Paul Salvage Blogs - Brighton and Hove Psychotherapy

Psychiatry, Psychology and Psychodynamic Psychotherapy

September 20, 2021 by BHP Leave a Comment

Why there’s nothing as infuriating as Anger Management

Throughout my career as a Psychotherapist, particularly when working with statutory services, I have often been asked to provide, ‘Anger Management’. Now I do understand that some people desperately need help with their anger and that it often has destructive effects on them and their relationships. However, what was, (its much less heard of these days), called anger management often consisted of cognitive techniques to control anger, breathing exercises, counting backwards etc, and while these may help a few people they don’t really touch the surface for most. The appeal is in a simplistic idea of control, the idea that we can simply choose which emotions to feel.

Once a certain point of anger has been reached rational thought has gone and telling someone to just control their anger is a bit like saying to someone with depression, “hey bud, don’t be sad’.

The psychodynamic approach along with all exploratory therapeutic approaches, seeks to understand the hurt behind the anger, attempting to address the root rather than the surface ‘symptom’.

The root of anger is very individual, each person has their reason to be angry and an analytic approach seeks to understand the reasons, meaning and purpose of an individual’s anger, helping them feel understood.

Anger and Depression

Anger is often part of a complex set of internal feelings and conflicts and is felt to be a bad feeling and sought to be repressed, setting up feelings of guilt and self-criticism. The hurt behind the anger often relates to a personal sense of wounding, rejection and loss. Anger is sometimes directed inwardly towards the self and this is causal factor in depression.

This sense of internal rejection, which of course can come from very real experiences of feeling let down or rejected and while sometimes may be due to genuinely abusive experiences can also be due to a care givers unavoidable unavailability. For instance, if a caregiver themselves suffers a depression, the feeling of the child can be one of personal hurt and rejection, leading to a painful feeling of unwanted-ness, self-loathing and externalised or internalised anger.

However, it can be very hard to be angry at someone one needs or is dependent on, powerful guilt and/or anxiety can be stirred up about these aggressive feelings towards someone loved, with a feeling that these feelings may damage the loved person and therefore the anger has to be split off and directed elsewhere. Splitting is an age old defence mechanism, alive and well in todays world, whichever side of any given debate you can be sure that many on either side will be using that debate to project their bad feelings onto the others over theirs.

The ability to tolerate both angry and loving feelings (ambivalence) towards a loved person is hard and Psychotherapy aims to create a safe non-judgmental space where these feelings and conflicts can be expressed through words, easing the need to either split them off or act them out.

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

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 –

What makes Psychotherapy Different?

Psychiatry, Psychology and Psychodynamic Psychotherapy

August 30, 2021 by BHP Leave a Comment

What makes Psychotherapy Different?

“The Patient who will not suffer pain fails to suffer pleasure.” Wilfred Bion 1970.

I’ve been a therapist for over ten years now and one of the things I love about the job is how demanding it is of me to stay awake and stay alive. The training never stops and development is always a work in progress.

After many years of various work and an enduring interest in self-development and study, encompassing Eastern thoughts and practices and various experiential group experiences, I started my formal Psychotherapy training in 2008 and finished in 2014. However, what I didn’t realise was that this was the beginning much more than the end of something.

What makes Psychotherapy so important to me is that it requires one to become a psychotherapist rather than to do psychotherapy. The non-behavioural psychotherapeutic interaction is not one where I teach someone strategies, but one where I seek to on a sustained, regular and meaningful way to contact another human being, always in service of them and focusing on them but using my own present being to help make sense and bring to awareness what is going for them. I do this with all that I have available my mind, my senses, my bodily feelings, my intuition, to try and get a felt sense of what things are like for them.

Jonathon Shedler, the American Psychotherapist and researcher, says “don’t ask what model your therapist practises but how much therapy they have had.”

For me this is what makes psychotherapy truly interesting, of course learning about different theories of the mind and the way it functions and disfunctions is hugely important but it is in our own therapy that we truly learn the ‘praxis’, (practice) of psychotherapy. This involves being challenged to reflect deeply on our own internal processes, our own avoidance and defence mechanisms all human difficulties are on a spectrum and that if we look deeply enough all of us can relate to our patients through our own reflecting selves.

