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When it comes to change, is it better to stop or to start?

Stop the Boats!  You may be familiar with this recent government slogan referring to the persistent behaviour of vulnerable people, risking their very lives in setting out to sea in search of a better future. For me, regardless of how any of us might respond to this slogan in terms of our values or politics, the most deadening aspect of its expression is the injunction to stop doing something.

It is difficult to say the word ‘stop’ without frowning. Say the word ‘start’ and your face opens up. In the inherent wisdom of language, one word feels energy sapping to say, the other enlivening.

Stop the Boats! You may be familiar with this recent government slogan referring to the persistent behaviour of vulnerable people, risking their very lives in setting out to sea in search of a better future. For me, regardless of how any of us might respond to this slogan in terms of our values or politics, the most deadening aspect of its expression is the injunction to stop doing something.

It is difficult to say the word ‘stop’ without frowning. Say the word ‘start’ and your face opens up. In the inherent wisdom of language, one word feels energy sapping to say, the other enlivening.

Much of what appears in the media around the issue of migration is interwoven with metaphors of conflict and talk of enforcement, deterrents and exclusion. As a public response to behaviour that has become recognisably problematic, it has reminded me of personal behaviours at the individual level and how we as practitioners, alongside our clients, seek to make sense of those that have become challenging points of focus for them.

Thinking about unwanted behaviours of our own:

Oftentimes people seek therapy in response to a ‘stuckness’ they feel in some repeated behaviour or fixed way of relating. When I ask about their presenting issue, it’s understandable to hear many say, ‘I just want to stop doing X’. And as with the government’s ‘stop’ campaign, there can be a rush towards their need for relief, alongside a belief that ‘just’ stopping the behaviour will be the most effective route to change.

In the modality of Transactional Analysis (TA), we work with a model of the personality which suggests that our unhelpful ways of being are often related to aspects of ourselves that repeat parentally influenced or child-like processes, which we take on developmentally as part of equipping ourselves to deal with life. We call these processes Parent and Child ‘ego states’, or consistent patterns of thinking, feeling and behaving as our parents once did or as we once did as children.

While many of these processes may have worked for us before, some of them may now be causing us to feel stuck.

In terms of parental processes, part of an unwanted behaviour might be a debilitating voice of harsh self-criticism. Other behaviours might be related to a child-like over-adaptation to the wants of others in our lives. Both processes can lead to anxiety for us and contribute to conflict in our key relationships. And they can be such second nature for us to experience, that only a therapeutic relationship can help us fully identify how we might be limiting ourselves.

Exploring unwanted behaviours in therapy:

Working with these examples in therapy, we might feel a strong pull to concentrate the work on stopping the self-criticism or the automatic need to please others. But one way of conceptualising personal change is to think about our behaviours, however maladaptive we feel them to be, as simply forms of energy. And instead of an urgent focus on ‘stopping’ them, we might allow ourselves to become curious about them, how they recur, how they might have served us well in the past and how much of our energy they consume now.

And thereby we create a collaborative space to explore how we might ‘start’ to expend our energy in different ways, such as finding a more parentally nurturing voice for ourselves or experimenting with ways of asking others in our significant relationships to recognise our needs. By this means we might be said to pour our energy from one place to another in a way that diverts energy previously always available for the problematic behaviour.

Back to the boats slogan, I don’t think I’d be alone in suggesting that solving a complex problem of international migration with energy directed at enforcement and confinement might be better approached through energy channelled into inquiry about the complex reasons for the crossings and asking, ‘What could we start doing instead?’

It’s natural that when faced with a behavioural crisis we feel an urge to act in stopping ways that seek to suppress the symptoms of our difficulties. But if we bring our attention to the deeper meaning of our behaviours, we start to direct energy into new behaviours that can free us from feeling stuck.  

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

Chris Horton is a registered member of the British Association for Counselling & Psychotherapy (BACP) and a psychotherapeutic counsellor with experience in a diverse range of occupational settings. He works with individuals (young people/adults) in private practice.  He is available at our Lewes and Brighton & Hove Practice.

 

Further reading by Chris Horton

The end

You’re not watching me, Mummy!

I’m the problem – It’s me!

Making sense of our multiple selves

Let’s not go round again – how we repeat ourselves!

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Can Psychotherapy help Narcissists?

In my last two blogs on the topic of narcissism, I have covered off what narcissism is (and is not), and provided my perspective on whether we are, collectively, becoming more narcissistic.

In this final blog (for now) on this topic, I shall offer my perspective on the commonly asked question of whether psychotherapy can help narcissists? As with pretty much every question relating to mental health and psychotherapy, the answer to this seemingly simple question is ‘it depends’.

First off, what is mean by narcissism? Has the person in question received a diagnosis of having a narcissistic personality? And if so, by whom?

The clinical definition of narcissism is one that differs significantly from how the term has been hijacked and is now used in popular culture. Clinicians are far less concerned with outward behaviour that pop culture seems to label as narcissistic and instead think about how the personality of the patient is organised. We are all capable of selfish and inconsiderate behaviour at times, however, this does not mean that we all have narcissistically structured personalities.

I shall not revisit the detailed clinical definition in this blog as for those of you who are interested, you can read more here. However, in summary, someone who has a narcissistic personality style ‘scaffolds’ their sense of self through constant external validation. They therefore have a very fragile sense of self – of who they really are – and instead define themselves by their purchases, conquests or achievements. How most narcissists portray themselves to the outside world (and to themselves) is in direct contrast to how these folks feel on the inside – insecure, inadequate and unlovable.

There is a second type of narcissistic personality which is generally overlooked and often misdiagnosed and that is the deflated or collapsed narcissist. On the face of it deflated narcissists seem to be the opposite to their grandiose counterparts in that they present as depressed and as if nothing they have ever done is any good. However, unlike people with depressive personalities, deflated narcissists are filled with a sense of rage and injustice that they have not been afforded the life and opportunities they believe they deserve – in other words, their internal world is grandiose and consumed by fantasy, whilst externally they seem collapsed.

OK, so now we know what we are dealing with, I can return to the question of whether narcissism can be treated?

The successful treatment of any patient in analysis or psychotherapy is dependent on that patient desire to change. As treatment unfolds, it often becomes clear to the patient what change involves and all change on a structural level is slow and painful. Whilst many people successfully engage with psychotherapy, most if not all harbour a secret wish that change can happen without them actually having to change! This is generally a stronger fantasy in the world of the narcissist.

