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Why do I do that? A Dramatherapist looks beneath the surface

I am a dramatherapist and I am talking today about one of my favourite subjects. I am going to explain the benefits of working with creativity in the therapy room.

When we are being creative we are using a part of our brain which does not relate to logic or linear time. This part of the brain thinks in pictures, metaphor and symbols. It is representational rather than objective. It endows personal subjectivity to our experience. It is what makes us human and unique. It records and remembers everything that has ever happened to us, every thought, every sensation, every feeling, every hope, every dream. What a storehouse of information waiting to be revealed!

But here’s the thing. Whereas we can easily access the logical part of our brain, so we know to carry an umbrella when it’s raining. We have learned this, it’s logical. Our creative brain thinks in pictures, sensations and emotions. Experiences and memories are recorded and stored in a different way which means they’re not always readily available for us as information because they reside outside of our awareness.

So for example: you’re normally a reasonably polite friendly person, but behind the wheel of your car you rage at other drivers and you don’t know why you do this. This behaviour stems from something in your psyche that is ‘out of your awareness’. So you can’t stop yourself doing it by simply noticing it and trying to change your behaviour. The interesting thing about this type of ‘out of awareness’ behaviour is that we can’t seem to learn from it no matter how hard we try.
This is where the dramatherapist armed with a creative toolkit can help. We know from research that when the mind is engaged in a creative task, the logical mind takes a back seat. It goes off-line and allows us to tap in to the resources that are held ‘out of awareness ‘ and hidden beneath the surface of our everyday experience.

Here we can see why we behave the way we do and where/ how  it originated. We can explore the triggers. In doing this we can actually heal our past experience and recover form it. And that’s what we want from therapy, right?

One way I get my clients to tap in to their ‘out of awareness’ experience, is to use a method called hot-penning. First of all I prepare my client using relaxation techniques to enable a clear focus on the issue at hand. The client then takes pen and paper and writes whatever comes to mind. The rule book is thrown out and the pen is given free reign. The writing need not be logical or sequential, it may be a stream of words, you’re allowed to swear, it does not have to make sense. After a couple of minutes of loosening up the client will generally begin to write meaningful narrative which can be very revealing. Clients are so frequently surprised by their own articulacy and the wisdom that they express. Quite often there will be the ‘a-ha’ moment.

In my experience when the client has insights unprompted by the therapist they are more motivated towards lasting change.

Dramatherapy as a creative therapy can help the client to begin to live more fully ‘in awareness’ and be less affected by ‘out of awareness’ behaviours which formerly tripped them up.

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 with us by telephone or email. Online therapy is available.

 

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Online Therapy

We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?

There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.

There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?

Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.

Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.

A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.

Here are a few points you might want to consider if you want to access therapy online:

  • You will need to have a good, stable internet connection for the duration of your session.
  • It is best to have a few connection options available – such as wifi and data, and a couple of different options of apps – such as Skype and Zoom, to allow for tech difficulties.
  • You need to be comfortable working online and familiar with the tech you are using. It’s a good idea to turn off any notifications for the duration of your session as these are very distracting when you are trying to work with your therapist.
  • You need to ensure that the location you are in is private and confidential.
  • You should check the credentials and qualifications of your therapist before you engage in any online therapy. There is a growing number of people setting up online as ‘therapists’ with little or no training. Make sure your therapist is registered with a professional body such as UKCP.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

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Psychotherapy and the Climate Crisis

In times such as this, I question my role as a psychotherapist wishing that I had studied something that could truly and directly help the climate and environmental crisis that we face. I feel so connected to the natural world that to see it being destroyed, disregarded and exploited to this scale, to see us, humans, destroying what sustains us is truly horrifying and evokes in me a profound sense of helplessness.

I love my work because it entails looking at human psychology. In essence, understanding why we feel and behave the way we do.  This is much easier to do with an individual sitting in front of me than to speculate what drives us to collectively cause harm or do nothing.

Biologically we are wired towards survival. Capitalism and consumerism, paired with technology have made us more and more disconnected from our bodies, our food and our environment.

