Psychotherapy Blogs - Page 5 of 13 - Brighton and Hove Psychotherapy

November 28, 2022 by BHP Leave a Comment

Online versus In-Person Therapy

When Covid struck we could no longer deliver therapy face-to-face and so this meant that many of us had to adjust to therapy online using a video web platform such as Microsoft Teams or Zoom. This was both challenging for the therapist and the client, however many people now prefer therapy online.

Research has shown that therapy using a video web platform is just as effective as in person therapy. Studies published in the Journal of Psychological Disorders and the Journal of Affective Disorders, Behaviour Research and Therapy have shown that online CBT and counselling are as effective as in person therapy in helping people address a wide range of issues including anxiety and depression.

There are some obvious benefits to online therapy such as therapy in the comfort of your own home, not having to leave your house so no travelling to appointments; the convenience of accessing appointments anywhere providing you have internet access and privacy. I have had some clients attend appointments in their car or sitting in their garden and even whilst on holiday. There is also the anonymity of not having to go to a therapy practise setting for appointments. There is also something about not having to meet your therapist in person which can allow some clients to open up more.

There is no doubt that some clients prefer the connection of in person therapy. They feel it allows for a more fulfilling relationship. In addition, some clients are already having to work online and don’t want to do anymore ‘on screen’. The issue of privacy and being interrupted by family members can be difficult as well. In person therapy allows for a neutral location, a safe space for the client to share private information away from everyday life.

In person therapy has always been considered as preferable and certainly this was the case before Covid, but now this is shifting and we are learning that online therapy is also a valid option.

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch. Online therapy is available.

November 14, 2022 by BHP Leave a Comment

What does Couple Counselling do?

At a fundamental level, couple counselling provides an opportunity for a couple to explore their relationship with a therapist who facilitates the exploration. Couples have said to me that they really value the dedicated time, space and support to talk about feelings and difficulties that don’t feel safe to share with each other elsewhere. What else couple counselling does is more provisional and it’s perhaps helpful to think about what couple counselling can do?

First of all, I’d like to make it clear what, in my opinion, couple counselling doesn’t do. Couple counselling is not about the counsellor determining whether a couple should split up or stay together. Nor is it about the counsellor telling either individual how to behave or taking sides. (There are exceptions to this if one of the partners is coercive or violent.) The more behavioural approaches to couple counselling often provide communication exercises and homework between sessions, humanistic and psychodynamic approaches tend not to do this.

I think a key element of what couple counselling can do, is to give a couple the opportunity to see their relationship from a more objective position, to help a couple step away and see themselves as if looking in from the outside. People are often familiar with repeating patterns in the interactions with their partners. They know which situations end in a row or sulking or tears – “you always …,” “you never …” but they can’t necessarily recognise the dynamic that underpins the patterns. How they both act in a way that means these situations keep playing out in the same way again and again. They know that over time painful feelings have built up, such as hurt and resentment, frustration and fear, disdain and humiliation. These feelings can reach a point where one or both partners question whether they can carry on living like this or would it be better to break up. Then they come to couple counselling.

A couple counsellor can notice and comment on what they see being enacted between the partners in the session. They and the couple can think about how this dynamic can play out in the relationship and the way it impacts how they feel about each other. This close attention from the therapist can make couple counselling challenging, each partner becomes aware that their behaviour is coming under scrutiny. They may be fearful of owning their own behaviour and ashamed about revealing aspects of themselves, aspects that may be protecting them and hiding feelings of weakness, vulnerability or lack of self-worth that probably originate from their past.

A therapist can encourage both partners to be more compassionate with themselves and each other, to let go of the feeling that their partner is a potential threat and they need to defend themselves. A couple can then begin to see their partner as someone who is on their side, who is on the same team but perhaps brings a different perspective.

Hopefully a couple can recognise the dance between them and acknowledge the relationship they have created together is a shared responsibility, both the positive and negative parts. This means that the project of creating a more satisfying relationship, or a constructive separation, can also be shared and is perhaps more possible than they imagined at their first counselling session.

October 3, 2022 by BHP Leave a Comment

What Can Relationship Counselling Help With?

For most of us, the start of a relationship is an extremely exciting time. Not only is the relationship itself hugely enjoyable – fun and life-enhancing – but it can also seem to transform our world. Put simply, it makes the world seem a better place.

It seems odd to think that something that develops from a place of such unbridled joy, can be connected to the development of so much unhappiness for many couples. The intimacy the couple once shared freely and with delight, now feels like a chore and is doled out with resentment; the home they once thought of as their refuge has become their prison; the person who was once lover and confidante is now an enemy. And so on.

Of course, not all relationships that run into difficulties have a narrative that can be summed up in as binary as fashion as that above – but they do all have a narrative. The exploration of this narrative is the generic purpose of couples counselling. As the couple talk through the journey of their relationship, it will help them to understand the reasons – often unconscious forces – behind their behaviours and feelings. They can then make choices based on understanding rather than unconscious drives.

Communication and the presence of the past

It is difficult to avoid the presence of the past in almost anything we say or do. We learned our communication skills when we were very young from the family and environment in which we were raised. It is no surprise that those skills will play out strongly in our relationships as adults. If our communication skills are poor, we may feel misunderstood. If we feel misunderstood, we may become defensive, which might well be experienced by our partner as hostility. Over time the behaviours driven by such communication may leave both partners feeling isolated, which in turn will drive further alienating behaviours.

One of the most important aspects of relationship work will be to explore how the couple communicate and, importantly, what is driving those communication methods. If there is will, whatever has been learned can be unlearned and replaced. It just takes a little bit of work!

Intimacy

Intimacy is not necessarily the most important area in a relationship, but it is often a touchstone for other matters and its lack can be felt intensely by either or both partners. It can be difficult for couples to understand how something that once seemed so colourful and vital now appears so pale and lifeless. The prospect of intimacy can be threatening. It touches on areas of desire, shame, self-worth, driving fear – again often making us aware of
the presence of the past. Through an exploration of this aspect of the relationship, the couple will have a better understanding of what is behind their behaviours in the area of intimacy and can begin to move towards a re-connection in this most vital part of how they relate to each other.