Unlike other conditions, people rarely if ever present for therapy because ‘they are narcissists’ – after all, why would they? They are not the problem – everyone else is.

As long as the narcissistic person’s defences (systems of external validation) are working, then they simply will not see that there is a problem. If someone with a narcissistic structure does attend therapy it is either because their defences have failed and they want help putting them back in place, or they have reached an age (usually middle-age) where they realise that the quality of their relationships is limited to none existent and they want to understand why. The latter is the hopeful position.

In clinical language, there are couple of formulas that enables us to evaluate how successful psychotherapy is likely to be for someone with a narcissistic personality: firstly, how rigid is the personality – the more rigid and towards the realms of personality disorder, the less likely treatment will be successful; secondly, whether there narcissistic personality is combined with elements of psychopathy (anti-social personality). Where someone has a strong combination of narcissism and anti-social traits (or sadistic traits) then treatment outcomes are very poor.

Assuming we are dealing with someone who has a dominant narcissistic personality, but one that is neither too rigid nor mixed with sadism or anti-social traits, then there is hope.

The two approaches

There are two main schools of thought in the psycho-analytic community around how best to treat narcissism which were put forward by two of the main thinkers in the field – Kohut and Kernberg.

Kohut proposed that because what has been lacking in the narcissistic patient’s childhood was an empathic and attuned parent who could see the child’s needs, the work should therefore focus on an empathic and attuned approach of validating the patient’s feelings and working to enable the patient to both bear their ordinary vulnerability as well as to combat their shame about having emotions.

Kernberg, who it has been argued focuses more on the pathological end of the spectrum, takes a more confrontative approach to the narcissistic patient and advocates (in the context of a robust therapeutic relationship) the need to challenge the perspective of the narcissistic patient and to push them to consider the experience of those with whom they are having a relationship. Kernberg’s theory centres around challenging the narcissists central tenet that everything and everyone revolves around them.

So which is right?

The correct approach to treating a patient with a narcissistic personality will be tailored to that patient by the clinician – just as it is for every patient.

My perspective on treating patients is that where there is genuine will on the part of the patient, treatment outcomes are often successful.

Psychotherapy, whether for someone with a narcissistic personality, or indeed any presenting issue, is a courageous endeavour. What brings most of us to therapy is a need for change and change is frightening and painful.

Whilst it is a part of my role to assess and evaluate whether a patient is suitable for psychotherapy, I do this from a clinical and ethical position, rather a moral one. If I cannot help someone, or believe therapy will exacerbate their symptoms or push them into psychosis, I have a duty to not take them on and to refer them for other treatment.

Narcissism, contrary to TikTok and other social media platforms, is not a trait that can be diagnosed just on how someone behaves or treats us. Often it takes a fair number of sessions before I fully understand that someone is developmentally stuck with a narcissistic personality that dominates. However, as long as they want to attempt to enter into a relational world of others then I believe there is hope.

 

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.

 

Further reading by Mark Vahrmeyer

Are we becoming more narcissistic?

What is narcissism?

The medicalisation of mental distress

Can chatbot companions relieve our loneliness?

What are feelings anyway?

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Do you have Unrelenting Standards?

Put another way, is getting anything less than 100% not acceptable to you, and a trigger for uncomfortable feelings of failure, of not being good enough, of self-criticism, self-doubt and shame?

In my experience as a psychotherapist, a personal drive for perfection is often the root cause of distress in many of those seeking therapy. It can be a hard issue to resolve. After all, why would we not try our best?

An illustration of how much pressure unrelenting standards (US) can generate is a client I saw who, for ‘relaxation’ – as she saw it – became a triathlete. Nothing wrong with that, of course, but for this thirty-something woman, who for this blog I will call Caroline, her hobby required a series of log books and electronic aids to record every jog, every swim and every bike ride with painstaking notes about her heart rate, timings and much more (1).

It emerged in therapy that Caroline took any sign that her performance was not improving as a trigger of dismay. Was it because she was getting old? That she was physically too weak? Or that she was simply not good enough? She spoke about her ‘hobby’ almost as if it was a military exercise. The physical benefits were clearly being offset by that the effort involved was itself yet another source of worry. Worry about worry!

So how do unrelenting standards develop as a pattern of behaviour that can have maladaptive and counter-productive overtones? In a previous blog, I wrote about basic human needs, and pointed out that, according to US psychology researcher Caroline Dweck (2), in order to feel safe we need to come to feel that we exist within a secure base. How is this generated? Key elements are that we need to grow up feeling that the world is reasonably predictable, that we are accepted and loved (by those around us) and that we are sufficiently competent.

If that happens and we believe we are indeed broadly secure, the Dweck paper also says that we come to believe we can trust other people, we feel that we have a reasonable degree of agency and control over what happens to us in the world, and we develop a healthy and balanced sense of self-esteem.

Against that background, how do unrelenting standards develop? The current theory is that if we feel we have been abandoned in any way during our lives (for example by bereavement or as a result of divorce), and/or if we have been badly mistreated or abused, and/or if we come to believe we are basically defective, feelings that we are fundamentally unsafe develop. Our secure base is seriously compromised.

Those feelings are triggered in a part of the brain called the limbic system, which exists to monitor danger and to provide the tools for dealing with perceived threats. It is an extremely powerful and fast-acting structural network and if was not, we would soon be dead. Our fight-flight-freeze responses – all there to protect us – originate in the limbic system and they are activated by the five basic emotions: fear (through which we become aware of danger); anger (with which we can deal explosively and rapidly with threats); disgust (which, when triggered, prevents us ingesting poisons); sadness (loss of a loved one is perceived as a threat because we evolved as pack animals); and joy – the one positive emotion, which is an expression of the pleasure and sense of safety we feel when connected with the world and others.

The upshot of this is that if we feel we are in danger, the limbic system goes into overdrive.

We cannot relax. Any signal, however small, of abandonment, or abuse, or of defectiveness has to be countered by effort and that involves making sure that every aspect of what we do is ‘safe’.

How can this be treated? A vital step is to obtain an understanding of the root causes. In Caroline’s case, it gradually emerged that a significant factor was that her father – though otherwise very loving – never seemed satisfied with what she achieved. He regarded a ‘B’ grade in an exam as a failure and even an ‘A’ was not good enough unless she was also top of the class. Caroline often turned to her mum for reassurance, but instead, she sided with dad. The result was that Caroline first came to dread exams and then went into constant
overdrive to make sure she got the highest possible grades and left nothing to chance. She became locked in what felt like a desperate battle to prove she was not defective. A relentless drive towards perfection felt like the only way she could get love and affection from her parents.