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

Further reading by Paul Salvage –

Psychiatry, Psychology and Psychodynamic Psychotherapy

May 31, 2021 by BHP Leave a Comment

Avoidance in therapy as the axe for the frozen seas between us

In this blog I will briefly discuss avoidant attachment strategies and how what can look like independence is actually a sort of suit of armour designed to protect and hide a locked box of vulnerability and need, preventing mutual dependency and intimacy.

The person who has developed the avoidant strategy has done so in order to cope with a lack of understanding and attunement to their needs from their caregivers, and have therefore had to deny their needs to themselves and make the decision (unconsciously) to repress or bury these needs and create an equilibrium for themselves where the pain, disappointments and griefs of these unmet needs are locked away. They can often find alternative ways to feel good about themselves and compensate for the shame of the disappointments and low self-esteem that they feel as a result of this lack of attunement. These alternative strategies can lead them to developing their intelligence as a way to circumvent their feelings and they are often very successful in their field of work. The problem of course is in their relationships, sometimes their relationship with themselves or parts of themselves.

The strategy seeks to enable them to have self-worth while keeping painful feelings of rejection at bay, they have found others unreliable and can therefore only trust themselves. They create an image of themselves that appears independent and strong but comes at the cost of denigrating others, especially those that are more comfortable with the parts of themselves that seek mutual reliance and inter-dependence on others. In extreme forms these others can stir up painful feelings of envy and hatred although these feelings too are disavowed. A calm state of coolness is sought that numbs any sort of emotional aliveness. However, this defence is often a fragile one and when a crisis occurs as it always does at some time or other in life then these defences can shatter, leaving the person distraught and desperate, unable to manage or deal with the emotions that now can’t be neutralized. Suicide can be one tragic outcome.

Brett Kahr, a British Psychoanalytic Psychotherapist, discusses the pain of this strategy which can be handed down generationally: – “Although many people inflict horrific cruelty upon their partners, the vast majority cause pain as a result of emotional unavailability, fuelled by avoidant attachment structures.”

Therapy takes time and requires an enormous amount of patience and keeping the patient in therapy is no easy task. However if they stay then perhaps the patient can slowly start to develop a more trusting relationship with the therapist, who can attune to them, who doesn’t need them to be other than who they are, who can accept their need for distance and who can digest their sometimes overt, but often covert denigrations, understanding them without retaliating or shaming them but not colluding either, calmly without judgment bringing to awareness what the patient is doing and the fear and pain behind these defences against relatedness.

The Author, Colum McCann, describes the work of literature, and I think his description also describes the therapeutic process.

“The job of literature is to acknowledge the heartbreak of the world and then to share that heartbreak in the hope that somehow you can find a little light, just a little, no matter how damaged and bruised. This light, then, must necessarily acknowledge the darkness. At the same time, it might just lift a portion of the dark, past the curtains, awaken us.”

He goes on to quote Kafka, “A book must be the axe for the frozen sea within us.”

So too must therapy.

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

Further reading by Paul Salvage –

Psychiatry, Psychology and Psychodynamic Psychotherapy

Psychiatry, Psychology and Psychodynamic Psychotherapy

January 25, 2021 by BHP Leave a Comment

What’s wrong with good advice?

Often, the people who engage in therapy with me will ask for advice, tips on managing anxiety, what to do about a relationship situation, how to manage a tricky situation at work. Sometimes someone might ask for general ‘life advice’. Of course, mostly what they want is some sort of reassurance and although its not true that therapists never give advice I tend not to offer reassurance. Why not?

Well to start with, the problem is rarely not knowing what the right thing to do is. If someone wants ‘tips’ on sleep or anxiety strategies, I might advise them to look on the internet, there’s plenty of it out there and its free and of course generally sound. Eat your greens, go to bed at a regular time, do some exercise, especially yoga and don’t take too many or too much, mind altering substances.

This reminds me of a joke, –

‘Doctor, If I stop drinking alcohol altogether, eat my greens and give up sex, will I live longer?

Dr – Well I can’t tell you with any certainty whether you’ll live any longer, but one thing I do know, it will certainly seem much longer!’