Surviving conflict

Couples counselling will help us to understand what is happening with us when we are in conflict. Many couples will want to avoid conflict, and it can be difficult to understand that dealing with it can be good for us. It can help us learn that we can be in dispute – with all the anxiety associated with it – and then return to a place where we feel safe again. Conflict does not have to mean catastrophe. However, this is another aspect of communication, and
we need to develop our resilience in the area to avoid becoming (once again!) prisoners of our past.

Knowing me, knowing you

The ‘unexamined life is not worth living’ might seem a little reductive. Perhaps Aristotle should have put it more positively – more like, ‘understanding oneself has great benefits.’

However, within a relationship, understanding yourself and your partner does indeed have great benefits. I would argue it is one of the significant rewards of attending therapy as a couple. Being valued, being understood are the building blocks of love.

Talking and listening

It is not unusual for couples to find it difficult to talk to each other. Over time, the pair may begin to avoid difficult topics, often through fear of conflict, or maybe through fear of potential outcome more generally. Couples counselling will help the couple discover and explore these areas of difficulty and, importantly, help to build a model which can be used outside and beyond the sessions to make sure that couples have the skills to talk and listen
effectively.

A good ending

A cursory look at divorce rates would demonstrate, starkly, that many relationships do, and will, end. Sometimes, the issues couples bring to their therapy, either as individuals or as a pair, lead them to decide that what is between them is overwhelming and that their best option is to separate. Couples counselling can help to navigate these challenging decisions and the very difficult feelings associated with them. All of us must deal with endings in our lives, and all endings involve loss of one sort or another. Although dealing with endings is often the one of most painful processes of couples counselling, it does not have to be catastrophic. If the decision is to end the relationship, counselling will help the couple to find a way to keep intact as much of the positive connection between the couple as possible.

September 27, 2022 by BHP 2 Comments

Will counselling save my marriage?

One of the most common questions asked by individuals enquiring about couple’s counselling is whether the process will save their marriage? This is an understandable question and is driven by anxiety in relation to thoughts of a break-up.

The answer to this question is not simple and the variables lie with the two individuals in the couple, rather than with the therapist. Allow me to explain:

If a couple enter into couple therapy with clarity about wanting to work through some difficulties with the goal of continuing with their relationship AND this is reflected in the work then it is likely that the outcome will be a stronger relationship between the two individuals in the couple resulting from improved dialogue and intimacy.

However, this is often simply not the case. At best one partly frequently has ambivalent feelings about staying in the relationship or simply cannot get in touch with whether this is something they want due to the strength of feeling around unresolved issues.

Let us take the example of an affair. This is a fairly common presenting issue with couples who seek out couple counselling. In a typical scenario where one party in the relationship has been unfaithful, the other is likely to be feeling betrayed, hurt, angry and mistrustful.

Until these emotions can be worked through in session (if they can) and the hurt party can both come to terms with the affair, as well as with how both parties in the couple contributed to a loss (or avoidance) of intimacy, the question of whether the marriage can be saved remains a moot point.

Working with a skilled counsellor or psychotherapist can only benefit your relationship in terms of providing you both with a therapeutic relationship and environment in which difficult feelings can be worked through and better dialogue and understanding reached between to two members of the couple.

As painful as it is, sometimes the best outcome for a couple can be that both amicably go their separate ways.

September 26, 2022 by BHP 1 Comment

What are the Benefits of Counselling and Psychotherapy?

Counselling and Psychotherapy can help with a range of issues that we may find difficult overcoming by talking to friends and family. There is a significant difference in talking to a skilled professional outside of your social and family circle, someone who is formally trained and experienced in what they do and understands how to work with psychological issues. I won’t go into the differences between counselling and psychotherapy, as this has been addressed in a separate blog. Rather I will focus on what makes talking therapies so beneficial.

Providing a safe environment

Anyone going through a crisis or wanting to discuss sensitive issues needs to feel heard, validated and understood. The therapy space is one which is designed to create containment, consistency, and safety. Weekly sessions usually at the same day and time, a calm and relaxing setting without distractions, an hour dedicated to you, and a professional who creates an environment conducive of trust and safety are all important aspects of the “talking cure”. These elements comprise what we call the “therapeutic frame”, which underpins and supports the work we do as therapists.

Someone who listens but not just listens

In my opinion, listening skills are highly underestimated. Listening isn’t just about listening, but also about making sure that the other feels heard and understood. Although this is considered a basic and essential skill in any talking therapy, listening takes presence of mind, body, and spirit. It is not as easy as it seems. The last thing anyone wants is a distracted therapist or one who seems they don’t listen or understand what you are telling them. For some it can bring up painful past and present experiences of lack of care, it can also convey a lack of interest and touch on previous abandoning and rejecting experiences. So, to get the basics right is very important!

Getting stuck in

Once you have a place to come where you feel comfortable, at a set time each week, with a person you feel you can trust and speak to without being judged, then the work can begin.

“The work” can be compared to an exploration, excavation, unpicking and un-knotting of the different strands of the issue or issues that you came to talk about and get help with.

This can be sophisticated work of great skill, but also messy and clunky at times. There is much uncertainty about what will be revealed and the paths that you will walk together.

The therapist’s job is to help you keep on track, but also allow for new pathways to be discovered. This is what makes the work interesting, fascinating, and rewarding for both parties. This relationship can be one of collaboration, creation, and deconstruction. None of this is necessarily smooth or easy but knowing ourselves is always ultimately rewarding.

The benefits

All the above is designed to support trust building, lessening isolation, creating space and safety amongst turbulent and uncertain situations, helping individuals regain control over their lives, feel and process difficult feelings, make sense of confusing situations and build or rebuild better relationships with self and others. Other benefits include: increased self-awareness, self-development, psychological and emotional strength and resilience, finding more meaning and purpose in life, making positive changes, and better communication amongst many other things.

