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What is EMDR?

You might have seen EMDR being spoken about in the media a fair bit recently.  Many famous people have been speaking out about how it has helped them with psychological difficulties, most often past traumas, but what actually is it?

EMDR stands for Eye Movement Desensitisation and Reprocessing.  It was developed in 1987 by American Psychologist Francine Shapiro, initially as a treatment for trauma.  Shapiro tells how she discovered the main premise, almost by accident, as she walked in the park:  She noticed that as she thought about some distressing memories, her eyes moved back and forth and the distress she felt reduced.  From this she went on to develop EMDR, which is now widely practiced across the world.

The National Institute for Health and Care Excellence in the UK currently recommends EMDR as a treatment for Post Traumatic Stress Disorder.  There is also a significant and ever-growing evidence base for the use of EMDR to treat other psychological issues.  EMDR can be used effectively with children and adults.  Clients often notice quick changes (sometimes in even just 2 or 3 sessions) which can have long lasting effects.

There are several theories as to how EMDR actually works, although it still isn’t 100% clear.  The main premise is that the two sides of the brain are alternately stimulated whilst the person holds a difficult thought or memory in mind.  Traditionally the therapist would stimulate alternating sides of a person’s brain by moving their hand side to side, whilst the person tracks with their eyes (hence the name Eye Movement).  However, there are other techniques, such as alternating hand buzzers, hand taps, audio or light bars.  This allows things have that become ‘stuck’ to be re-processed, and therefore to be less distressing.  The eye movements (or other forms of alternating stimulation) form a significant part of the therapy.  There is also talking involved, but people do not necessarily have to share all the details of their traumatic story if they prefer not to.

EMDR is an advanced therapy and should only be delivered by highly skilled, trained therapists.  In order to become an accredited EMDR therapist there is a significant amount of training and then supervised therapy work with clients.

The website of the EMDR Association UK and Ireland has more information on EMDR, finding a therapist and some stories of people who have benefitted from EMDR therapy – www.emdrassociation.org.uk

 

Dr Emma Stevens, HCPC Registered, Clinical Psychologist, is currently undergoing the training process to become an accredited EMDR therapist and is able to offer EMDR, under specialist supervision.   She has an integrative approach drawing on Cognitive Behavioural, Systemic and Psychodynamic models, as well as Attachment Theory. Emma sees individuals primarily for short-term work. Emma is available at our Lewes Practice.

 

Further reading by Dr Emma Stevens –

Emotional Well-being

 

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The Therapeutic Relationship and the Unconscious

Therapy is often referred to in terms of it being relational, or as a relationship, albeit a particular type of relationship, one that has very specific parameters, particularly around money, time, touch, and about whose inner life is there to be explored.

Despite this, in some ways, very one-way relationship, an awful lot of what goes on is a kind of relating. The therapist will encourage the client to speak as freely as possible and through a careful listening to the client’s words and to what is evoked in themselves, through this listening, they will try and relate as closely as possible to the clients experience and will feed this understanding back via their own comments, or interpretations.

What makes this different from other listening conversations, is that the therapists understanding and feedback will be influenced by the therapists training, specifically their own therapy and their learning of theories, which provide maps of mental structures and types of human experience and distress.

The therapist as well as listening to the stories, will also listen for patterns, for words, they will try and be attuned to what is going on emotionally for the client and also pay attention to the actions of therapy, to the how the client goes about relating to the therapist. When the therapist feels something useful has been understood, they will share this.

Sometimes this may not have been consciously known by the client, and this is why it can be useful. However, it can also be unnerving, as we like to believe we are the masters of our own houses, independent and not in need of the help of another.

Freud said there have been three great blows to man’s ego, the Copernican discovery that the solar system didn’t revolve around the earth, Darwin’s discovery that we are descended from animals, and share an essentially mammalian brain structure and Freuds own discovery that we have a dynamic unconscious, that the rational beings we like to believe ourselves to be is only one part of the story.

Part of this unconscious is the repressed unconscious, the place where we store the things we don’t want to know about ourselves, however these things are known at some level and we can expound a great deal of energy trying not to know them.

Getting to know and understand these parts of ourselves although often frightening to begin with, can actually be a huge relief as we come to know and accept these parts of ourselves, parts of ourselves that may seem like monsters under the bed and cast scary shadows but are usually essentially human characteristics.

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

A Nation Divided

Adolescence: the trials and tribulations

Does the male mid-life crisis exist?

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How do I choose a psychotherapist?