Of course, what people struggle with is not, not knowing, what the healthy thing to do is, it’s doing it and the reason for this is that they/we are conflicted.

Many clients may come saying they want to stop, whatever it is, that is causing them problems. So I ask why don’t they then? and they say I don’t know. Well the answer is simple, another part of them doesn’t want to stop, whatever it is there doing, is serving some purpose, even if the consequences of continuing to do it are grave. Of course, in many cases this can indeed be tragic, people find themselves compulsively doing things that they know hurt themselves or others, damage, destroy or put important, sometimes essential relationships at risk.

Therefore, advice on stopping the behaviour rarely works as the addiction or compulsion is a solution to another, sometimes, -unconscious problem., as Depache Mode noted, they’re, “looking for love in all the wrong places”.

– “in the woods of anguish, it’s easy to lose your way”. (George Nash 7.9.2020)

The difficulty in a way is in beginning therapy, as the client and therapist needs to come to a together about what the problem is and what the contract of work is.

I have had many clients come with problems and basically say, well, I’ve told you the problem, now over to you to give me the right advice to fix it. Needless to say, these client’s often leave before the work starts. For instance, someone I saw with a destructive addiction was clearly harbouring a long festering repressed grief about an abandonment by his father, however this wound was so repressed that any interpretation of mine that it might be important to look at this just didn’t work and we were immediately at a stalemate.

Of course, my job is to be as tactful as possible, to not push the client beyond where they are ready to go and to be as patient as possible, BUT, destructive behaviour is always the result of past hurts and unless we do find a way together to think about these, a stalemate or premature ending will be the result.

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

Further reading by Paul Salvage –

Face to Face and Online Therapy Help Available Now

August 3, 2020 by Brighton and Hove Psychotherapy Leave a Comment

Psychiatry, Psychology and Psychodynamic Psychotherapy

I am aware that these terms often get confused, so will use this blog to offer some very brief definitions and distinctions. Full disclosure – I’m biased, the psychodynamic model is ‘my bag’, however it’s also really important to point out that, the research suggests a pretty equal efficacy between therapeutic approaches and that the working relationship with the therapist is more important than the particular model of therapy they practice.

Psychiatry: – which isn’t a therapy but the branch of medicine that seeks to treat ‘mental disorders”. As its part of medicine, it seeks to take a scientific, biological view of the disorders and its main source of treatment is ‘medicine’ or psychiatric drugs, such as anti-depressants or anti-psychotics. These ‘disorders’ are seen primarily through the prism of chemical imbalances and this is what is known as biological Psychiatry. However, within Psychiatry there are differences, for instance, – Social Psychiatry. Social psychiatry, challenges the traditional psychiatric view that mental illness is caused by abnormal thoughts and actions relating to biological imbalances and stresses the importance of social factors, such as relationships, and the wider contexts of a person’s life.

Counselling Psychology:-A counselling psychologist will have first completed a degree in Psychology and then an additional counselling training. In theory their approach, or at least the ‘psychology part’, will be based on theories resting on experiments and scientific deductions, for instance the British Psychological society states that “As a science psychology functions as both a thriving academic discipline and a vital professional practice, one dedicated to the study of human behaviour – and the thoughts, feelings, and motivations behind it – through observation, measurement, and testing, in order to form conclusions that are based on sound scientific methodology.”.

A critique of this would be around the critique of scientific methods, for instance A few years back, scientists at the biotechnology company Amgen set out to replicate 53 landmark studies that went on to be widely accepted as fact. They were able to replicate the findings of the original research only 11 percent of the time. This proves a general critique of science, which is that is inherently flawed as it is undertaken by humans and therefore always, although often subtly and perhaps unconsciously, driven by unconscious subjective and paradigmatic factors.

Psychodynamic Psychotherapy

Johnathan Shedler, working in America, contrasts the psychiatric and psychodynamic approach, arguing that, “a psychiatric diagnosis alone is a poor and limiting way of understanding a person” as it, “fosters the fiction that we can treat emotional pain as encapsulated illness separate from the person having the pain.”