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 and Clinical Superviser and Executive Coach. She works with individuals and couples in Hove and Lewes.

Further reading by Sam Jahara

What makes us choose our career paths?

Antidotes to coercive, controlling and narcissistic behaviour

An in-depth approach to leadership coaching

Demystifying mental health

Women and Anger

September 21, 2022 by BHP Leave a Comment

How to prepare for couples counselling

So you have taken the difficult step to go to couple counselling – what do you do now?

Obviously there are a lot of variables when it comes to couples’ attending counselling together. Some couples are both on the same page and have a common goal, albeit they are struggling to reach that goal, whereas others may have very different wants and needs to each other. Your particular circumstances will dictate whether you prepare for your first session as a couple or you take a more individualistic approach.

If you are new to counselling in general and couple counselling specifically, the days and hours leading up to your first session may feel daunting and anxiety provoking. You are likely to worry about both how the session will go and whether or not your counsellor or psychotherapist will be someone you can work with.

On of the most common fears that individuals in a couple have is that the counsellor will ‘side’ with one party in the couple against the other. Indeed, one can go a step further and suggest that secretly this is often a wish that individuals in a couple may have: that the clinician will see things from their point of view and help explain to their partner where they are going wrong. Well, whether a wish or a fear, any couple counsellor who is well trained
is not going to take this position and will work instead to facilitate a dialogue between the couple and to establish the goals of the work.

Unlike open-ended psychotherapy which can go on for many months or years (indeed, it should), couple therapy is very different, in that it is far more goal orientated. The goal(s), however, are to be defined by the couple themselves and if this is unclear then this can often be the first piece of work that is done together.

A couple counsellor is not invested in whether a couple stay together or not. This may sound counter-intuitive, but they will work with the wants and needs of the couple and in couple counselling, whilst break-ups are invariably painful, a ‘good’ break-up can be an as successful a piece of work as where the couple decide to remain in the relationship.

Returning to the question of how best you can prepare for couple counselling, if you are working towards a common goal as a couple then it can be wise and productive to spend some time in advance of the session talking about what you each wish to get from the session(s) as well as what you as a couple wish to get. You will both have individual
needs and the couple as an entity also has needs.

If you are unable to communicate together, or are clearly on very different pages in terms of what you want, then I would suggest you spend some time on your own thinking about what you want to achieve from the work.

Lastly, it is important that you are both comfortable enough working with your couple counsellor. Inviting a third party into your relationship is an intimate act and you need to be sure that the person you are seeing is both qualified to help you as well as someone you both feel you can be honest with. If one of you is too uncomfortable to work with a particular clinician, then there is no point in proceeding with any further appointments.

September 12, 2022 by BHP Leave a Comment

What Can Couples Counselling Help With?

Couples Counselling or Couples Therapy can help the couple communicate better, look at past influences on present behaviour and help the individuals within the couple understand themselves and their partner better. Depending on approach to couples therapy, the therapist will either work with the here-and-now issues and provide the couple with tools to better communicate and relate to one another, and/or look at the dynamics stemming from each person’s family of origin and what each brings into their relationship.

In a sense, the role of the therapist is to introduce the individuals in the couple to one another. There are sides of ourselves that might be difficult to show to our partners without the help of a third party who is “looking in” the relationship.

Observation

The couples counsellor acts as an observer of the couples existing communication style, noticing how they interact both verbally and non-verbally. This information assists the therapist and the couple in helping to identify unhelpful patterns and difficulties in getting important messages across. Communication involves speaking, listening and other vital non-verbal cues.

The aim is to achieve greater awareness of how we come across by slowing things down, reflecting on what was said and noticing how things are received by our partner. Patterns of communication usually stem from how we were taught to communicate in our family of origin, therefore what comes naturally may not be what is needed to improve a relationship.

Mediation

Some couples work involves mediation between parties, especially in situations of conflict and impasse. When the couple gets stuck in recurring patterns of behaviour, a skilled third party can assist in calming things down when exchanges get heated, keep track of certain dynamics, and suggest new and different ways of dialogue that are more conducive to conflict resolution. Ideally, in time, mediation is no longer needed and the couple will eventually learn to slow things down themselves and reflect on their style of relating without the help of a professional.

Education

The therapist’s role is also that of an educator in the art of relating and communicating better. People who are very skilled in other areas of their lives can get stuck when it comes to their relationship. There is no shame in being a master communicator in your job but completely fail when it comes to your relationship. This is because there is so much more at stake. The closer we are to someone, the more difficult it is to see things clearly. Some people may feel resistance to coming to couples therapy because they don’t want to be taught to do something that they think they should know themselves. However, a certain degree of humility when it comes to improving your marriage or partnership, can go a long way. Afterall, we are all learning new things all the time.

Final Thoughts

It might feel daunting for couples to talk about the difficulties in their relationship to a total stranger. It can also feel exposing to talk to a stranger about your feelings in front of your partner. However, this very exposure is what enables us to lower our defences and put us in a more receptive and reflective frame of mind. Individuals within a couple often, over the course of their relationship, built walls around themselves as a protection against emotional
hurt and pain. Within a safe space and with a trusted therapist, the couple can hopefully begin to talk about and understand the origins of these feelings. This usually leads to partners getting to know each other better and feeling closer as a result. With more tools and healthier patterns of relating learnt during the sessions, the couple should feel more equipped to continue working on their relationship even after the therapy has ended.

September 5, 2022 by BHP Leave a Comment

How to get a Mental Health Diagnosis

The term ‘mental health’ is pretty broad and encompasses emotional and psychological health.

When people talk about mental health they are often referring to symptoms such as depression or anxiety but rarely do they mean psychiatric disorders such as schizophrenia, for example. Therefore, the answer to how to go about getting a mental health diagnosis is – it depends.

It is possible to go to a GP in the UK and present with symptoms that fit the criteria for anxiety or depression and to receive a ‘diagnosis’ from this doctor. In turn they may ‘prescribe’ counselling or offer you medication such as anti-depressants.