In psychotherapy, we try to help people tolerate their feelings, be in their bodies, understand what drives them to make certain choices in life, etc. I believe that as a profession we can help to heal the wounds and traumas of the past so that we don’t have to continue repeating painful experiences. Psychotherapists can help individuals and groups to think the unthinkable and feel our most painful feelings. This is both a delicate and yet powerful process, which happens over time in order to not overwhelm the system.

Too much information, and we either react or disconnect.

A similar process is taking place collectively. The issues we are dealing with are huge and require serious attention. But how we pay attention is key. Reactivity and disconnection are inevitable responses to such overwhelmingly big issues. Therefore we need to learn to face things and not run away from them. We need to talk about and help one another grieve not just our personal losses but also the loss of nature and life, as we know it.

I deeply admire climate activists, environmentalists and all the scientists that dedicate their lives to bringing all this information to our attention and who are desperately trying to raise awareness to protect our natural world. But this depends on all of us waking up to what is happening and beginning treating ourselves and other humans/beings/the planet with care and respect.

We can only wake up and take action from a place of consciousness. So, it’s time we stop burying our heads in the sand and take a serious look at how we live, the choices we make and how we treat the planet every single day.

As a profession, a society and a nation, we need to face our areas of contradiction, our “splits”.  After all, the personal is the political.

In the words of Great Thunberg:

“If the walls of your house truly came tumbling down, surely you would set your differences aside and start cooperating.

Well, our house is falling apart. And we are rapidly running out of time. And yet basically nothing is happening.

Everyone and everything needs to change. So why waste precious time arguing about what and who needs to change first?

Everyone and everything needs to change.”

Global Climate Strike 20 and 27 September 2019

https://globalclimatestrike.net/

Further reading by Sam Jahara –

Psychotherapy can change your life – but you may not want it to

On rushing towards answers

How do Psychotherapists work with anxiety? Trio of Blogs – Part 3

 

Sam Jahara is UKCP Registered, CTA, PTSTA and is one of the Brighton & Hove Psychotherapy Co-founders.  She is an experienced Transactional Analysis Psychotherapist. Her special interests include culture, identity, belonging, sustainability and environmental issues. Sam is available at our Lewes and Brighton & Hove Practices.

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What is EMDR?

You might have seen EMDR being spoken about in the media a fair bit recently.  Many famous people have been speaking out about how it has helped them with psychological difficulties, most often past traumas, but what actually is it?

EMDR stands for Eye Movement Desensitisation and Reprocessing.  It was developed in 1987 by American Psychologist Francine Shapiro, initially as a treatment for trauma.  Shapiro tells how she discovered the main premise, almost by accident, as she walked in the park:  She noticed that as she thought about some distressing memories, her eyes moved back and forth and the distress she felt reduced.  From this she went on to develop EMDR, which is now widely practiced across the world.

The National Institute for Health and Care Excellence in the UK currently recommends EMDR as a treatment for Post Traumatic Stress Disorder.  There is also a significant and ever-growing evidence base for the use of EMDR to treat other psychological issues.  EMDR can be used effectively with children and adults.  Clients often notice quick changes (sometimes in even just 2 or 3 sessions) which can have long lasting effects.

There are several theories as to how EMDR actually works, although it still isn’t 100% clear.  The main premise is that the two sides of the brain are alternately stimulated whilst the person holds a difficult thought or memory in mind.  Traditionally the therapist would stimulate alternating sides of a person’s brain by moving their hand side to side, whilst the person tracks with their eyes (hence the name Eye Movement).  However, there are other techniques, such as alternating hand buzzers, hand taps, audio or light bars.  This allows things have that become ‘stuck’ to be re-processed, and therefore to be less distressing.  The eye movements (or other forms of alternating stimulation) form a significant part of the therapy.  There is also talking involved, but people do not necessarily have to share all the details of their traumatic story if they prefer not to.

EMDR is an advanced therapy and should only be delivered by highly skilled, trained therapists.  In order to become an accredited EMDR therapist there is a significant amount of training and then supervised therapy work with clients.

The website of the EMDR Association UK and Ireland has more information on EMDR, finding a therapist and some stories of people who have benefited from EMDR therapy – www.emdrassociation.org.uk

 

Please follow the links to find out more about about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

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How do I choose a psychotherapist?