In my experience many patients have adopted this split way of viewing themselves, it’s very seductive, the idea we are in control and can pick and choose between our emotions rather than having to surf whatever waves they may throw up, this can appear comforting, however its isn’t because it’s a fallacy. A recent humorous Instagram, post suggests: – “1. Avoid emotional burnout by never experiencing emotions in the first place.”

Shedler describes the difference between having therapy and having meaningful therapy; – If someone has had meaningful therapy, they will be able to describe the relationship with their therapist, what it was like and what they learnt about themselves, some patients can have had lots of therapy but not be able to describe these aspects as they and the therapist have seen therapy, as a “provider of techniques. “

A critique of Psychodynamic Psychotherapy is that it is often unfocused, that it has no clearly defined goals and no clear direction, which is a fair point but one that is an inherent part of a truly analytic approach. Barnaby Barratt, author of ‘Beyond Psychotherapy-Radical Psychoanalysis’, defines Psychodynamics as relating to, “an understanding of the human condition that is non-manipulatively interested in the meaning of life’s events for the participant and one that is holistically interested in ‘mind, body and spirit’”, I.e. is interested in the dynamic interplay of these aspects of being human without taking sides, but simply in allowing the conflicts inherent in being human to be explored and brought to consciousness so that whatever uneasy peace may be possible, can be facilitated, and that folks in relation to being human in my opinion is as good as it gets.

Further reading by Paul Salvage –

Face to Face and Online Therapy Help Available Now

June 22, 2020 by Brighton and Hove Psychotherapy Leave a Comment

Analytic Therapy for Addictions

In this blog I want to briefly explore the analytic approach to addictions. Freud stated that his aim in Psychoanalysis was to help the patient transform ‘hysterical misery into common unhappiness’. In Buddhism, a central concept is that of Dukkha, commonly translated as ‘suffering’, ‘unhappiness’, ‘pain’, or ‘stress‘. It refers to the fundamental painfulness of mundane life.

Henry David Thoreau (1854) declared that most men lead a life of quiet desperation.

As depressing as these concepts seem, the intention is actually to relieve suffering, that it is the excess of suffering that we visit upon ourselves by an excess of demand, the demand to be excessively happy, to criticize and shame ourselves for not being ‘good enough’, the sadistic internal voices that berate us for the shortcomings of what is often an unachievable internal ideal that creates an unbearable pressure.

Modern life is designed to sell us things. One the most successful early pioneers of advertising, Edward Bernays was a nephew of Freuds and advertising has very successfully realized that we are driven to buys things that we imagine will make us feel better about ourselves, that within the object brought is an identity of ourselves as, better, more desirable, happier etc, in short to offer us promises of less painful or even pain free lives.

Zizek notes that the unconscious ideology of today is the demand to ‘enjoy’.

In terms of addictions, especially the addictions, now facilitated by the internet, and even more so by the internet in the pocket, the phone; gambling, pornography and shopping, these promises are ever ready. Its is also worth noting that addictions can be hidden in seemingly healthy pursuits; healthy eating, work, exercising, that can also be used as an avoidance of emotional pain through compulsive stimulation.

There are broadly speaking two approaches to therapy and to treating addictions and their underlying causes, the conscious strategies and good advice model and the more exploratory underlying approaches. Both have their place and it may be necessary to utilize both to really address issues.

The first model; involves CBT and specialist structured interventions; – managing access to the source of addictions, keeping diaries, replacing destructive habits with healthier ones and these will be more advice led. Sometimes it may necessary to utilize these approaches to try and get something under control. However, what these models may not do is to really dig down and get underneath the causes of the problems. The addictions are often the symptoms of underlying traumas and difficulties, sometimes these are not conscious and this is where the analytic or exploratory approach focuses its beam. The problem with not doing this, is that in true wac-a-mole style, the underlying causes tend to resurface and one addiction will merely be replaced with another.