Once Caroline became aware of the nature of the pressure involved, she could begin to see that as an adult, she could make her own choices about the amount of effort she wanted to expend on tasks, and could begin to experiment with dealing with day-to-day demands in a less stressful way, including that sometimes- and maybe even often – 70% is not failure.

Further information about unrelenting standards is contained in this You Tube video.

 

David Keighley is a BACP Accredited counsellor/psychotherapist offering short and long term therapy to individuals and couples using a variety of techniques such as EMDR, CBT and Schema Therapy. He is also a trained clinical supervisor.  He is available at our Brighton & Hove Practice.

 

Resources –

(1) Details changed to ensure client cannot be identified.
(2) https://moodle2.units.it/pluginfile.php/358466/mod_resource/content/1/2017%20Dweck%20PR.pdf

 

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Cultivating a Tolerance for Uncertainty

The 13th century Persian poet Rumi invites us to wait in the unknown in his well known poem Guest House, to wait and see what transformations might occur.
This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture.
Still, treat each guest honourably.
He may be clearing you out 
for some new delight…….                 
                                                           Rumi (Guest House)
Psychotherapy invites something of the same experience as that which Rumi describes – an opportunity, a space, to sit with and pay attention to news from within. The more we sit with experience the more happens – new feelings , thoughts and perspectives emerge and shift and as time passes our tolerance for experience grows. When we pay attention to (rather than acting on) the many conflicting urges within, sitting becomes a different form of action.
Being right/ Being wise
An attitude of unknowing, whilst challenging when in search of solutions, might also protect us against false omnipotence. In a conflict with a partner it is all too easy to be convinced that you are right and they are wrong – to blame the other and exonerate oneself. The reverse might also occur. Either way aggression can turn against the other and/or the self. Misery and/or righteousness are quick to follow.
Like the universe though, we are mostly unknown to ourselves. Assimilating the fact that we do not know everything about ourselves or the other can help facilitate a condition of greater openness and humility. Becoming more interested in learning who (else) we might be requires a different attitude, an attitude of unknowing, wholly different to that of omniscient (although not entirely conscious) dogma with which we so often proceed. Our investment in being “right” will often do more harm than good. Cultivating a more exploratory appreciation of complexity is not a new concern – Socrates taught that much of what passes for knowledge is opinion. It is one thing to be right, it is another altogether to be wise.
My truth v your truth
In couples work in particular it is not unusual to witness people bludgeon each other with their “truth.” Whilst it is not difficult to take sides with truth against lies, realities are often far more complex, and thinking one’s truth is the truth is not truthful. In the context of couples therapy “truths” will often fly across the room like bullets from a gun. Weaponising truth, using it to distance and wound another might feel good in moments of high tension, but using truth to a more compassionate (productive) end means paying attention to how it is delivered.
Growth requires us to allow a space for ignorance in the face of knowledge. This can be difficult …particularly in a long term partnership where so often we are inclined to think that we know our partner better than they know themselves. Knowing ahead of time what is going to happen next is more often a defence against the intensity of experience….. (if we already know it then we don’t have to experience it). In the psychotherapeutic meeting  we allow space for and pay attention to psychic realities… conscious and unconscious. It is possible to hold a lived experience and investigate it at the same time. When we experience life in the present we are also less inclined to become stuck in ruminating about the past.

To enquire about psychotherapy sessions with Gerry Gilmartin, please contact her here, or to view our full clinical team, please click here.  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.

Further reading by Gerry Gilmartin

The importance of generosity and forgiveness in a hostile world

Understanding sexual desire

Reflections on freedom and security in a turbulent year

Reflections on getting back to normal

The Passage of Time and the Discipline of Attention

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Subjective Perception, Shared Experience

Nel Tuo Tempo…….In Your Yime

The artist Olafur Eliasson’s exhibition ‘Nel Tuo Tempo’ was described as addressing the ‘subjective perception and shared experience’ of a Florentine building.

He did this using light, colour and shadow. Some of the twenty exhibits were complex structures, others were more about how we see the building in which the exhibition was staged. In one room, a series of lights outside the building cast shadows of the windows on an adjacent surface, be it a wall, floor or screen. The windows were high on the wall, but the shadow was right there in front of us. Detail that wasn’t possible to see in the window became crisp and clear in the reflection and shadow. The minute particles in the glass were visible in a way that was impossible to see without the artist’s intervention.

Artistic works can resonate with us emotionally in ways that are unexpected. These exhibits not only provoked an emotional response, but also raised question about what we could understand about the fabric of the building.

Moving between detail

Psychotherapy is about how we experience and relate to our emotions and that through our emotional world we can gain insight into the ‘fabric’ of ourselves. We begin thinking about how we feel now, what is going on in our world and how we relate to it. The gentle exploration of emotions, history and our lived experience gives a sense of what makes us who we are. Like the exhibits in the museum, we can be curious about so much more than what we see.

You could observe people moving in close and seeing the details of the glass panels, then standing back and looking at the window as a whole felt. This felt like moving between detail in a similar way to how we move between thoughts and feelings during psychotherapy. The detail of daily life, which puts emotional demands on us, alongside a wider view of life and history, shifting between thoughts to build a complete picture. Like the artist does, it’s about creating a space in which we can be curious about what is there and what is less easy to see, moving from what is subjective into something shared. Asking ourselves if it’s possible to not fully understand and remain curious.

Subjective Perception, shared experience

The connections and considerations of psychotherapy and art are numerous and much commented on. This exhibition brought to mind the fact that both art and psychotherapy can give us a much greater insight into our emotional world, by moving beyond what is seen and what is not seen, but is felt. It can also reveal some of how when we engage with certain art works, we also mirror what goes on therapeutically between the practitioner and the client. Shifting between detail, emotions and understanding, the subjective perception becomes the shared experience.

Psychotherapy is about moving from the subjective to the shared. Being heard and seen as a means of gaining a deeper understanding of who we are and our relationship with our selves and those around us.

 

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove . To enquire about psychotherapy sessions with David , please contact him here, or to view our full clinical team, please click here.

Further reading by David Work –

In support of being average

Collective grief

The challenge of change

Thinking about origins

Bridging Political divides

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What Psychological Processes make us ‘Choke Under Pressure’?