However, receiving a mental health diagnosis is not the same as receiving a diagnosis for a physical disorder. Let me explain.

Nobody has seen a mind.

If you are unfortunate to break a bone due to a fall, it is safe to assume that unless you are encountering an incompetent doctor, you will receive the same diagnosis irrespective of which hospital you attend wherever in the world; a broken bone is exactly that.

When it comes to mental health, the criteria is different as we are really talking about the ‘health’ of the human mind (or in many cases the emotional system), and the problem is that nobody has ever seen a mind.

Most mental health diagnoses are therefore based on the presentation of ‘clusters’ or groups of symptoms that a patient experiences over time. A GP will consider your experiences and the duration over which you have experienced them and on that basis will offer you a ‘diagnosis’.

Whilst this may be helpful in order to access medication of brief counselling, it is unlikely to resolve matters. And bear in mind that most GP’s have had very little mental health training – generally only weeks, compared to the years of training around physical health.

A psychiatric diagnosis

If you have severe symptoms that quite possibly may include delusions, you may be referred to a psychiatrist. A psychiatrist is a medical doctor who has specialised in ‘diagnosing’ psychiatric disorders and on the basis of a diagnosis you will likely receive medication and/ or psychotherapy.

Counselling and Psychotherapy

The parallel but distinct professions of counselling and psychotherapy are both related to mental health and approach treatment of mental health conditions through what is known as ‘the talking cure’. In reality the cure comes about far more through listening, rather than talking on the part of the clinician.

Whilst there is disagreement about the fundamental differences between counselling and psychotherapy – which I have previously written about here – a reasonable differentiation is that counselling is used to as a shorter term treatment working on a more superficial level.

Psychotherapy, as defined by the UKCP _United Kingdom Council for Psychotherapy) involves a similar process to counselling but working with a clinician trained for a longer period of time who is crucially able to formulate, unlike counsellors.

Formulation is the word psychotherapists use to ‘diagnose’ but as we do not tend to work within the ‘medical model’ and recognise that mental health issues encompass both psychological as well as emotional issues, we use a different language and different models to the medical model in order to make sense of a person’s inner world.

Is psychotherapy about getting rid of symptoms?

Whilst most people presenting for psychotherapy simply wish to ‘feel better’, a large part of the process of therapy is to become curious about one’s symptoms in the context of the therapeutic relationship. Psychological or emotional symptoms, much like bodily symptoms, are often there to inform us of something important that needs attending to.

Psychotherapy is fundamentally about working to create a deeper relationship with oneself, through the relationship with the psychotherapist. And through this deeper relationship we can come to understand our symptoms better as signals that are telling us something about our life: often either about something in the past that has not been processed or worked through, or something about what we yearn for in the future.

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 do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

Mental health problems in Brighton

August 29, 2022 by BHP Leave a Comment

What is Psychotherapy?

Psychotherapy is a method of treating mental health issues through psychological, rather than medical means.

Known as ‘the talking cure’ a psychotherapist’s role is to work with patients or clients, generally on a minimum of a weekly basis, over a period of months or years. The work takes place within what is called a ‘therapeutic relationship’, characterised by the psychotherapist listening and thinking carefully about the client’s experience and working with them to make sense of it. Thus, whilst known as the talking cure, it could be more accurately described as the listening cure.

Psychotherapy developed from psycho-analysis, which is similar in nature, but involves multiple weekly sessions (up to five) and can often last for up to a decade. Freud referred to (psycho) analysis as a ‘cure through love’ and this applies to psychotherapy in much the same way. The relationship between psychotherapist and client is unique and one in which all the focus, attention and thought is about the client’s process. The closest example to this type of relationship is between mother and child, or primary-caregiver and child, and it is often due to failings in this primary attachment relationship that clients seek out psychotherapy in later life.

Do I need to have a mental illness to go into therapy?

Whilst it is very common for people to seek out the assistance, support and expertise of a psychotherapy due to them feeling like they are in a crisis in their life, the crisis is often only the catalyst that brings a client into psychotherapy. Indeed, it was once again Freud who said that psychotherapy (analysis) only begins once the patient’s crisis has passed. What did he mean by this?

One of the goals of psychotherapy is to bring space and contemplation into a person’s life so that they feel less at the mercy of their emotions and more able to hold themselves in mind. Once a crisis has passed, clients can often start to focus on using the therapeutic relationship and space to examine why they think and feel the way they do and to develop a construct or idea about who they would like to be. Psychotherapy is thus about getting in touch with our appetite, or passions.

Whilst most people access psychotherapy due to an issue covered by the term ‘mental health’, most remain for months or years in order to learn to have a better relationship with themselves and others.

How does psychotherapy work?

Human beings are relational beings, meaning that we are, from the moment we are conceived, in relationship to another. Relationships shape not only our worldview and our relationships to others in our life, but also shape our relationship to ourselves.

If we have learnt through early relationship(s) that others are unsafe and/or that we are not worthy of love then this shapes our worldview of all our relationships going forward. If we have been wounded in relationship then it takes another (therapeutic) relationship to work through all the hurt and to discover a new way of relating through how we are related to.

What training do psychotherapists have?

In the UK, the terms of psychotherapist and counsellor are not legally protected meaning that virtually anybody can use these terms with impunity.

Whilst some clinicians use the terms of counsellor and psychotherapist interchangeably, the UKCP (United Kingdom Council for Psychotherapy) is the largest professional body for psychotherapy clinicians and lays out its training and membership expectations for clinical psychotherapist very clearly.

Psychotherapists in the UK (who are UKCP members) train for a minimum of four years at post-graduate level, undergoing their own psychotherapy throughout this period, obtain at least 450 clinical hours of experience and undertake a mental health placement. Most UKCP psychotherapists will therefore have a minimum of a Masters degree in the field.

What’s the difference between psychotherapy and counselling?

There is much disagreement about the differences between counselling and psychotherapy and this is something I have previously addressed here. Fundamentally, psychotherapists are trained to work at a deeper level than counsellors and have been trained to formulate – our word for diagnose.

How do I find a psychotherapist?