Lance Dodes (2019) an analyst specializing in addictions highlights three pertinent areas of exploration:-

Feelings of helplessness or powerlessness, produced by specific situations whose meanings interact with prior traumas. In this situation the additive act or even just the decision to undertake an addictive act can help the person regain a sense of control. The exploration of the issues leading to these feelings can unpick the unconscious feelings leading to the urges and ‘allow anticipation of future addictive urges, with the possibility of mastering the behaviour.’
These feelings of powerlessness are often related to past traumas and difficult experiences often in relation to the clients attachment history, which has led to internal feelings of powerlessness and corresponding feelings of rage against these feelings.
These feelings are displaced into addictions, through therapy these feelings that were once felt to be overwhelming and unbearable can over time and within a strong therapeutic relationship begin to be able to be felt to be understood and able to be experienced, often through the experience of the therapist being able to face and contain the feelings with and alongside the sufferer.

Further reading by Paul Salvage –

Face to Face and Online Therapy Help Available Now

January 27, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Loss

You can hold yourself back from the sufferings of the world, that is something you are free to do and it accords with your nature, but perhaps this very holding back is the one suffering you could avoid.”? Franz Kafka

In this blog, I wanted to write about Loss and try and explain a bit about what the hell we are supposed to do with it! I think loss is perhaps one of the things that I find it hard to think isn’t a feature of almost every encounter I experience as a Psychotherapist, and perhaps as a human, it is a pervasive part of being human, a painful part but a part none the less.

I encounter loss in the therapeutic encounter in a huge range of experiences, from the sudden tragic losses due to bereavement; due to the more ambiguous everyday losses of identity due to the ongoing vicissitudes of life and changing circumstances. These include the loss of who we are when our situations change, the loss of childhood experienced by parents and their children, due to adolescence, the loss of much-loved work identity in retirement and of course the frequent and painful losses when relationship change or end. So what do we do when, as a colleague poignantly put it, “ the glue dissolves”.

During my training, and in the literature, there is much talk of processing these losses, the need to mourn etc. and about what can happen when these things get stuck, but what do these things actually mean?“

I think a lot of what I’m doing as a therapist is trying to reflect mentally through my experience and the sharing of my experience of being with someone, a mirror to them so they can come to understand what it is they are doing. Often in grief, there is pain and this pain has to be managed, feelings have to be managed. I will seek through this reflective process to help clients understand what they are doing to manage their grief, not to judge it as good or bad but simply to bring some awareness to it, so it can be thought about. Often, through this exploration of these important-survival strategies, and over time, the experience of grief often so raw and frightening can start to be experienced, to allow it bit by bit to be felt, the good and bad of what has been lost to be experienced and allowed to pass, or at least survived. Sometimes a loss has to examined from many different angles, many times over. Loss is painful and hard to stay with.

Darian Leader in his excellent book, The New Black, revisits Freud’s concepts of Mourning and Melancholia, to explore a more nuanced experience of loss and argues that, modern society has created a pressure to package and treat loss and that this has created a simplistic definition that can be biologically defined and then treated by adjusting the chemicals within the brain via medication. This has led to the many complex and often unconscious causes of depression being narrowed and linked to biological markers that can be targeted via drugs. That’s not to say drugs can’t be helpful, they can be, but they rarely resolve the underlying causes.

Leader while praising Freud’s new thinking about depression, argues that he misses a vital element of mourning, its communal aspect and looks at various cultures and the way in which they share the process of mourning.

For me I am struck by the Musician Nick Cave and his wife; Susie’s, much-documented loss of one of their twin boys, aged 15. Nick Cave, has since that loss and after a period of retreat, sought to engage with his audience and to open himself to the experience of loss, he writes a webpage called the Red-letter diaries, has gone on speaking tours and often engages and shares in the stories of loss with his audience. He cites this as an essential part of what has helped him survive this tragedy. As he says there are an awful lot of mourners out there.

Both Cave and Leader cite the Buddhist story of a Mother who loses her baby and has the dead baby strapped to her chest, a monk says that she must find some mustard seeds from a house that has experienced no loss and as she goes from house to house in search of these, never finding a house that has experienced no loss, but as she comes into the contact with the various losses of each house and in the sharing of their grief’s she is eventually able to lay her baby to rest.

Paul Salvage is a 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 –

Adolescence: the trials and tribulations

A Nation Divided

Face to Face and Online Therapy Help Available Now

November 13, 2019 by Brighton & Hove Psychotherapy Leave a Comment

What is Psychoanalytic Psychotherapy?