It is a process whereby our bodies experience environmental stressors as a threat to our physical survival, thereby releasing stress hormones such as cortisol and adrenaline. This is an essential part of all mammal’s fear or threat response, which has become maladaptive in the modern world, as the threats we experience in modern life often do not require us to fight or flight, but rather be calm and think. The threat response, or ‘fight/ flight/ freeze’ responses draws on a more primitive part of the brain which shuts down all other systems to gather its energies and resources to survive danger. This means that our more evolved thinking and reflecting part can’t be accessed either.

Are some individuals more prone to ‘choking under pressure’? 

Some people have this survival system more activated than others. Usually this is linked to having experienced more emotional, psychological or physical threat and danger in childhood, when the brain is still developing. These individuals can end up perceiving life as dangerous a lot of the time. There are also certain triggers for chocking under pressure, such as a major past event or failure, a significant poor performance in a certain area which has led to loss of confidence, or certain negative associations. It could also be that a person is experiencing a lot of stress in their present life and therefore the resources for good performance just aren’t there.

How can we prevent ‘choking under pressure’?

Usually by gradually increasing exposure to situations which are perceived as threatening and checking these against reality. The idea is to challenge our false perception of certain situations. If your threat system is often activated, then I would suggest working with a psychotherapist on past traumas that are being re-activated by present events. Increasing self-confidence in certain areas, challenging negative self-belief and self-perception, and also teaching your body to relax through breathing and other activities that help regulate your emotional system. By increasing the focus on the task at hand, rather than on the outcome, takes focus and a calm state of mind. All of these tools can help either in isolation or in combination, depending on how bad the “chocking “ and how often it occurs.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

 

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading by Sam Jahara

Finding Contentment in the Age of Discontent

Having Healthy Conversations with Men about the Menopause

What causes low self esteem?

Online therapy: good for some but not everyone

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The Medicalisation of Mental Distress

The foundation of the paradigm shift in how we now view mental health, or as I prefer to consider to consider my field, emotional distress, is one where the problem is increasingly located in the individual as a disorder, rather than in the environment that the individual finds themselves.

The inception of this paradigm in thinking began with the publication of the third version of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) produced by the American Psychiatric Association (APA) which had a specific focus on meeting the needs of a wider clinical audience in the field of mental health. It was never specifically intended as a guide to clinical treatment and despite the introduction of specific clinical categories, there was an assumption that prior clinical wisdom across the field would endure, however, in practice it was the clinical categories that took precedence.

In no other field of medicine – which is the direction that mental health has taken – is symptomatology clustered together as it becomes fundamentally unreliable and invalid in understanding what may bring about a syndrome, condition, or as the DSM prefers to refer to it – a disorder.

For example, how mental health disorders are clustered is based on symptoms and were this to be replicated in the field of physical medicine, we would have groupings of ‘fever disorders’, ‘limp disorders’ or ‘headache disorders’ – an idea that would be absurd and yet is the basis for psychiatric classification.

The reality is that there is no consensus in psychiatry about what exactly causes ‘disorders’ and yet the list of disorders continues to grow with every revision of the DSM and with it more and more ‘disorders’ become both labels and terms of abuse in popular culture – after all the problem is now firmly located in the individual. We have seen an explosion of disorders from around 106 in the 1970’s through to 365 in the latest incarnation of the DSM (DSM-V)! And, not only has the number of disorders increased exponentially, but in parallel so too has the bar been lowered at which point a patient qualifies for having a particular disorder.

In clinical practice we now see the normalisation of these disorders with patients using disorder terminology to ‘self diagnose’ so rather than presenting for therapy with a statement such as ‘I notice that I feel very shy in social situations’, we are increasingly presented with statements such as ‘I have social phobia’. The problem with this is that it can serve to eradicate curiosity around why a person may feel shy in certain situations and inherently positions them as ‘wrong’ rather than suggesting a position of openness towards how this may be adaptive behaviour learnt during childhood.

Under pressure

The profession of psychotherapy is increasingly under pressure to comply with this new world of diagnostic criteria in that the language has been adopted by general practice in medicine, public health and by insurance companies. The latter meaning effectively that patients cannot get psychotherapy sessions reimbursed without a patient meeting the criteria for a disorder.

Arguably what has underpinned this shift in the field of mental health is how the sector has responded to meeting the needs of the economy, rather than those of the sufferers. The focus of public mental health and overarching classification system for psychiatry has shifted from being patient centred to being directly linked to economic productivity.

An example o this is how in the UK, The NHS’ mental health initiative ‘Improving Access to Psychological Therapies’, now renamed Talking Therapies for Anxiety and Depression has its foundations in getting people back into work. Whilst there is nothing intrinsically wrong with a drive to enable people to return to the workplace, in many instances it is a normal human response to environmental stressors that lead a person to feel anxiety or depression. This is the crux of the schism – are mental health disorders located in the individual and therefore indicative of a failing or are they responses to the external environment?

Suffering has been turned into a commodity

The problem is located in the individual rather than seen as an adaptation to past or present environment. This eliminates both a capacity for curiosity as to cause and blame – a person simply has a disorder. From a macro systemic perspective governments can provide a health service that treats’ the problem in the individual rather than consider how societal issues lead directly to emotional suffering – mental health problems.

Secondly, the industry that benefits from the drive towards specific disorders located in the individual is the pharmaceutical industry, which, despite there being little to no evidence of increased efficacy in psycho-pharmacological treatments over the past 40 odd years, This question pervades all types of emotional suffering and the past well-trodden path of linking emotional suffering with a broader and deeper developmental, social and economic narrative is being cast aside in favour of a diagnostic super-highway with disorders based on symptoms and neat psycho-pharmacological solutions. Essentially the invitation is to disconnect the threat response from the threat; to increasingly shift away from asking ‘what’s happened to you?’ to simply ‘what’s wrong with you?’

 

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.

Further reading by Mark Vahrmeyer

Can chatbot companions relieve our loneliness?

What are feelings anyway?

Client or patient; patient or client – does it matter?

The psychological impact of the recession

Why do people watch horror movies?

 

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What Causes Low Self-Esteem?

Low self-esteem stems from beliefs that we have about ourselves, a negative self-evaluation which is usually rooted in childhood experiences. The way we were spoken to, treated, and made to feel as children has a significant impact on how we see and therefore relate to ourselves later in life. Some of us may also have grown up with parents who were not very confident and had low expectations of themselves and their children. Social class, culture, race, gender, sexuality, and disability are also societal and environmental contributing factors to how we self-evaluate.