Finding a psychotherapist can feel daunting. Brighton and Hove Psychotherapy is a physical clinic comprised of a group of skilled clinicians offering psychotherapy across the greater Brighton and Hove area and Lewes. You can use our search function to find a psychotherapist near you.

Alternatively, the UKCP holds a directory of all registered UK based psychotherapists which can be found here.

Further reading by Mark Vahrmeyer –

How to improve mental health

How do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

August 15, 2022 by BHP Leave a Comment

How to Improve Mental Health

Mental health is constantly in the news and not a day goes by without an article, blog post or news piece on the topic.

The great contradiction is that whilst we know more about mental health now and how to manage it, the busy, chaotic and plugged-in world we live in does little to help our mental health. Nor is it often that clear what exactly is meant by the term ‘mental health’.

Mental health is a ‘catch-all’ phrase that encompasses our emotional, psychological and social wellbeing. It therefore includes our mind, our emotional system and our social world. It stands to reason that good mental health means attending to all three, but I would argue that there is a fourth – the body – which is intrinsically connected to good mental health.

When people refer to their mental health, what are they really saying?

As I write this article, the media will have us believe that mental health is currently under crisis in the UK. Waiting times to see a mental health practitioner are at an all time high, people are increasingly struggling to cope with high stress levels and many folks remain isolated or fearful for social contact following the numerous and lengthy Covid lockdowns.

Poor mental health can manifest in a range of symptoms from low level depression and anxiety through to diagnosable psychiatric illnesses. For most people concerned about their mental health, the latter is fortunately not very common and therefore we can think about how you can take responsibility for improving your mental health.

Steps you can take

Sleep is crucial to good mental health and it is no coincidence that many of us struggle with poor sleep which ever time can have a very detrimental impact on our mental health (as well as our physical health).

Establish a sleep routine and stick to it – going to bed at a set time and avoiding stimulants such as caffeine before bed can be very helpful. Another stimulant that you would do well to avoid is watching the news prior to bed – whilst informative, the news impacts significantly on our nervous system and can leave us feeling ‘activated’ exactly when we need to get to sleep.

Exercise is good for the body, but also the mind. Many folks are put off exercise as they see it as something that involves strenuous exercise in a gym, however, this need not be the case.

Exercise does not need to cost anything and can be a way of combining being in nature with moving the body. A brisk walk or sea swim (in the midst of this heatwave) are both good forms of exercise.

Eating sensibly is another activity associated with physical health but which can also have a significant impact on our mental wellbeing. Stimulants such as coffee and sugar impact on moods and with this can in turn impact on sleep patterns, so be aware of when you consume stimulants and avoid eating anything late into the evening.

Socialising is not only enjoyable but is also good for our mental health. Human beings are relational, meaning that we are born into relationship and require relationship(s) to develop. Even when we are alone, in a psychological sense we are in relationship to someone – we call this an internal object – and constitutes how we hold ourselves in mind and make the ‘best’ choices for ourselves.

The mind body connection

All of our emotions stem from the body. They start as sensations and we then notice them and group them into emotions; feelings are the words we use to describe emotions.

Each feeling, or set of emotions, has its own somatic (body) blueprint, which means to say that each feeling is made up of a unique set of sensations in the body. For example, anger, whilst ‘feeling’ different for everyone has the in-common body sensations of tight stomach, tight jaw, clenched or tightened fists and a narrowing of the eyes. Conversely, joy, is felt in the body as an openness and moving towards something or someone. Joy tends to bring a smile to our face and it is as if our whole body opens to receive more of what we are enjoying.

Everyone has a different shaped and sized body and everyone has a body that can perform different tasks depending on fitness, ability, age and (dis)ability. However, unless a person has a ‘good enough’ relationship with their body, it is simply not possible to have good mental health.

Hence why the body must be included in psychotherapy and feelings stemming from the body attended to.

Practicing gratitude towards your body for what it can do and how it looks after you, getting curious about what your body needs and wants and treating your body with respect, are all significant pathways to good mental health.

Talk to someone

When things get too much it can be good to talk and whilst a social and support network is important, some things need to be thought about with a mental health professional such as a psychotherapist.

A psychotherapist is someone who has trained at postgraduate level for a minimum of four years and undergone their own journey of analysis or psychotherapy throughout their training and ideally well beyond. In the UK, psychotherapists are registered with the UKCP who hold a directory of qualified clinicians or you can search for one using the search function on our own website.

People generally enter in psychotherapy because of a crisis of some sort in their life, however, they tend to stay because they find the therapeutic relationship so invaluable in not only improving their mental health but in developing an appetite for their lives. As Freud said, psychotherapy (analysis) begins after the crisis has passed.

Further reading by Mark Vahrmeyer –

How do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

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Mental health problems in Brighton

July 11, 2022 by BHP Leave a Comment

Antidotes to Coercive, Controlling and Narcissistic Behaviour

There have been many more articles written on Narcissism in recent times, as it seems to be the age we are living in.

Narcissistic political, organisational, and religious leaders who lack accountability, manipulate information, and deny any wrongdoing has become a normal phenomenon across the world. This is not a new problem – narcissists have always existed and will continue to do so. In fact, every one of us has some degree of it, which is not necessarily a bad thing. A healthy degree of self-belief and self-confidence is in fact necessary. Narcissism of a more problematic kind exists on a spectrum, ranging from higher- than-usual degree of self-centredness to a deluded idea of omnipotence and specialness.

These characteristics are problematic because when the focus is on oneself only, the other simply becomes a means to an end, rather than a relationship between two human beings with differing needs. Clearly, relationships with narcissists can be very difficult. Unless the other is a good reflection of the narcissistic self and helps sustain their self-image, then the relationship will go smoothly. In fact, it can feel good to be a part of this ‘narcissistic bubble’. However, if the person disagrees, has their own opinion, or wants to assert their difference, then things can quickly take a turn for the worse.

The narcissistic character will do everything they can to maintain a good image of him/herself, which often involves projecting anything that is perceived as bad onto the other.