In this video interview, Paul Salvage demystifies psychoanalytic psychotherapy and explains what clients can expect from the process. Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.

Face to Face and Online Therapy Help Available Now

November 13, 2019 by Brighton & Hove Psychotherapy Leave a Comment

Who might be helped by Psychoanalytic Psychotherapy

In second of two video interviews, Paul Salvage discusses who may benefit from psychoanalytic psychotherapy and explains how it has evolved since the days of Freud. Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.

Face to Face and Online Therapy Help Available Now

November 4, 2019 by Brighton & Hove Psychotherapy Leave a Comment

Post Natal Depression in Mothers & Fathers

In this blog, I want to write about post-natal depression, revisiting and summarising a classic paper by Lawrence Blum, an American Psychiatrist and Psychotherapist. The paper was written originally in relation to postnatal depression in mothers, however, because it essentially explores the conflicts aroused in becoming a parent and caregiver, particularly in relation to our own experiences of caregiving. I think it applies also to fathers and to same-sex couples and heterosexual couples where the caring of the infant is more equally shared.

Blum’s paper, titled the “Psychodynamics of Postpartum depression”, is available on the web.

The paper draws a distinction between baby blues which he defines as the hormonally induced depression resulting from pregnancy and childbirth, and post-natal depression, which has typical features of depression, – ‘sadness, crying, insomnia, or excessive sleep, low mood, low energy, loss of appetite, agitation and self-critical thinking.’

He describes the external factors that can contribute, such as prior anxieties and depressions, low external support, difficult relationships, difficulty conceiving, stressful life events, etc. He summarises the studies at the time into the results of different therapies and concludes that supportive counselling, CBT and Psychodynamic Psychotherapy were all superior to the control and that Psychodynamic therapy had the biggest impact on depression, as defined by the DSM 111.

The focus is then on the possible ‘psychodynamics’ of the depression and these are what I shall briefly outline here as these are what can really be usefully explored and alleviated by Psychotherapy. Three principle emotional conflicts are outlined; Dependency conflicts, Anger conflicts and Parent conflicts.

Dependency Conflicts

In order to care for a baby, there is a need to be utterly depended upon, this is tiring and emotional and benefits from support. If there is a conflict about receiving support, self-denial of the caregiver’s own needs, they can seek to repress their own essential vulnerability and needs and get depressed.

Often people manage this part by becoming carers and end up in caring roles, such as therapists (a good reason as any why therapists need their own therapy!) This counter-dependent strategy can work until it doesn’t. Someone who seems to be managing everything well, suddenly finds the balance has tipped too far. A baby can stir up the caregivers previously unconscious or sleeping wishes to be cared for, hidden by a display of independence.

Anger Conflicts

A conflict with feelings of anger, which can feel counter to the role of the caregiver. Parents can feel they don’t have a right to be angry, feel guilty about it or frightened of it, yet may have experiences and histories, which have left them feeling angry. Anger can be felt towards the baby, either as a projection of past hurts or for the very real things it has done to the parents lives; tuned them upside down, deprived them of sleep, money, jobs, sex, etc, while carrying on with its incessant demands obliviously. The danger apart from depression in all of this, is that these feelings are denied and controlled and ‘loss of control can follow from over control as internal pressure builds up”, and has to be released, either threatening the relationship with the baby or more commonly being displaced onto partners.

Feeling the anger, tolerating it, and judiciously putting it into words, easy for the clinician to say, is the difficult and essential task for the person who is looking after the baby.

Parenthood conflicts

Caring for a baby can stir up unresolved and unprocessed feelings about the caregiver’s own experiences of being cared for, whether a mum or a dad by a mum or a dad. Although a negative experience of being cared for can positively inform the ways in which the caregiver feels they don’t want to be, it doesn’t necessarily translate into clear ideas of how or what to be. In addition, the caregiver, giving the baby what it didn’t receive, can be gratifying but can also stir up the wounds of what they, the caregiver, didn’t receive.