Knowing where negative self-belief and low confidence comes from is the first step in effecting change. Feeling things that we don’t understand can be confusing and cause anxiety and depression, further perpetuating negative self-belief. The next step would be to begin challenging these beliefs and check them against the reality of your life and achievements, skills, etc. Many of the beliefs we carry are just that: thoughts about ourselves that do not match reality. This can lead to perpetual feelings of failure, regret or agonising about every small decision for fear of making mistakes. Some of these feelings can be debilitating and hold us back from moving our lives forward with confidence in our decisions.

Awareness of negative self-talk is also useful in that we can choose to gradually replace this self-talk with more positive inner dialogues. Sometimes people are surprised at how much time they spend being self-critical. The way we think has a direct impact on how we feel, therefore it is important to work on these issues.

How Relationships Affects Self-Esteem
Cultivating positive and healthy relationships is essential in gaining more confidence. A sense of belonging and acceptance comes from a variety of places, but the main place that it comes from is relationships. Therefore, being in relationships that don’t make you feel good about yourself, where you are badly treated, taken advantage of, etc is only going to make you feel worst about yourself. This includes both personal and professional relationships.

The definition of a healthy relationship is one where there is mutuality and exchange of support, ideas, validation, trust and honesty. The more we base our relationships on these principles, the stronger they will grow. Sometimes low self-confidence can get in the way of building relationships or seeking career opportunities for fear that others will think that we have little to offer. Again, challenging these beliefs and checking them against reality can help us to start to behave differently, take more risks and challenge ourselves in a good way.

In Psychotherapy we work with the root causes of low self- confidence, for instance how early relationships have contributed to the beliefs that we have about ourselves today, and then gradually replacing these with more helpful and realistic beliefs about who we are and what we are capable of. This usually leads to making better choices in life in the areas of work,  relationships and health.On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

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Does your Life Story make Sense?

Why are stories so important to us humans?

Human beings are the story species. From the earliest mythic hunts retold around tribal fires to the modern-day family evenings spent bingeing on the latest Netflix series, stories have captivated us. And yet, when it comes to our own life story, we are more liable to tell well-practised narratives that are unable to explain our struggling relationships, our lack of fulfilment or a life we feel adrift from.

As the human mind and its cognitive powers exponentially increased over millennia, humans found themselves increasingly at an evolutionary advantage. Like no other species, humans were able to learn from the past – through memories recalled and pored over – and imagine and shape future possibilities. This way of experiencing ourselves has placed us at the centre of our own story-world with us as the protagonist of a story moving from the past to the future in a continuous present. This uniquely human experience, where we can out-think our competitors, also tends to mean that we get pulled along by the mesmerising, dreamlike narrative.

Is what we experience and do in our awareness?

Though we believe we live in our own lives close-up and in technicolour, the truth is that much of what really happens is hidden from us. This can be a difficult thought to accept. We get a sense of this being true, however, when we try hard at our relationships, for example, but they keep breaking down in similar patterns, or when we achieve a life-long goal but it doesn’t make us happy. We can get a sense that our stories don’t match up with our experience.

The majority of the processes that the body and mind carry out – such as controlling our heart rate to deciding if we trust a person we’ve just met – are performed out of our awareness. This can be likened to an iceberg where only one tenth of its mass is visible above water. Nine tenths are out-of-sight below the surface.

How the past presents in the ‘now’

Another key factor is that many of our life decisions were made in childhood. This might sound strange, perhaps even outlandish, but think about it. Did you decide the family and culture you were born into? Or did you choose the personalities who surrounded you and their specific needs and struggles? Of course not. You – like all of us – did the only thing you could as a child: you adapted to your environment to try and get your needs met. While the impact of that process and what the cost was to you is often unseen.

Within early and intimate relationships, we do the best with what’s on offer to receive some level of acceptance and approval. These hidden life decisions, based on the logic of a young, immature mind, set us on a course for life as we try to make sense of experiences and create an unconscious working model of how we can be in relationships with others and who we are in those relationships. As a consequence, our self-stories have likely faced little challenge through their life journey to where we are at this very moment.

Through our life, we have been surrounded by other people’s stories – in our family, with friends, in the broader culture. These can have a positive, reinforcing impact on us. They can also overly influence us, make us maladapt and even make us lose touch with our own stories. Or trying to make our life fit someone else’s story.

How psychotherapy is about your story

People come to psychotherapy often due to problems encountered in their immediate lives, such as suffering from depression or a relationship breakdown. These issues however often point to deeper, underlying issues. Therapy offers the opportunity to look at what is going on underneath the one tenth of the iceberg. We do this together, therapist and client, in a collaborative process, using curiosity and compassion. It is through this unfolding process that a fresh and more connected story can emerge.

Through this therapeutic re-storying process, you engage with your personal narrative as the adult you are now, not the younger version of yourself who found themselves locked in rigid narrative episodes. As Jeremy Holmes, psychiatrist and writer on attachment theory and narrative, said, “Each story is there to be revised in the light of new experience, new facets of memory, new meaning” in a process of “narrative deconstruction and construction”. It is through this therapeutic work of review and rebirth that “narrative truth” and new meaning can surface and your story not only becomes understandable and real but it again becomes yours.

The mythologist and academic Joseph Campbell, who wrote about the ‘monomyth’ or common hero stories common across cultures, said, “I don’t believe people are looking for the meaning of life as much as they are looking for the experience of being alive.”

And perhaps this is a key aim of working with story in therapy: through opening up and meeting your self-story afresh, you can make sense of it, reclaim it and play an active part in its ongoing development. This offers the possibility of living a fuller and more engaged life, where you feel more here and more alive.

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

Thad is an experienced psychotherapeutic counsellor and a registered member of the British Association for Counselling and Psychotherapy (BACP). He works long-term with individuals in our Brighton and Hove practice.

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Some existential musings on love, generosity, and the relation between self and other (part two)

(Adapted from a presentation given at the SEA conference November 2022) – (Part two)

Speaking of life itself as a movement of becoming. Have we forgotten the isness and replaced it with beingness, an allegedly unified subject of self-consciousness, contained and stuck within a name or a label? Must knowledge be part of it, must we always think our way in?

Does that remind you of anything? The masculine economy of desire tells us I think therefore I am (Descartes, 1998). It invites us to believe in the binary. But Nietzsche (1886/1978) tells us differently. He gifted us multiplicity, and music to dance to. He invited us to affirm life beyond the narrow confines of self-preservation: to play with all the dynamic forces and tensions.