This is usually paired up with an inability to take responsibility, emotional immaturity, and the portrayal of a false sense of self-confidence. The key here is that the person is operating from a self that is idealised, inflated and false, rather than a real self which incorporates good and bad aspects, and is realistic about its limitations.

Deep down, the narcissist feels vulnerable but will do all it takes to protect themselves from this feeling. Unfortunately, people with a strong narcissistic disposition will prey on the vulnerable, using them to achieve their own gains, project uncomfortable feelings onto them, attack, undermine, and belittle them.

At this point you might be asking yourself “why would anyone choose to be in a relationship this bad?” Those in a relationship with a narcissist can go from feeling very special to feeling persecuted, manipulated, intruded upon, and objectified. A typical example would be a situation of domestic violence. It is usually very hard to leave because one is either kept in fear or hopes for the return to a time when things “felt really good”.

The Antidote

Building up self-esteem and self-confidence is an important aspect of making healthy relationship choices. We all have self-doubt, but excessive self-doubt leads to a vulnerability to manipulation and control. A healthy degree of self-belief and self-esteem can help in asserting needs and act as a protective mechanism against self-doubt that can feel paralyzing in the face of coercive, manipulative and controlling behaviour. It also sends a strong message out that your mind is your own and you are not vulnerable to control.

Setting strong boundaries is another vital antidote. Taking more ownership of your physical and psychological space, sending the message that you will not be intruded upon without consequences, and reasserting your boundaries again and again will go a long way towards self-protection. If this isn’t respected, then trusted others may need to become involved in helping you create a strong self-protective shield around you. In the extreme case of violent intrusions, criminal and abusive behaviour, reporting the crime might be the only way to set those boundaries. Even in less severe cases of manipulation and intrusion, it is going to be helpful to set strong boundaries and stick with them.

Don’t be seduced by an illusion of specialness. There are different ways to feel special – are you being seen and respected for who you really are, or because you conform with who the other wants you to be? Do you feel valued or seen for your own virtues, feelings and thinking? Are you being encouraged to be who you are, even if you disagree with them? Do you feel you can be different, separate, do your own thing? Are you often put down, belittled, or told that you are no good?

Psychotherapy can help with assertion, boundary setting and improving self-esteem. Most importantly, it is a space to examine the motivation for relationship choices and unhealthy beliefs about self and others.

Sam Jahara is a UKCP Registered Psychotherapist, Superviser and Tavistock Certified Executive Coach. Sam has recently been interviewed by Talk beliefs on the harmful impact that cults have on children, drawing from her personal and professional experience. See the link to Sam’s interview.

Further reading by Sam Jahara

An in-depth approach to leadership coaching

Demystifying mental health

Women and Anger

Why all therapists and mental health professionals need therapy now more than ever

Fear and hope in the time of Covid – part 2

June 13, 2022 by BHP Leave a Comment

Mental Health Problems in Brighton

Brighton and Hove Psychotherapy, as the name would suggest, is an applied psychology practice located in central Brighton and Hove in operation since 2014. Whilst many of our clients travel from further afield to see and be seen by our clinicians, and whilst we offer online therapy, most of our clients over the years have been from the Brighton and Hove area. As such we are in a privileged position to have a good insight into the specifics of the state of mental health amongst the general population of this city.

Do different cities have specific mental health trends?

There is much in the media being published about the poor state of mental health (and mental health provision in England) at the moment. Years of austerity, the pandemic and soaring addiction problems are fueling a national mental health crisis across the nation. This is no different in Brighton and yet some of the issues that people present for therapy within Brighton will also be an expression of the demographic and culture of the city.

The demographics of Brighton

Brighton is a vibrant city on the south coast of England, within easy reach of London. It has a relatively young, highly educated population, many of whom move here for the lifestyle or have graduated from one of the two universities in the city and made the city their home.

It boasts both the highest proportion of small and medium sized enterprises in the country as well as the most start-ups per capita; both these are testimony to the young, highly educated population many of whom are liberally minded and self-starters.

Brighton considers itself not be ethnically diverse though statistically this is not reflected in the figures with 87% of the population being white. Brighton also markets itself as a ‘hip and happy’ city that is the epicentre of the LGBTQ community, though again, the statistics and perception may mask certain realities.

Millennials and mental health

As Millennials have come of age and are now approaching their thirties and beyond, we are noticing increasing numbers of them presenting for therapy. This is a national trend, however due to the large numbers of young people living in Brighton coupled with their education and entrepreneurial spirit, we see many Millennials presenting for open-ended psychotherapy to use as a relational tool to get deeply curious about who they are and what they want from their lives.

Whilst everyone who crosses the threshold of a psychotherapy practice has a ‘presenting issue’, these Millennials will often stay in therapy for a long time to engage in a depth relationship in with to get in touch with their deeper desires. They are often extremely bright as a population group and well-versed in psychological concepts. This in contrast to my own generation – Generation X – who consume the most alcohol and drugs of any generational group and will often only present for therapy once they reach crisis point (a generalisation, but true nonetheless).

Drug and alcohol use

There is a saying in Brighton that nobody who lives here is actually from Brighton. Of course this is a complete exaggeration, however, the city does attract a lot of ‘migrants’ from other parts of the UK as well as beyond. It is liberal and open at heart and, as already discussed, has a young demographic. It is therefore not surprising that drug and alcohol use and misuse is at the highest rate for the South-East of England and one of the highest for the UK. Indeed, back in 2011, Brighton held the disconcerting record for being the drug-death capital of the UK.

Another saying that seems to go some way to defining Brighton is that it is a ‘Peter Pan Town’ where nobody wants to grow up. This would be the ‘shadow side’ of its fun, hip culture in that the city and its culture can draw people into an ongoing cycle of ‘living for the moment’ and avoiding the realities of life.

Psychotherapy has many goals but one is that it is about growing up psychologically – working though past losses and moving with purpose towards what you want. Peter Pan, beneath his boyish charm, was someone who was frightened of the future and of adult responsibility, but unlike Peter Pan we all must grow up as otherwise life simply passes us by.