I would like to finish with Donald Winnicott,’s, (a British paediatrician and Psychotherapist), funny but true reasons why a mother, (or father or caregiver), hates their baby, with the intention in which they were written, to provide relief from the day to day conflicts, that can be felt in the rewarding, important but by no means easy job of nurturing an infant:-

The baby is not her own (mental) conception.
The baby is not the one of childhood play, father’s child, brother’s child, etc.
The baby is not magically produced.
The baby is a danger to her body in pregnancy and at birth.
The baby is interference with her private life, a challenge to preoccupation.
To a greater or lesser extent, a mother feels that her own mother demands a baby so that her baby is produced to placate her mother.
The baby hurts her nipples even by suckling, which is at first a chewing activity.
He is ruthless, treats her as scum, an unpaid servant, a slave.
She has to love him, excretions and all, at any rate at the beginning, till he has doubts about himself.
He tries to hurt her, periodically bites her, all in love.
He shows disillusionment about her.
His exciting love is cupboard love so that having got what he wants he throws her away like orange peel.
The baby at first must dominate, he must be protected from coincidences, life must unfold at the baby’s rate and all this needs his mother’s continuous and detailed study. For instance, she must not be anxious when holding him, etc.
At first, he does not know at all what she does or what she sacrifices for him. Especially he cannot allow for her hate.
He is suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt.
After an awful morning with him she goes out, and he smiles at a stranger, who says: ‘Isn’t he sweet!’
If she fails him at the start she knows he will pay her out forever.
He excites her but frustrates—she mustn’t eat him or trade-in sex with him.

Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74.

Paul Salvage is a 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 –

Adolescence: the trials and tribulations

A Nation Divided

Face to Face and Online Therapy Help Available Now

Adolescence: the trials and tribulations

July 8, 2019 by Brighton & Hove Psychotherapy Leave a Comment

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.

Further reading by Paul Salvage –

A Nation Divided

Does the male mid-life crisis exist?

Face to Face and Online Therapy Help Available Now

April 15, 2019 by Brighton & Hove Psychotherapy Leave a Comment

How to find a Therapist

I’m in agreement with Brett Kharr who argues that unfortunately we have a strange situation in therapy where there are an almost innumerable different types of therapies to choose from. I think this reflects the consumerist, swipe right, swipe left age we live in and actually makes starting therapy more confusing for clients.

Richard Chessick, a Psychoanalyst, writes that;

“It is the experience of the therapists personality and the encounter with the therapist as a human who is truly present, rather than any verbal exchange, that makes the fundamental difference in therapy. It forms a link, that brings the patient in consistently over years of treatment, even at times when the patient is very angry or upset. (85).”

If, as a client, you are serious about wanting to change things and about wanting to engage in therapy then it does pay to think a bit about which therapist and therapy may be a good match for you. Sometimes you may feel comfortable with the first therapist you meet after perhaps doing some online research or obtaining a personal recommendation. Sometimes you may want to have a few initial consultations with different therapists. As a therapist I would always be more than happy for you to do this. As a client I would advise on being as honest as possible with the therapists you meet about this, as it’s a good chance to gage their reaction. A therapist where you feel you might have to worry about hurting their feelings, may not be the best choice.

When I began my training the course leader, in one of our first seminars, talked about the therapists needing to have personal therapy and how to choose and get the most out of therapy, said one thing that has stuck with me –

“Make sure to give your therapist hell”.

I have often thought about that statement and have come to appreciate, that I think at essence, its saying how important it is to be as honest as possible in therapy, especially about the things you don’t want to say and especially about the things you don’t want to say to your therapist.

This may feel strange. You may feel your therapist is annoying, a disappointment, etc. What’s useful about this and I believe unique to therapy is that the therapist who has had a thorough therapy themselves won’t take it personally, they will be able to reflect on the bits that may be true, but also may be able to help you think about the bits you may be bringing that you may also bring to other areas of your life. Is the experience of finding your therapist annoying/boring/uncaring or whatever, something you experience in other areas of your life in relation to other people? If so the special circumstances of the therapeutic relationship can be a unique chance gain insight into these recurring patterns as they are happening, not just in an intellectual way but also at a deeper more affective level. It is at that level that I believe change can really occur.

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February 18, 2019 by Brighton & Hove Psychotherapy 1 Comment

A Nation divided

There has been much talk of how Brexit has divided our country, and indeed, in my own extended family I have members on both sides of the debate.