Perhaps generosity is a type of life force? Bazzano (2019) says, in Nietzsche there is no individual will to power but “power understood as a generous expenditure” (p.95). But generosity is often suppressed in favour of rigid identities. In current culture it seems the human animal is seen as depending upon an idea of self, perhaps influenced by patriarchal forces. Discourses of subjectivity rely on notions of individuality, autonomy, and self-preservation. The different other often becomes a threat as does the potential for an unstable, non-unified experience of self.

And what about suffering? Are we allowed to suffer anymore? Is that not sometimes where the gift of transformation lives? Yes there is a paradox here, as Nietzsche (1974) writes, suffering is markedly personal because it is an aspect of self-expression, in time. In which the very process calls us forth to reshape and become; reinterpreting the past through healing and releasing what was and opening to the new. However, don’t we all rely on each other for that too?

Helene Cixous (1991) tells us “only when you are lost can love find itself in you without losing its way” (p. 39). This feels important to me. In Renshaw’s interpretation, Cixous seems to refer to “the very structure of desire that is made
possible in a non-possessive, feminine relation to difference. She goes on to say:

“Only when we are lost to ourselves, to the extent that being a self means being one and unified, are we opened to the possibility of a becoming that is expansive, abundant, and opened to the indeterminable difference of the other. Only then can love descend upon us the way it wants, in one of its bewitching, magical and divine forms” (p.183)

In her essay, The newly born woman, Cixous (1986) writes of the feminine economy of desire as a notion able to grasp the abundant and often incongruent aspects of desire, refusing to “exclude the contradictory, and the ability to
embrace a cycle of relations that are constituted in movement …never static …marked by movements, towards, away and elsewhere” (p.125).

There is much to consider here. In her book, ‘The Subject of love’ (2009, p.6), the academic Sal Renshaw offers us some questions to ask ourselves.

Perhaps we can explore them together.

“Can we love as a gift that does not return?
What would it take to love the other as other, neither to refuse nor to embrace the
other but to create a space in which the other is met, is brushed against, is
perhaps felt as well as seen”
Can we live our subjectivities in a way in which love emerges in the in-between,
not as something the ‘I’ does or has, but rather as something that happens to us,
that emerges, in the very space of meeting?
What kind of being or becoming, does it take to love the other in their otherness
and not to sacrifice oneself in doing so?
What kind of relations to and between subjectivities make possible a generous
meeting in difference?”

Part one of this blog can be found here.

To enquire about psychotherapy sessions with Susanna, please contact her here, or to view our full clinical team, please click here.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

 

Further reading by Susanna Petitpierre –

Some Existential Musings on Love, Generosity, and the Relation Between Self and Other? (part one)

On living as becoming (part two)

On living as becoming (part one)

Some thoughts on becoming (part two)

Some thoughts on becoming (part one)

 

References – 
Bazzano, M. (2019). Nietzsche and Psychotherapy. Oxon: Routledge.
Carson, A. (1998). Eros: The Bittersweet. Illinois: Dalkey Archive Press.
Cixous, H. (1986 [1975]). ‘Sorties’. Trans. Betsy Wing. In Helene Cixous and Catherine Clement. The Newly Born
Woman. Minneapolis: University of Minnesota Press.
Descartes, R. (1998). Discourse on Method. Indianapolis: Hackett Publishing.
Merleau-Ponty, M., (2012) Phenomenology of Perception. Oxon: Routledge

Nietzsche, F. (1886/1978). Beyond Good and Evil: Prelude to a Philosophy of the Future, trans. R.J. Hollingdale. London:
Penguin.
Nietzsche, F. (1974). The Gay Science. Trans. Walter Kaufmann. New York: Random House.
Renshaw, S., (2009). The subject of love. Manchester: Manchester University Press.

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Some Existential Musings on Love, Generosity, and the Relation Between Self and Other

(Adapted from a presentation given at the SEA conference November 2022) – (Part one)

Anne Carson (1998) wrote,

“‘Now’ is a gift from the gods and an access onto reality. To address yourself to the moment when Eros glances into your life and to grasp what is happening in your soul at that moment is to begin to understand how to live.” (p.153).

Was it Merleau-Ponty (2012) who showed us that, without you, I do not know who I am. I cannot see the back of my head. I need you, the other, to tell me so I can build a picture of it. Yes, it seems we are made in the social.  But that means there will be ruptures too. Losses and suffering will prevail without our control. Can we transform in them? Do I need your help for that too?

Sal Renshaw (2009) describes the relation between self and other as a continual movement intrinsic to our becoming. Not only does the relation between self and other reveal the movement of becoming. It also signifies the impossibility and impermanence of the unified subject or absolute being. Encountering self and other reveals difference, perceived “somewhere in the space between that which returns to us that which we recognize as the same, and that which escapes us” (Ibid, p. 2).

Sometimes difference is felt as a conflict, sometimes as a threat, sometimes as an interest and an opportunity. But difference can be, and is, an opening into our becoming.

It may entail a complex exploration: maintaining positive regard for the other without being implicated in a kind of sacrificial logic rooted in Christian morality and its derivatives and without being caught in the web of patriarchal narratives. As Renshaw states (2009) writers such as Helene Cixous inform us of the extent to which “women have traditionally borne the brunt of sacrificial logic in a patriarchal structure” (p. 7).

How can we hold a space for a version of selflessness that is generous, alive, affirmative and does not fall into self-abnegation? A difficult task, no doubt. But an important one: “loving the other as other, allowing them and oneself to be born into the present in love” (Renshaw, 2009, p. 176). Perhaps they have forgotten or never knew that difference is the astonishing source of their love.

Isn’t there always more to the story, yes, more to come, more to become?

Is not life itself a movement of becoming …

Part two of this blog can be found here.

To enquire about psychotherapy sessions with Susanna, please contact her here, or to view our full clinical team, please click here.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

 

Further reading by Susanna Petitpierre –

On living as becoming (part two)

On living as becoming (part one)

Some thoughts on becoming (part two)

Some thoughts on becoming (part one)

What is the Menopause? (part one)

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Online Therapy: Good for Some, but not Everyone

Therapy over the phone and in more recent years on video has been around for a long time, but since the recent pandemic it has become normalised with lots of online therapy platforms emerging and an abundance of “mental health” apps.