The LGBTQ community and feelings of not belonging

Brighton prides itself on inclusivity and this is reflected in the size of the LGBTQ community. However, as with everything, there is also a shadow side here and over the years myself and colleagues have worked with individuals who identify as LGBTQ but feel no sense of belonging in the Brighton community, or worse still, feel ostracised.

There is prejudice everywhere and some research has shown that minority communities can unconsciously exhibit higher levels of prejudice towards others who do not meet the criteria of ‘their community’. This is not unique to the LGBT community nor to Brighton and has been observed in racial minorities who have been seen to express higher levels of racism towards other minorities that is present in the general population.

To what extend the above is ubiquitous in Brighton lies beyond the scope of this piece, however, I have had numerous clients over the years who felt that they ‘did not belong’ in the Brighton LGBTQ scene and who found this enormously difficult and painful as it had been one of the reasons why they moved here. They felt that the way they were ‘gay’ or ‘lesbian’ was not accepted.

We all need a sense of community and belonging and it can be extremely painful if we intentionally move to a place to be a part of a wider community with whom we identify on a profound level, only to find that the way we are in that identity is not accepted.

Cities are communities and communities are collectives of people who, through their unconscious process, create a collective unconscious that’ has an identity to it – so it is with Brighton.

Psychotherapy is a relational process embedded in culture and thus practicing as a psychotherapist in Brighton, the specifics of the community will both be expressed and need to be worked with.

Further reading by Mark Vahrmeyer

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

May 23, 2022 by BHP 2 Comments

The Limitations of Online Therapy

Online psychotherapy is not a new concept; it was around before the pandemic and successfully used as a medium for delivering psychotherapy, counselling and coaching. However, what is new is how nearly all of us were obliged to work online to maintain continuity of sessions for our patients and clients during lockdown and how ubiquitous it remains. It is clearly here to stay but does that mean that in-person psychotherapy is a thing of the past?

Online psychotherapy brings with it some advantages over seeing a psychotherapist ‘in the flesh’ such as:

Access to a wider pool of clinicians;
Less time consuming as no travel is required;
Some people may find it easier to ‘open-up’ online rather than in person.

Like many psychotherapists, during the pandemic I had to abruptly move my whole practice online and together with my clients adapt to virtual sessions. Now at the tail-end of the pandemic the world is a different place and yet I have found that the vast majority of my clients have of their own volition decide to return to in-person sessions. I have explored this with them and below is a synthesis of some of the limitations of online psychotherapy and why, I believe, it will never replace in-person face-to-face sessions.

Psychotherapy is a body to body communication

Though often referred to a ‘talking therapy’ psychotherapy is much more a ‘listening therapy’ and the clinician is trained to listen in a very particular way – to what the client says as well as how they say it.

More than half of our communication is non-verbal and is a combination of tone and delivery in conjunction with body language. With online therapy much of the latter is lost due to the limitations of what can be seen on screen. But there is another reason why it gets lost – online psychotherapy is ever so slightly ‘out of synch’. It is almost imperceptible (most of the time) but there is a slight lag between the delivery of the sound and the delivery of the image which makes for a disconnect between the spoken and unspoken. And whilst almost imperceptible to the conscious mind, it gets registered by the emotional system.

Psychotherapy as re-parenting

Everyone who crosses the threshold of a psychotherapist’s consulting room is bringing with them unresolved experiences and patterns from their childhood. Many of the patterns are laid down in the formative years of bonding and dictate our attachment style. And because they were laid down between birth and around 2 years of age, they are non-verbal (and unconscious).

Psychotherapy is about working with these patterns – often referred to as ‘working in the transference’ – to understand how the client ‘does’ relationships; in this sense it is a process of re-pare helping the client to feel safer and more secure in relationships and in expressing boundaries.

The transitional space – travelling to therapy

Travelling to sessions in person can be time consuming and with today’s fuel prices, expensive. However, the travelling aspect has an important psychological function as it operates as a transitional space between the ordinary world and the unique world of introspective psychotherapy.

In online sessions I have often found that clients can be distracted as they have literally just ‘left work’ and entered my virtual consulting room – they have no given themselves time to make the journey to psychotherapy and it can then often take a significant part of the sessions for them to arrive.

Likewise, I have had clients who have scheduled work meetings immediately after their online therapy which can act as a powerful prohibitor to allowing themselves to ‘be in therapy’ as “I don’t want to get upset because I have a meeting with my boss”.

Lastly, when clients visit my consulting room in person, I am responsible for most of the physical boundaries. Clients know where they will be sitting, where the furniture will be positioned and this will remain the same week after week – it is part of be providing a consistent experience. Seeing a psychotherapist from home may mean that the space feels less safe with other members of the family in the same home or just simply having daily distractions around such as a picture of the family on the desk next to the monitor.

Psychotherapy is about making contact

Starting psychotherapy in any realm can feel like a daunting prospect. Coming into a consulting room, which is the domain of the psychotherapist, is a brave step.

Clients have often sat on my couch and mused or fretted about what to talk about. I generally sit in silence as they try and find their words as, to me, what they say is often less important than why they are telling me. If a client tells me anything they are telling me something about themselves that they feel is important and that they want me to see as important – often we need to figure out together why it is important but we generally get there in the end.

Therefore, psychotherapy is about ‘coming into contact with another’ – taking a risk to be seen and heard. Whilst this can be achieved to some extent online, nothing can be a substitute for in person contact where two bodies are in the same room and in communication and contact with each other.

Until we start raising babies and infants over virtual connections and can do so successfully – which is neither desirable nor remotely possible due to our physiological and psychological make-up – face-to-pace in person psychotherapy is not going anywhere.

Further reading by Mark Vahrmeyer –

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Parental Alienation and the impact on children

April 25, 2022 by BHP Leave a Comment

“I’m interested in therapy but isn’t it a bit self-indulgent?”

