Neuroscience Blogs | Brighton and Hove Psychotherapy

November 27, 2017 by Brighton & Hove Psychotherapy 1 Comment

What is Psychotherapy?

In this age of jettisoning the past and continually embracing the new, the answer to the question of how psychotherapy works has remained largely unchanged since the days of Freud. Modern enquiry and comprehension brings the capacity to understand what happens in the brain as a result of effective analysis, psychotherapy, or indeed, good enough parenting.

To use an analogy, Freud worked out how to bake the cake of psychoanalysis and with it, what ingredients to use. Modern science has the capacity to empirically prove how those ingredients work through neuroscience research. In this piece, I shall concern myself solely with the main ingredients of what is needed for effective psychotherapy. Although they are but two, how they are applied marks the difference between an amateur cook and a master chef.

In 1968, Michael Balint, a psychoanalyst in Britain, wrote the following ‘recipe’ for effective analysis which holds true for counselling and psychotherapy to this day:

“Although, as a rule, it is not stated quite so implicitly, we are compelled to recognise that the two most important factors in psychoanalytic therapy are interpretations and object relationship. It should be borne in mind, however, that with the latter we are on comparatively unsafe grounds because psychoanalytic theory knows much less about it.” (p159, The Basic Fault – Therapeutic Aspects of Regression)

Balint is making two important points in this brief paragraph. Firstly, he gives us the key ingredients of what makes psychotherapy work. Secondly, he tells us that while object relationship is an essential ingredient, in 1968, psychoanalysis lacked an understanding of why that is.

A basic cake ingredient remains the same through the generations. No doubt, there are scientific reasons to explain why the chemical constituents of flour and egg make a good cake. This is also true of Balint’s main ingredients; interpretations and object relationship, or, put more simply, understanding ourselves and the importance of the therapeutic relationship.

Understanding, or, Knowing Thyself

Insight and understanding is a key tool in making changes. If clients can form a compassionate – and that word is key – understanding of how their past relationships (object relationships) and experiences have shaped them, they can develop the capacity to change. However, this possibility of change is entirely contingent on the therapeutic relationship they form with their therapist. Insight alone cannot lead to change. This is the fundamental answer as to why the many shelves of self-help books comprising an ever-increasing proportion of high street booksellers, never really lead to any change in their hopeful authors. Change requires a relationship in which loss can be worked through and trust built in a new way of relating; trust that the other person in the relationship (the psychotherapist) will not let the client down. At least not catastrophically.

Object Relationships

Why can change only take place in the capacity of a relationship? In the past, I have written blogs about the therapeutic relationship and its importance, as well as on the principles of attachment. However, to recap, psychotherapy is about re-parenting. On a fundamental level, it is about helping the client to experience a good enough relationship where they are listened to, cared about and held in mind. Through this, the client can start to develop their own mind, and over time, hold themselves in mind in ways they have not been able to do in the past.

If the therapeutic relationship is so important, why is it not enough? It can be argued that affective attunement is about offering interpretation, if interpretation is about helping a client to understand why they feel, think or behave in a certain way. Is this not, after all, what a good enough mothering relationship provides, minute by minute, hour by hour and day by day?

To contradict myself, it is also too simplistic to simply suggest that the object relationship with a psychotherapist is akin to re-parenting. It is far more disappointing and frustrating than that. It is, for the client, a coming to terms with the stark reality that they cannot and will not ever have the mothering they needed for the child they once were. It is the working through of this and then, ultimately, the abandoning of infantile objects – unconscious childhood trauma driven states of mind – for adult objects – conscious adult states of mind that can tolerate the limitations of adult life and adult relationships; a tolerance of pain and abandonment of pleasure.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

How to grow a mind?

The connected human brains - Humans as a social beings

Connected human brains – humans as relational social beings

The word ‘mind’ is one that most folks use quite regularly and comfortably. Us psychotherapists use it more often than most. However, to the best of my knowledge, nobody has actually seen a mind. So, what is a mind, and why should we grow one?

Those of you who follow us know that at Brighton and Hove Psychotherapy we believe in mind-body integration and espouse a range of approaches in order to facilitate this. Furthermore, our approach is also in keeping with the latest neuroscience findings on why therapy works So, back to the mind. While there are differing definitions, we believe that a mind is that part of a person that enables them to make sense of their world (inner and outer) and can navigate and mediate between feelings and intellect. If the brain is in the head (no disputing this fact) and emotions originate in the body as sensations, then the mind is what enables us to connect the two up (counter-intuitively, neuroscientists are now suggesting that rather than residing in the brain, the mind is in the body – just like the unconscious).

In psychotherapy, the mind is very different to intellect. We can all probably bring to mind folks who have academically brilliant intellects, but struggle to apply a rational, wise mind to how they relate to themselves and the world around them. It could be argued that some of these people even hold quite powerful positions in government and business, so sometimes having a limited mind does not hinder performance, at least in certain parts of our lives.

We grow our minds from the moment we are born, perhaps even in utero. A mind is grown from the mind of our parents (or caregivers) and thus, the quality of our mind is generally directly correlated to that of our parents. They are the ones who use their auxiliary mind to build ours, hour after hour, day after day, and throughout our young lives.

They begin by helping us make sense of the turmoil of the sensations we feel in our bodies as tiny infants and give shape and form to our emotions through naming them and normalising them. With time, they help us understand that we are not alone in the world, and so, while our own emotional experience really matters, so does that of those around us. Finally, they guide us in developing wisdom in using our minds to navigate a complex arbitrary world. That’s if it all goes to plan, anyway, and often it doesn’t.

If our parents’ minds are limited because their parents didn’t enable them to grow their minds, they won’t have so much input to give us. This is one example of inter-generational trauma. Or, if our mother was depressed after we were born, she won’t have the capacity to attune – to be fully present – to us. In fact, any form of abuse or neglect will have a detrimental impact on our minds.

To emphasise the difference between the intellect and the mind, consider the impact of boarding school, particularly where children are young. This is traditionally an environment where the development of the mind is forsaken in lieu of intellectual prowess.

Why does all this matter? Well, because psychotherapy is about helping clients grow and develop their minds where, for whatever reason, this did not fully happen when they were young. It is precisely why therapy cannot be rushed and needs to be consistent and regular. One cannot fast-track the growing of a mind.

Let’s move on to another word we use a lot and consider how this all fits together – trauma. Again, this is a word with many definitions, and it is very much the zeitgeist at present. Essentially, trauma in an emotional sense is shock that has not been processed. There are broadly two types of psychological trauma: single-incident trauma, known as PTSD, or Post-Traumatic Shock Syndrome, and complex trauma, also known as Childhood Developmental Trauma. They are fundamentally different and require different approaches. We can treat PTSD with a range of approaches including counselling, brief psychotherapy, Cognitive Analytic Therapy (CAT), EMDR and energy psychotherapy, to name a few. All of these can be very effective. None of them grow a mind.

Childhood developmental trauma, or, as I prefer to think about it in most cases, a lack of parental attunement, requires a slow consistent methodical relational approach to enable the development of the client’s mind. This is what depth psychotherapy offers and the research – back to neuroscience – evidences that the relational approach does this best.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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May 23, 2016 by Brighton & Hove Psychotherapy 3 Comments

On Affect Regulation

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

What is regulation?

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

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

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

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

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

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

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

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

How do we learn it?

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

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

Why does it matter?

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

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

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

Types of regulation

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

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

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

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

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

How does psychotherapy help regulation?

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

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

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

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