At Brighton and Hove Psychotherapy we offer both face-to-face and online therapy, and whilst many people can benefit from the latter, this option is certainly not advisable for everyone. I would like to share some of what I have observed about psychotherapy conducted online from my own clinical experience, from supervising clinicians who work with clients online and from many exchanges with colleagues in the field, especially since the beginning of the Covid-19 pandemic. Here are some considerations:

Doing therapy from the comfort of your own home x travelling to see your therapist

The journey to a therapist’s office is a part of the work itself, as long as it isn’t so arduous and exhausting that it becomes unsustainable. The intention and commitment to make the journey each week, the space to reflect, the checking in with self before entering the therapist’s office, arriving at a physical room and being greeted in, or waiting for your appointment, all are rituals that are a part of the process itself. There is also the journey after the appointment, which hopefully is long enough to allow some space to be with yourself before engaging in any other activity. Time poor people will argue that they can fit therapy into their day more easily if it’s done online, however one of the goals of therapy for some individuals could be to look at difficulties in prioritising personal needs, including making time for therapy appointments.

Choosing from a larger pool of therapists x choosing someone locally

Depending on where you live it may be easy or difficult to choose someone to work with. However, the very process of choosing is an important one. I compare some online directories or platforms to fast food. We live in a consumer-led culture where convenience is highly sought after. We want quick results because many of us are time poor, but consider that this is probably on of the most important choices you will make. Therefore, it is worth spending some time and effort choosing a therapist as it might determine the future state of your mental health and even your life.

People who are socially anxious can access help at home

Unless someone has a debilitating condition that keeps them housebound, in which case psychiatric care would be advised, colluding with or perpetuating the existing issue might be counter productive. Encouraging someone with social anxiety to venture out and travel to see a clinician face to face is a small step towards creating a relationship that is safe and manageable for the client, before they risk other forms of social engagements that go beyond the therapy room.

“ The therapist’s office is intimidating ”

Here is another great reason to explore why it is more difficult or intimidating to talk about yourself when faced with a therapist – a real person in the real world. Psychotherapy should enable and encourage people to have better relationships that are real. If the ease of talking more about yourself when you’re meeting someone online could be linked to difficulties forming and sustaining real relationships. Just as we see brilliant poets and writers who can barely utter a word when faced with a social situation, someone who is seemingly confident and capable of relating on the screen, can be very different in person.

Having said all the above, I remain an advocate of virtual sessions depending on the person and type of work. For instance, more cognitive and solution-focused approaches can work well online. Whereas in-depth psychotherapy which draws on unconscious processes is undoubtedly much better done in person. I would not recommend online therapy to those who struggle to maintain clear boundaries, feel easily emotionally overwhelmed, or are dealing with a range of complex psychological issues. People leading chaotic lives usually find it more containing to have the predictability of their therapist’s office environment. I also would not advise anyone training to become a psychotherapist to have their therapy online, and couples work can be difficult virtually, especially if the couple is in the middle of a lot of conflict.

This is not to say that good work can’t take place virtually, but we have to accept that there will always be a missing component and that the therapy will probably not achieve it’s full potential.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading –

The Psychology of Mindful Eating

Defining Happiness

What are the benefits of counselling and psychotherapy?

Why is mental health important?

What makes us choose our career paths?

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On Living as Becoming (Part Two)

We seem to be in a world slipping deeper into seeking safety, transparency and the need for power and control to sanitise life. All as an apparent response and remedy to pain and suffering. A desire for continued uninterrupted happiness and security. We seemingly long for the place where happiness is and will remain,  but as Nietzsche states-  

“the hunt for happiness will never be greater than when it must be caught  between today and tomorrow; because the day after tomorrow all hunting time may have come to an end altogether”. (Walter a. Kaufmann, Nietzsche. Philosopher, Psychological, Anti-Christ. Princeton: Princeton University Press, 1950, p.140.

I interpret Nietzsche’s quote as an ironic statement, one that is not validating the search for happiness but understanding it as a fleeting endeavour. I believe he is asking us not be distracted by it. To go deeper and face and live life in the knowledge of our impermanence.

Both Nietzsche and Kierkegaard (great influences in existential thought) were concerned by how humans repressed and avoided self enquiry. They both strived to understand human existence and used their own existences as a case study for analysis. They recognised how they, and others, would seek to protect themselves from reality and consequently suffer extreme symptoms and tensions, such as depression, guilt, anger, anxiety, obsessive behaviours and disconnection. They had not even considered the effects of social media as an escape on human experience when writing this.

What might get lost in avoiding these affects in terms of our potential and freedom?  Soren Kierkegaard (1844) felt without anxiety there would be no possibility and growth as a human being. He suggested anxiety is the ‘dizziness of freedom’ and ‘freedoms possibility’. He famously wrote,

“Whoever has learned to be anxious in the right way, has learned the ultimate…” (Kierkegaard S. The Concept of Anxiety. New York: Liverlight; 2014. p. 188.

They both emphasised the influence and importance of passions and the significance of commitment,  to take responsibility for their existence, to act, to create. They discussed in their own ways how our affects are significant for explorations (see more in a blog on Nietzsche’s magnificent monsters).  That attempts to avoid inner conflict and intensity and intellectualise and externalise struggles were in some way a defence against one’s own vitality. Anxiety was considered as a potent and necessary force for transformation. Potentially leading to an individual’s confrontation with their illusions and consequently a deeper awareness of how they are implicated via defences and rationalisations. As a dear friend and wise man recently said,

“without inner conflict, what chances do we have to give birth to ourselves. At the very least inner conflict is good for generating creative work”. 

Both Nietzsche and Kierkegaard died young (in the modern sense of the word). In that time they wrote prolifically and created great texts and thoughts, used to this day, that inform life and some types of psychotherapy in particular. In my mind both seemed to surrender generously their existences to creating and self enquiry (distanced from a need for notoriety or self preservation). They certainly left an enriched soil for those yet to come. There are many stirring and striking aspects to both of them and their writings.  However what moves me the most is their similarity to the eucalyptus tree’s surrendering of self-preservation as a dominant force: letting their passions, tensions, vulnerabilities, heartbreaks,  limitations and crises become a strength and force for creativity and transformation for those who are interested.

To end this piece, although more will come later about Nietzsche’s ideas about Will to Power’, I thought it might be fun to insert a quote kindly gifted from the aforementioned wise friend, where Nietzsche compares himself to a plant.

“It is absolutely unnecessary, and not even desirable, for you to argue in my favour; on the contrary, a dose of curiosity, as if you were looking at an alien plant with ironic distance, would strike me as an incomparably more intelligent attitude towards me”. (Nietzsche in a letter to Carl Fuchs, July 29, 1888)

 

To enquire about psychotherapy sessions with Susanna, please contact her here, or to view our full clinical team, please click here.

 

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

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Client or Patient; Patient or Client – Does it Matter?