Deciding that you want or need psychological help can be a difficult position to arrive at.  Choosing the right practitioner to work with can feel like a daunting task with so many different fields of talk therapy, types of therapy and professional bodies overseeing the field.  This blog is a guide to helping you find your way to the right psychotherapist for you.

Counselling, psychotherapy or psychology?

Counselling, psychotherapy and psychology all broadly fall under the category of ‘talking therapy’.  They have much in common, yet are also very different.  I have previously written a piece on the difference between counselling and psychotherapy; the former being largely for shorter-term work and the latter being appropriate for deeper and long-term work on the personality.  We also have an in-depth page on psychology here so I shall not go into more detail about that here.

Depth of work

In choosing a psychotherapist, it can be helpful to have a sense of what it is you are seeking to gain from therapy.  Generally, psychotherapy is longer term than counselling and rather than working with one specific issue, is instead a relationship through which the client can work through relational patterns (with themselves and others), formed in childhood that they wish to change. Depth relational psychotherapy takes time – months to years – to understand and process relational, or attachment, losses. It is a commitment to a process of therapy and to oneself with sessions being as a minimum weekly, at the same time and on the same day each week.

Professional Body

There are a few professional bodies who offer voluntary registration to counsellors and psychotherapists – the BACP and UKCP. Whilst the BACP includes the ‘P’ for ‘psychotherapist in its acronym, the minimum training requirements of the BACP for someone to call themselves a psychotherapist are quite low. The UKCP, on the other hand requires all registered psychotherapists to undertake a minimum of four years of post-graduate training at an accredited training institution alongside a mental health placement and four years of personal therapy, before permitting applicants to join.  At Brighton and Hove Psychotherapy, all of our psychotherapists have trained at least to this standard and many far beyond.

Training

Psychotherapy training is long, challenging and requires the candidate to be in their own personal therapy throughout the training period.  Most training institutions are located in London, or further afield, and so a great deal of commitment is required to reach the necessary training standards. One of the main aspects that sets UKCP registered psychotherapists apart from counsellors is that they have been trained to ‘formulate’, which is another work for diagnose, or understand, more complex trauma and mental health issues.

First Appointment

If you have never previously been in therapy, then the prospect of the first appointment can be daunting. It is the job of your psychotherapist to set clear boundaries and create an environment that ‘feels safe, but not too safe’.  What does this mean?  Psychotherapy is about learning to tolerate difficult feelings and your psychotherapist is there to facilitate this process through their relationship with you.  They are not there to be liked, or to be your friend, as this would not be beneficial to you or to your process. If all goes well at the initial consultation then you and your psychotherapist may ‘contract’, or agree, to work together.  This means that they have assessed what work is required to facilitate change for you and you have decided that you are going to enter into an intimate relationship unlike one you have perhaps ever had before.

Length of Contract

How long is a piece of string?  Most psychotherapy can last for months or years, however little can be inferred from the duration.  For example, someone attending a year of therapy is not necessarily ‘healthier’ or ‘saner’ than someone who attends weekly for many years.  It is entirely dependent on the work required, how the client wishes to ‘use’ therapy and the relationship formed. Freud famously believed that therapy only begins when the client is no longer in a crisis.

Final Thoughts

Finding a good psychotherapist begins on paper but ends with a feeling, or a set of feelings.  As it is in the relationship that the unravelling of the past takes place, it is critical that as a client, you feel you can build a therapeutic relationship with your psychotherapist. The capacity to do this will hinge on their degree of training, clinical experience and therapeutic boundaries, as well as on it being a relationship that feels ‘safe enough’ – not too safe to not be challenging – within which the therapeutic process can unfold.  

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.

 

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What causes insomnia?

Insomnia is defined as being a habitual, or regular, inability to sleep.

Whilst it can be linked to medical conditions, the most common causes of insomnia are lifestyle related as well as anxiety, depression and stress related.

With regards to anxiety, depression and stress, insomnia is not only caused by these conditions, but it further exacerbates them too creating a vicious circle.

What can I do to help with my insomnia?

Improve your sleep hygiene

Sleep hygiene is a term used to describe a holistic approach to sleeping encompassing who you are as an individual and your sleep environment. Improving sleep hygiene involves thinking about where you sleep, how you sleep and what may work best for you.  Sometimes this will involve a degree of experimentation, for example, do you sleep better with the window open or closed? 

Stick to a routine of sleeping and waking

Research has shown that we are biologically predisposed to sleep and wake at the same time each day, ideally in synch with the setting and rising of the sun.  Whilst the latter is a far cry from modern life, coming up with a routine and sticking to it can be extremely beneficial to both your sleep patterns as well as your physical health.