In this blog I want to write a little bit about how we as humans are divided and how Psychotherapy can ease some of the conflict contained in that. This divide, or split, can happen when we think or do things that don’t accord with what we believe to be our own beliefs. Beliefs about ourselves as doers of good, thinkers of pure thoughts etc.

Freud describes how these splits can be repressed, by quoting Nietzsche’s phrase: –

“’I did that’ says my memory; ‘I cannot have done that’, says my pride and refuses to yield. Finally – memory gives way.’”

Splitting is not necessarily a bad thing, it is often a way to manage something that cannot be managed at the time, so, cleverly, the psyche represses it. However, this repression is never total so the thing that wasn’t able to be managed, perhaps due to it being too overwhelming at that time, seeks to come out in some other way.

The outpouring of grief at Princess Diana’s funeral, for instance, was not only about the sad and untimely death of Diana but also presented a triggering of an outpouring repressed and split off grief in so many people and perhaps goes to show how much grief so many of us carry around.

Another way splits can occur is when we have, as we almost always do, conflicting feelings of love and hate to those we are close to. This can sometimes create a terrible conflict, where the anger or disappointment or hurt, feels like it can’t be expressed for fear of hurting the one that is also loved and therefore potentially causing us to lose that person.

However, the feelings are still there, so find other ways to come out; – road rage, shouting at the TV, getting into arguments at work, etc. Most of us want to be good and can find these parts of ourselves distasteful and best not thought about. However, that has side effects, sometimes serious ones and that is when a person will sometimes seek psychotherapy.

The psychotherapist will work to facilitate the unearthing of these conflicts in a way that is sensitive, non-shaming and understanding, in order to allow their expression and lessen their negative effects on the client’s life.

To start with this can seem strange and almost feel like the therapist is only interested in their ‘bad bits’. However, it is not that the therapist wants to humiliate the client, but rather to do the opposite of colluding with the sometimes-long history and input of well-meaning friends and family who have tried to make them feel better by joining in the game of pretending to look the other way.

As Carl Jung said :-

“One does not become enlightened by imagining figures of light, but by making the darkness conscious.”

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

Adolescence: the trials and tribulations

In this blog, I want to briefly outline some of the reasons I like working with adolescents and what are perhaps some of the key struggles faced by adolescents, their carers’ and those who work with or alongside them.

One of the most famous depictions of adolescents’ in my memory is probably Kevin, of Kevin and Perry fame, a very funny, exaggerated, but not unrecognizable depiction of a ‘teenager’. Kevin is by turns, childlike, demanding, exasperated at his parents, however reasonable they try and be, and genuinely struggling with the desire to experience the thrills adult world as he sees it and his unbearable lack of experience and shyness.

I think a good indicator of how it hits a note, is that some of the teenagers I know well, loved this depiction and found it hilarious.

What the characters focus is on the conflict the adolescent faces in needing to leave the world of childhood and its unquestioned dependence on caregivers, to somehow find their own identity. This can involve a painful, but perhaps temporary jettisoning of everything the parental figures seem to represent, however benign they may or may not be.

I think the pleasure and the pain of working with adolescents is how they remind us of some of the fundamental conflicts of, all of our lives, sometime ones, we have dealt with by; ‘letting sleeping dogs lie.’

Adolescents are suddenly faced with issues of what sex is, or means, how to belong or not and whether they may or may not want to. They are often in a position of having to make serious life choices, with only really a very limited knowledge of what those choices may mean.

The Psychotherapist Adam Phillips, writes, that in working with adolescents; “Violent feelings, dejection, sexual obsession, serious self-doubt and terrible self-image are something everyone who is at all awake can’t help but feel” …and that “Anyone who does this work with any real commitment will feel destabilised by it”.

So why do it?

I think because of precisely these issues, working with adolescents reminds us of what it is to be human, to be alive to the rawness of experience, the thrills, the highs and the lows. Adolescents’ are serious about this and often dedicate a great deal of thought about it, and finally as Phillips notes, that, ‘despite sometimes overwhelming feeling of powerlessness and disturbance,’, they can be, ‘committed pleasure seekers; something we as adults are not always so good at.’

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.

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