in a heightened stress state for a prolonged period of time. This can have a negative affect on both our physical and emotional health and we need to be mindful of the signs that we are becoming too stressed.

What are the common symptoms of stress?

Cognitive symptoms: Inability to concentrate, constant worrying, racing thoughts, seeing only the negative in situations.

Physical Symptoms: Frequent colds of flu, aches and pains, nausea, dizziness, chest pains, rapid heart beat, loss of sex drive.

Behavioural Symptoms: Changes in sleep pattern, using alcohol or drugs to relax, changes in eating habits, withdrawing from other people.

Emotional symptoms: Depression, anxiety, mood swings, irritability and anger, feeling overwhelmed, loneliness and isolation.

What is causing your stress?

As well as noticing the signs and symptoms stress, we also need to identify the situation that is causing us stress. Some of the main work issues that can cause stress are: being overloaded, conflict with colleagues, management style of the organisation or our line manager, change and personal factors such as work/life balance. Some of these will be easier to address than others, but as a starting point, don’t carry the stress alone.

What can you do?

If possible, speak to colleagues and your line manager, and to your HR department if you have one. Letting others know that you are stressed will enable them to step in and help if they can.

Additionally, think about your work/life balance. Are you spending too much time at work with not enough down time? It’s easy to fall into the trap of needing to work more because you are stressed, which means you have less downtime and hence more stress. Re-addressing priorities in an important part of dealing with stress – make some time for yourself. If you able, do some physical exercise to help you unwind the physical tension. Start a mindfulness practice to allow your mind some ‘time off’. Speak to your GP if you are experiencing the physical symptoms mentioned above. And finally, if it becomes overwhelming, consider speaking to a counsellor or psychotherapist to help you process the emotions than can arise from feeling stressed.

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.