Mental Health Archives | Brighton and Hove Psychotherapy

January 7, 2019 by Brighton & Hove Psychotherapy Leave a Comment

How Psychotherapy Taught me to Live Life

This piece is written by a ‘fictional’ client who is a composite of three real-life clients who have shared their experience of psychotherapy with me. Some details have been changed to ensure confidentiality, however, the thoughts feeling and experiences expressed are those of three very real clients:

When I came to psychotherapy I did not even really know what it was. I knew I needed something because I knew I was struggling but whether that something was counselling, psychotherapy or what I simply had no idea.

As well as not having much of an idea about what to expect from my psychotherapy, I also had no idea about how long it would take. And I was impatient! It is therefore with a surprise that I look back upon my two-year journey of weekly one-to-one psychotherapy with some degree of awe with regards to how little I really understood what I needed and for how long; from my initial impatience, a sense of appreciation and security developed from knowing that on Tuesdays, at 5pm, I would be seeing my psychotherapist.

Where I say that psychotherapy taught me how to live life, I mean this in the sense of courageously living rather than existing.

Prior to psychotherapy I approached life and relationships from a default fear position. Not that I knew that at the time – the way I was all seemed perfectly normal to me. Normal is, after all what we are familiar with.

However, part of me also know that I felt unfulfilled and lacking in purpose and meaning. Meaning in terms of my own desires and meaning in terms of what relationships could offer me.

It has been through a slow process of learning to be in relationship with my psychotherapist that I have slowly learnt to have a healthy relationship with myself. Through being held in mind, I have learnt to hold myself on mind. And through trusting that the relationship with my psychotherapist was and is genuine, I have come to accept that just perhaps, relationships with others have something to offer me.

I am now two years into my ‘ongoing’ psychotherapy relationship. It has been hard, frustrating, frightening, constructive, containing and life enhancing all in equal measure. The only commitment: we both show up each week for the session.

How have I changed

Most of all I have let go of the past. My experiences still happened, of course. There is no magic to undo that. However I have accepted that I can still have a life without having gotten what I needed as a child. And through this have come to accept that I can treat myself differently to how I experienced my parents treating me.

My relationship with myself

‘Has psychotherapy made you happy?’, people I know sometimes ask me. No. But then happiness is not the purpose of life. I do, however, at times feel content and even happy. More importantly, I am able to feel the full range of human emotions without running away from them. I can navigate my emotional world using my mind in a way I simply could not before psychotherapy and instead would use all sorts of distractions to avoid feeling.

My relationship to others

I have far deeper and more authentic relationships with others – something I now realise I avoided in the past for fear of them really seeing me and then rejecting me.

Relationships have become important to me and I am far more able to tolerate difference in those around me – to accept that they have different minds.

In summary

Put simply, my life now has substance. I know more about who I am, who I have been and how I spent much of my life hiding from myself and others because of not feeling accepted; I now have compassion for this part of me.

Mark is an integrative psychotherapist primarily informed by attachment theory and object relations psychotherapy. He works relationally and sees individuals and couples in Hove and Lewes.

December 17, 2018 by Brighton & Hove Psychotherapy Leave a Comment

So what exactly is Mindfulness?

The term ‘mindfulness’ is much spoken about these days, especially in relation to mental health and wellbeing. But what does it really mean? Mindfulness generally relates to a meditation practice that has its origins in Buddhism. It is thought that the Buddha was practicing mindfulness when he gained enlightenment, and it is one of the key meditation practices for Buddhists.

However, the practice of mindfulness has been taken by psychologists out of its Buddhist origins and used as a technique to help with gaining better mental health and having a healthier and calmer outlook on life. Mindfulness is often used to help treat anxiety and depression, and is recommended by the NICE guidelines for people with depression to help prevent further depressive episodes.

How do I practice mindfulness?

To practice mindfulness is really quite simple. You just need to be aware of what is going on in your body, with your thoughts and emotions, and keep your focus trained on a meditative object such as your breath. Find a quiet place to sit, where you won’t be disturbed for a few minutes, close your eyes, and pay attention to your breathing. Notice the air coming in through your nose or your mouth. Notice how it feels, notice how your chest or abdomen rise and fall with each breath. Notice how your body feels different with each in-breath and out-breath. This seemingly simple practice is actually quite hard to do. You will notice that as you try to focus on your breath, your mind will start to wander. You’ll start thinking about things you need to be doing, planning your next activity, or wondering if you are doing it right. Also, you might start to notice feelings coming to the surface. Maybe you will feel anxious, or notice some sadness connected to an event that happened earlier in the day. When thoughts and feelings arise, all you need to do is to notice that they are there. Give them a label “I’m feeling sad” or “I’m planning” then bring your attention back to your breath. Do this gently and kindly. With regular practice, this will become easier, and you will find that your times of practicing mindfulness will become calmer and you will feel more peaceful. Also, you will start to notice how your mind wanders. You’ll notice the patterns of your thoughts and your emotions and you’ll become less entangled with them. After a while, you’ll start to realise that while you have thoughts and emotions, your are not your thoughts and emotions. They are part of you, but you don’t have to become consumed by them.

By having a regular practice of mindfulness, you can learn to regulate your emotions, and be able to tolerate more difficult emotions easier. You’ll also have more control over your thoughts and be able to step back from your thoughts when they are leading you to dark places. With time, mindfulness can help you become more compassionate to yourself and the others in your life.

And for how long?

It is often asked how often and for how long we should practice mindfulness meditation. The answer to this really depends on how much you want to commit to your wellbeing. A regular, daily practice is important. So try to practice every day if you can. In terms of duration, start small with about 5 – 10 minutes each day. Then start to work up to longer durations. Most people find that it will take about 20 minutes for the mind to really start to settle, and it is after that you will gain some of the deeper benefits of mindfulness. If you can, set aside 40-60 minutes each day to practice mindfulness. However, as we live in a busy world, setting aside this amount of time can be difficult, so if you can’t spare it, or just don’t want to do so much, stay with a smaller amount and keep your practice regular.

Mindfulness is a very important meditation practice that is accessible to all. The are many free videos and podcasts that will guide you in your practice, and many course available to teach it.

Combining mindfulness with psychotherapy is a very powerful way to understand your inner world and to make significant changes in your way of being in the world.

Simon Cassar is an experienced integrative existential psychotherapist and mindfulness practitioner providing long and short-term psychotherapy to both individuals and couples in Hove and Lewes.

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.