Many people believe that they don’t have a justified reason to go to therapy. They may feel they haven’t had anything ‘bad enough’ happen to them, or feel it is too self-indulgent. They may not think they are worthy of the attention they will receive. The truth is everyone is worthy of therapy. Therapy can help us look at our painful experiences and use them to adopt a different approach to living and engaging with ourselves and others.

Mental Health Imposter Syndrome Is Real

We’ve heard time and time again how clients feel they aren’t suffering enough to deserve mental health support. Following the pandemic, it’s more important than ever before to ensure you’re taking care of yourself.

Melanie Klein, an Austrian-British psychoanalyst, theorised a key early and ongoing development task is the realisation that others and different from us with their own needs rather than as extensions of our own. This forces us to realise the loss of what we want other people to be. However, this loss enables us to move on to a more realistic life.

Many feel that they don’t feel ‘that bad’ right now, however, it’s a common misconception that you much be going through some sort of crisis to be a good candidate for therapy. It’s easy for people to compare themselves to others or brush off their pain because it’s ‘a stressful time of year’.

Why We Need Therapy

Everyone’s experiences are valid, and many of us will benefit from therapy. A lot is going on in the world, especially following the pandemic. So, we must take time out for ourselves and work on what makes us feel good to be able to function to the best of our abilities.

The French philosopher and writer, Voltaire, tells the story of travellers who have suffered various trials and tribulations. These travellers hear of a murder at the Ottoman court. They pass an old man calmly tending to his garden and ask him if he’s heard about the murder. The old man doesn’t know anything about it and explains how he doesn’t concern himself with the affairs there. Voltaire uses this example for the idea that to live a good life, we should put more effort into the tasks that make us feel good and less about other worldly affairs.

Many of our therapists relate to this in the sense that many clients like to express their feelings and opinions on politics or activism, which, don’t get us wrong, is very important. However, we find that hidden within these opinions are parts of the client’s self that they are unable to face such as feelings of hopelessness, insecurities, despair, rejection and more.

Therapy Is Not Self-Indulgent

Rather than being self-indulgent, therapy is one of the best things we can do for ourselves and the world. By trying to understand ourselves, we don’t project our own pain onto the world. Through therapy, we can explore what is happening inside ourselves and utilise this new self-awareness to accept and understand ourselves better.

Voltaire argues in his book that cannot escape suffering, since the world is a brutal place. But rather than getting lost in these feelings of despair, we can accept them as part of the human condition. We must do our best to be honest about our feelings and cultivate what we can. Like tending a garden, the work is never complete.

February 14, 2022 by BHP Leave a Comment

Does the sex of my counsellor or psychotherapist matter?

A question I have often either been asked or has come up up is whether the gender of the clinician matters (or should matter) to the client?

The answer, as with most questions relating to the intricacies of psychotherapy is not categorically ‘yes’ or ‘no’. However, the question opens up other questions which may themselves be more interesting such as, what are your beliefs about psychotherapy and why should the sex matter?

To start with, there are clearly cases and instances where it is entirely appropriate for a patient or client to want or need to work with a therapist of a particular gender. Aside from the fact that this may simply be the wish of the client (and therefore to be respected) valid reasons may include a history of sexual abuse by one gender leading to the client feeling safe with the other gender (often their own).

However, if we drop beneath the obvious, the question takes on more of a philosophical slant and how it is answered gives much insight into what a clinician believes about psychotherapy – let me explain.

There are many ‘schools’ of psychotherapy and many methods, however most of these have more in common than they don’t and secondly, most clinicians are to a greater or lesser extent ‘integrative’ in that they use different models in their clinical work. The greatest distinction, or divide, perhaps lies in whether or not a method, and thus a practitioner, believe in unconscious process or not (and spoiler alert – I do profoundly).

As a psychoanalytically informed psychotherapist, I work with the unconscious which means to say that I take very little on face value and work with my clients to understand why they think, behave and act in the way they do; in other words, how is their past experience influencing their perception of the present without their knowledge. Through therapy the past can be uncovered, worked through, grieved and its hold on the present reduced. This frees clients up to make informed and thought through choices based on their reality as it really is now rather than where they were previously stuck.

Those who don’t believe in the unconscious (namely behaviourists or person-centred therapists to name a couple) take things on face value. They do not believe in unconscious process and work very much in the ‘here and now’.

How does the unconscious link to the sex of the therapist?

Those of us who work with the unconscious will, to a greater or lesser extent, work with transference – that is, work with whom we represent to the client in the room. And whom we represent will invariably be one of the client’s caregivers, usually a parent.

Transference is very similar to projection, which is something we all do at times – we ascribe values to a person based on prior assumptions rather than on the reality of who they are. The difference with transference is that the clinician, if trained well enough, will receive the client’s projections and be thinking about who they are (represent) for the client.

Freud believed (and rightly so) that transference occurs irrespective of gender/sex. We will therefore ‘transfer’ our unfinished business relating to either or both parents onto the therapist. This too is my experience as I work in the transference and so recognise that how the client relates to me tells me something important about how they learnt to relate as a child and I can represent their mother just as easily as their father in the transference.

Therefore, whilst in some cases the sex of the therapist may matter, in most, it does not. And I believe that has also been my clients’ experience over the years whereby they may have had a preference in working with a female, have ‘ended up with me’ and we have done excellent work.

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

Further reading by Mark Vahrmeyer

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Parental Alienation and the impact on children

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Online versus In-Person Therapy

What does Couple Counselling do?

What Can Relationship Counselling Help With?

Will counselling save my marriage?

What are the Benefits of Counselling and Psychotherapy?

How to prepare for couples counselling

What Can Couples Counselling Help With?

How to get a Mental Health Diagnosis

What is Psychotherapy?

How to Improve Mental Health

Antidotes to Coercive, Controlling and Narcissistic Behaviour

Mental Health Problems in Brighton

The Limitations of Online Therapy

“I’m interested in therapy but isn’t it a bit self-indulgent?”

Mental Health Imposter Syndrome Is Real

Why We Need Therapy

Therapy Is Not Self-Indulgent

Does the sex of my counsellor or psychotherapist matter?

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