Deciding that you want or need psychological help can be a difficult position to arrive at.  Choosing the right practitioner to work with can feel like a daunting task with so many different fields of talk therapy, types of therapy and professional bodies overseeing the field.  This blog is a guide to helping you find your way to the right psychotherapist for you.

Counselling, psychotherapy or psychology?

Counselling, psychotherapy and psychology all broadly fall under the category of ‘talking therapy’.  They have much in common, yet are also very different.  I have previously written a piece on the difference between counselling and psychotherapy; the former being largely for shorter-term work and the latter being appropriate for deeper and long-term work on the personality.  We also have an in-depth page on psychology here so I shall not go into more detail about that here.

Depth of work

In choosing a psychotherapist, it can be helpful to have a sense of what it is you are seeking to gain from therapy.  Generally, psychotherapy is longer term than counselling and rather than working with one specific issue, is instead a relationship through which the client can work through relational patterns (with themselves and others), formed in childhood that they wish to change. Depth relational psychotherapy takes time – months to years – to understand and process relational, or attachment, losses. It is a commitment to a process of therapy and to oneself with sessions being as a minimum weekly, at the same time and on the same day each week.

Professional Body

There are a few professional bodies who offer voluntary registration to counsellors and psychotherapists – the BACP and UKCP. Whilst the BACP includes the ‘P’ for ‘psychotherapist in its acronym, the minimum training requirements of the BACP for someone to call themselves a psychotherapist are quite low. The UKCP, on the other hand requires all registered psychotherapists to undertake a minimum of four years of post-graduate training at an accredited training institution alongside a mental health placement and four years of personal therapy, before permitting applicants to join.  At Brighton and Hove Psychotherapy, all of our psychotherapists have trained at least to this standard and many far beyond.

Training

Psychotherapy training is long, challenging and requires the candidate to be in their own personal therapy throughout the training period.  Most training institutions are located in London, or further afield, and so a great deal of commitment is required to reach the necessary training standards. One of the main aspects that sets UKCP registered psychotherapists apart from counsellors is that they have been trained to ‘formulate’, which is another work for diagnose, or understand, more complex trauma and mental health issues.

First Appointment

If you have never previously been in therapy, then the prospect of the first appointment can be daunting. It is the job of your psychotherapist to set clear boundaries and create an environment that ‘feels safe, but not too safe’.  What does this mean?  Psychotherapy is about learning to tolerate difficult feelings and your psychotherapist is there to facilitate this process through their relationship with you.  They are not there to be liked, or to be your friend, as this would not be beneficial to you or to your process. If all goes well at the initial consultation then you and your psychotherapist may ‘contract’, or agree, to work together.  This means that they have assessed what work is required to facilitate change for you and you have decided that you are going to enter into an intimate relationship unlike one you have perhaps ever had before.

Length of Contract

How long is a piece of string?  Most psychotherapy can last for months or years, however little can be inferred from the duration.  For example, someone attending a year of therapy is not necessarily ‘healthier’ or ‘saner’ than someone who attends weekly for many years.  It is entirely dependent on the work required, how the client wishes to ‘use’ therapy and the relationship formed. Freud famously believed that therapy only begins when the client is no longer in a crisis.

Final Thoughts

Finding a good psychotherapist begins on paper but ends with a feeling, or a set of feelings.  As it is in the relationship that the unravelling of the past takes place, it is critical that as a client, you feel you can build a therapeutic relationship with your psychotherapist. The capacity to do this will hinge on their degree of training, clinical experience and therapeutic boundaries, as well as on it being a relationship that feels ‘safe enough’ – not too safe to not be challenging – within which the therapeutic process can unfold.  

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.

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What is ‘Blocked Care’ as it applies to parenting?

The phenomenon of parental ‘blocked care’ is a term coined by Clinical Psychologists Dan Hughes and Jonathon Baylin and Psychiatrist Dan Siegal. It represents a central feature of the Dyadic Developmental Psychotherapy (DDP) approach to treating children and young people with a history of developmental trauma and attachment disruption.

Neuroscience research into the areas of attachment, trauma and neurobiological development, are teaching us that children’s brains are shaped on a neurological level by their earliest caregiving experiences. 