Avoid stimulants

We all know that caffeine and alcohol will impact on the quantity and quality of our sleep.  However, watching a disturbing drama right before going to bed – or the news – can have an enormous impact on the ability for us to get to sleep.  It is much better to consume the news in the morning when we have the mental capacity and waking hours to digest it.

Why do anxiety and depression make insomnia worse?

Anxiety and depression are two seemingly different mental health problems that frequently find themselves side-by-side in the same sentence.  This is because they are essentially two-sides of the same coin.

Anxiety is an uncomfortable (at times, unbearable) feeling that gives us the sense that all is not well with the world.  It is an ordinary element of being a human being and many scholars believe that we are ‘cursed’ with anxiety due to our (largely unconscious) awareness that we are going to die.

Anxiety causes restlessness and many people deal with anxiety by channeling it into activity – something that fails when it comes to going to bed.  Anxiety is often described as ‘free-floating’ and will seek to attach itself to something.  We can then convince ourselves that the ‘thing’ our anxiety has attached to is the real problem, however, this is rarely the case.

Depression is a state of inertia but an uncomfortable one.  Anxiety (and stress) can have the function of protecting us from depression, however, eventually anxiety will give way to the hopelessness of depression.  One may think that sleep would come easily in a state of depression but this is often not the case as hopelessness can feel unbearable.

Can counselling or psychotherapy help with insomnia?

If a client presented with insomnia than I would want to understand what may be causing the insomnia and to work with the client to gain a deeper understanding of what their feelings may be telling them – particularly any anxiety or depression.

Whilst anxiety is a normal element of being a human being, it should not be debilitating and an ideal is to engage in a meaningful life whereby the anxiety is channelled in a healthy way. 

Alongside this is a deepening of the relationship with ourselves in order to learn to better tolerate difficult feelings without becoming overwhelmed by them.

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.

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Why does empathy matter?

When you begin therapy you enter into a particular (perhaps peculiar) type of relationship, one with well defined boundaries and ethics. Beyond its method and structure, at the very heart of this relationship lies empathy.

As a therapist empathy means doing all you can to understand your client from inside their own experience. It requires an ability to communicate this understanding in ways that are sensitive, meaningful and useful, both verbal and nonverbal.

It is a powerful experience to feel understood, listened to, cared for and respected. Over time it can make it easier to have empathy for yourself, to take your own personal pain and suffering seriously, to judge it less, as trivial, stupid or simply a product of your own personal weakness.

When we begin to take our own struggles seriously, we gain access to another layer of empathy: compassion for the child that we were, often a child who made sense of what troubled them by deciding that there must be something wrong with them – that they were the problem. In the context of an authentic and empathic connection with another human being the shame or disgust or guilt that has become so entangled in our sense of self can begin to make way for new feelings. Sadness (perhaps) for what was lost and loving regard for the child who did the best they could at the time.  When there is more space in our imaginations for the reality of our own struggle, we can begin to see other people differently too. When we experience the power of feeling understood we may also experience greater internal space for new thoughts and feelings, both about ourselves and about others.

The therapist as client

All psychotherapists have had their own experience of being a client in therapy. Sharing the most intimate and often painful moments of someone’s life is made possible when you have felt and expressed your own. It is not that as a therapist you become an expert on life (not even your own) but that having undergone your own therapy you will be more equipped with the clarity to differentiate your separate self and experience from that of another.  To understand whose feelings are whose and to have the versatility  and flexibility to step into and out of another person’s shoes.

The circuitry of empathy

Empathy is a complex system of mutual cues and responses that regulates each persons experience of self and other. We observe this very clearly in parent/ infant interactions. How attuned a parent is to the (myriad/micro) communications of an infant will inform the infants reciprocal response to the parent.

It is not that in an ideal world infants and young children would be perfectly attuned to at all times. Over-attunement can be stifling and intrusive. What’s more important is the experience of an ongoing relationship in which misunderstandings and mis-attunements can be repaired.

Emotional neglect and emotional intrusion are flip sides of the same coin. Anyone who has suffered either will have good reason to believe that they may never be understood.

As a therapist we cannot “know it all” for our clients, we cannot tell someone how it is they feel or what is true for them. What we can provide is an open ended, respectful curiosity for our clients and a willingness to share in the important project of “getting it.”  Paying close attention to the unique form of connection that exists with each client means understanding empathy as a mutually influencing system. From this perspective, the communication of empathy becomes much more a mystery to engage with than a tool to master.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

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