A topic of certain difference, and at times discussion in the field of psychotherapy, is whether we refer to those we treat as ‘clients’ or ‘patients’.

Why might this matter?

On the face of it, it should arguably matter little to someone attending psychotherapy, as to what the therapist calls them on paper; in the room they will be referred to by name and thus, to some extent, the nomenclature used is academic.

However, psychotherapy is about how the psychotherapist thinks about the person who engages their services and this thinking will inevitably influence how the psychotherapist refers to those who come to see them and vice versa.

Why such different terms?

Psychotherapy was born out of psycho-analysis. And in both classical and modern psychoanalysis, as well as in the language of many psychoanalytical psychotherapists, the term patient is commonly used.

Historically, this is derived from Freud’s use of the term, whereby he situated psycho-analysis firmly in the medical field.

There is an additional term that is used in analysis which is ‘analysand’ – the person who goes for analysis. Whilst it bridges the gap between client and patient, I find it somewhat clunky and it is not a valid term to use in psychotherapy.

Who is the expert?

Much progress has been made in the field of psychotherapy to shift from a ‘blank-screen’ model on the part of the psychotherapist, to a relational approach – meaning broadly that the psychotherapist plays an active role in co-constructing the relationship and works within the context of the relationship to bring about change.

Many in the more humanistic field argue that one of the goals should be to bring about as much equality between the therapists and ‘client’, so as to eliminate the power imbalance.

Whilst a noble endeavour, I think this is naïve, as firstly, we are are there in an expert capacity and those of us who are trained and work at depth, understand that we carry an enormous burden of responsibility to those who engage our services. We are therefore, not equals.

Secondly, depth psychotherapy, using a psychoanalytic model, works with what the client or patient ‘projects’ onto us – something we refer to as transference. In the transference, we inevitably represent one of the parents for the client and it is arguable that the treatment process in psychotherapy is one of re-parenting.

Parents and children are never equal

I believe that roles come with firm boundaries – many of which are frustrating. For example, it is a parent’s role to always be a parent to their child. This role will evolve and change over time and eventually there will be two adults in the relationship, however, this does not imply that there are two equals. Part of the frustration of being a parent (and the child of a parent) is in acknowledging the firm boundary, meaning that a parent should not become a friend to their child, no mater the age of that child. This does not mean that this does not happen in some families, however, I view this as unhelpful.

The therapeutic relationship between a psychotherapist and their client or patient is sacrosanct – as should be the relationship between parent and child. We are there in an important, and at times, critical capacity and co-create with those who come to see us a deep intimate relationship that must be alive, messy, creative, conflictual, loving and hateful – but always and forever boundaried.

Boundaries frustrate but facilitate grieving

Over the past decade of being a UKCP registered psychotherapist, I have seen a fair few people come and go from my practice. Most have stayed for years and, I believe, done some very good and important work.

As in life, the relationships we form with those whom we see week after week matter to us and I have grieved with the end of the work and having to say ‘good-bye’ when treatment ended.

The grieving is necessary as, irrespective of how much we have come to matter to each other, I shall always be in the role of psychotherapist for all of my former patients. Most will never cross my threshold again, however, it is vital that they can hold me in mind in the role they assigned me and that I don’t deviate from that position and ‘befriend’ them. Whilst this may feel seductive to both sides (as it does for a parent and child), the boundary enables the relationship to work and continue working in the capacity it must for the patient.

On why I use the term ‘patient’

I have shown my hand in the previous paragraphs in using the nomenclature of ‘patient’ and shall now explain why I have, over time, shifted in my way of thinking.

Patients come to me because they are in distress. I am there as an expert, not to tell them how to live their lives, but to help them understand how and why they live their lives they way they do and offer them a stable and secure relationship through which to bring about change.

Psychotherapy is about change – it is not about enabling existing behaviour and this needs to be agreed between therapist and patient.

I view the term ‘client’ as representing a grey area when it comes to boundaries – with clients we can ‘have a chat’ and maybe take the relationship outside of the context in which it began. It also seems to me to be very transactional. This is a personal view and not an accusation of anyone who has a preference for this term.

My work as a psychotherapist is to ‘treat’ my patients. I am accountable for understanding their minds and helping them find a way through their distress. If they knew how to do this, they would not need me.

Lastly, rather than being a distancing term, I view ‘patient’ in this context of one towards which I can show the upmost respect. It does not imply, to me, that I am better than them, but it does show that I am willing to take on the responsibility for my part in their treatment and that the boundary will always hold. For me it is ultimately a term of ‘love’, in the way Freud meant it.

 

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.

 

Further reading by Mark Vahrmeyer

How to minimise Christmas stress if you are hosting

Can couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

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Is starting psychotherapy a good New Year’s Resolution?

Most of us make some sort of New Year’s resolution, whether overtly or covertly.  The new year can feel like an opportunity to put the past behind us and to start afresh.

Whether or not we actively name and own our New Year’s resolutions, most of us can also attest to the best held intentions for change slipping away. There are plenty of good reasons why New Year’s resolutions don’t work. We are often too unspecific in what would constitute change, and it can be hard to make change on our own.

Psychotherapy is about change.  However, the start of all change comes from inside. To make change, we need to understand ourselves and accept why we have made the decisions we have. Nothing is random.

Psychotherapy is first and foremost about learning to have a relationship with ourselves and to learn to hold ourselves in mind, often in ways others failed to do when we were growing up. When we hold ourselves in mind, we can objectively evaluate if something is helpful or in our best interests.

We learn to hold ourselves in mind through others holding us in mind. This is one of the main roles of a psychotherapist. Holding a client in mind is far broader and deeper than simply making notes and remembering what they told us. It is about having a relationship with them and helping them to understand their blind spots, their relational patterns to themselves and to others. Helping them work through this is the therapeutic encounter.

Psychotherapy is often hard. Keeping to a weekly day and time when we meet with our psychotherapist can feel like a slog. Unlike a New Year’s resolution, the process is held relationally. Your psychotherapist makes the time and space available to hold you in mind and expects you to show up for the weekly dialogue. Even if you do not attend, your therapist is there to hold you in mind.

Perhaps the question is not so much whether psychotherapy is a good New Year’s resolution. Rather, it may be whether you are committed to having a deeper and more meaningful relationship with yourself, and through this, learning to hold yourself better in mind. The latter will lead to long-lasting changes on a profound level which may or may not include more frequent trips to the gym!

Happy New Year from all of us at Brighton and Hove Psychotherapy.

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.

Further Reading

New Year Reflections

How psychotherapy works

What is psychotherapy?

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