We now even know that an infant’s brain is primed, even in utero, to adapt to the type of care that it anticipates receiving from its primary caregivers in order to maximise its chances of survival. In other words, even in utero, infants are relational.

The Five Care Systems in parents

What is perhaps less known however, is that parents’ brains are also neurologically influenced by their experience of caring for their child – that the relationship is symbiotic. When things are going well, we now understand that five main areas or ‘care systems’ in the parental brain are optimally functioning. These are:

  1. The Approach System: The system that enables us to fall in love with our children, to crave to be with them and to become completely absorbed in them. This system is associated with the release of oxytocin (colloquially known as the ‘love hormone’).
  2. The Reward System: The system that enables mutual delight and attunement when a parent interacts with their child. This system is associated with the release of dopamine (the ‘addictive hormone’).
  3. The Child Reading System: The system that enables parents to positively interpret our child’s behaviours and motivations and to remain interested in their unique qualities.
  4. The Meaning-Making System: The system that enables parents to think positively and meaningfully about their relationship with their child.
  5. The Executive System: The system that enables us to physically care for our children.

For some parent-child dyads however, things do not go so well and one or more of these care systems do not operate optimally. For example, some parents may face unmanageable levels of stress whilst caring for their infants, which may be exacerbated by their own poorly developed care and emotional-regulation systems. 

Others may be offering reparative foster parenting to children who, owing to previous experiences of abusive or neglectful parenting, now fear, mistrust and reject the care they are being offered, which can be extremely painful for their new carers to bear.

The real risk when things go wrong however, is that parents may enter (chronic or acute) periods of ‘blocked care’. When this happens, the first four systems listed above start to shut down. The parent no longer experiences joy or fulfilment of being with their child. They do not get the rushes of oxytocin and dopamine that other parents get, and they do not seek to be with their child.

These parents also become much more likely to interpret their child’s behaviours and motivations from a negative perspective (e.g. “he is manipulating me” or “she is a spiteful child”) as well as their own relationship with the child (e.g. “I am a rubbish parent”).

In psysiological terms a stressed out parent is operating in ‘survival mode’. They are no longer able to remain open and engaged to the child’s emotional and developmental needs and are simply coping. The feedback system between child-parent-child has effectively shut down, or become ‘blocked’.

Without external support, the final care system – the executive system –  may also start to shut down. This is the point when we start to see abusive or neglectful parenting emerge where parents are physically unable to care for their child or children.

The growing evidence-base for blocked care highlights the crucial need for psycho-education, as well as early and non-judgmental support to parents and carers who are most vulnerable to it.

 References:

Hughes, D. & Baylin, J. (2012). Brain-Based Parenting: The Neuroscience of caregiving for healthy attachment. Norton

Hughes, D. & Baylin, J. (2016). The Neurobiology of Attachment-Focused Therapy: Enhancing Connection & Trust in the Treatment of Children & Adolescents. Norton

Siegal, D. & Hartzell, M. (2003). Parenting from the Inside Out. Tarcher/Penguin

 

Please follow the links to find out more about about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

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Why does empathy matter?

When you begin therapy you enter into a particular (perhaps peculiar) type of relationship, one with well-defined boundaries and ethics. Beyond its method and structure, at the very heart of this relationship lies empathy.

As a therapist empathy means doing all you can to understand your client from inside their own experience. It requires an ability to communicate this understanding in ways that are sensitive, meaningful and useful, both verbal and non-verbal.

It is a powerful experience to feel understood, listened to, cared for and respected. Over time it can make it easier to have empathy for yourself, to take your own personal pain and suffering seriously, to judge it less, as trivial, stupid or simply a product of your own personal weakness.

When we begin to take our own struggles seriously, we gain access to another layer of empathy: compassion for the child that we were, often a child who made sense of what troubled them by deciding that there must be something wrong with them – that they were the problem. In the context of an authentic and empathic connection with another human being the shame or disgust or guilt that has become so entangled in our sense of self can begin to make way for new feelings. Sadness (perhaps) for what was lost and loving regard for the child who did the best they could at the time.  When there is more space in our imaginations for the reality of our own struggle, we can begin to see other people differently too. When we experience the power of feeling understood we may also experience greater internal space for new thoughts and feelings, both about ourselves and about others.

The therapist as the client

All psychotherapists have had their own experience of being a client in therapy. Sharing the most intimate and often painful moments of someone’s life is made possible when you have felt and expressed your own. It is not that as a therapist you become an expert on life (not even your own) but that having undergone your own therapy you will be more equipped with the clarity to differentiate your separate self and experience from that of another.  To understand whose feelings are whose and to have the versatility and flexibility to step into and out of another person’s shoes.

The circuitry of empathy

Empathy is a complex system of mutual cues and responses that regulates each persons experience of self and others. We observe this very clearly in parent/ infant interactions. How attuned a parent is to the (myriad/micro) communications of an infant will inform the infant’s reciprocal response to the parent.

It is not that in ideal world infants and young children would be perfectly attuned to at all times. Over-attunement can be stifling and intrusive. What’s more important is the experience of an ongoing relationship in which misunderstandings and mis-attunements can be repaired.

Emotional neglect and emotional intrusion are flip sides of the same coin. Anyone who has suffered either will have good reason to believe that they may never be understood.

As a therapist we cannot “know it all” for our clients, we cannot tell someone how it is they feel or what is true for them. What we can provide is an open-ended, respectful curiosity for our clients and a willingness to share in the important project of “getting it.”  Paying close attention to the unique form of connection that exists with each client means understanding empathy as a mutually influencing system. From this perspective, the communication of empathy becomes much more a mystery to engage with than a tool to master.

 

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.

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Why does psychotherapy matter in the modern world?

On the face of it, a process that is long-term, happens at the same time, on the same day, each week, would seem to be in stark contrast to modern life.

We are promised, and expected to subscribe to, a world where our wants and needs can be met almost instantaneously, where we can have things exactly as we want them and everything – society, identity, gender and sexuality – is up to debate and can be changed. And changed and changed again.

Social media floods our senses with messages about how to be happy, grateful and fulfilled whilst espousing ‘hacks’ and quick fixes for depression, anxiety and every human condition in between.

The shelves in book shops buckle under the weight of the latest ‘self-help’ guru or fad and life coaching promises tangible change in a few sessions. And if it does not work for us? Well, then we are simply not trying hard enough.

Psychotherapy subscribes to, and offers, none of the above.

It is not quick, it is not an experience where you can get immediate gratification or a relationship that will affirm you as always being right. It is something very different.

In many ways, psychotherapy is an antidote to all of the above. It is about learning through relationship to be in relationship with ourselves.

Through relationships we begin to see ourselves through the separate eyes of another who is compassionate, boundaried and can withstand us; nobody should become a psychotherapist if they want to be loved.

Psychotherapy is the opposite of Instagram and Facebook – it is about deeply knowing and accepting who we are and learning to live a meaningful live of substance and depth: it is about learning to be ordinary. And it is about accepting the realities of life: that life is unfair, often hard and that the only substance is to be found in relationship.

Car crashes

Car crashes have a nasty habit of drawing our attention. And then, of course, the likely outcome is another crash. When we see a car crash it takes a mature mind and person to not join it; to keep their eyes on the road and focus on their own experience.

The modern world is comprised of ever more car crashes – not necessarily in the literal sense, but in the many dramas (real and streamed to us) that draw our attention away from the road. Psychotherapy is an antidote to this – helping people steer a steady course through the chaos and drama and remaining in relationship to themselves. In this sense, psychotherapy matters very much in the modern world.

Mark Vahrmeyer is UKCP Registered and is one of the Brighton & Hove Psychotherapy Co-founders.  He 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 our Lewes and Brighton & Hove Practices.

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The Contemporary Consulting Room

Following on from the post featuring Andrew Robinson’s photographs of the rooms at Brighton and Hove Psychotherapy, I want to think about the objects in the room in which therapy takes place.

“Both room and house are psychological diagrams that guide writers and poets in their analysis of intimacy.” (Bachelard, 1958/1994:38). This implies we have a tacit (a felt but not easy to express in words) understanding of the psychology of physical space. I suggest that the surroundings in which therapy happens are part of the therapy.

In contemporary psychotherapy there is a concern about the blurring of the boundary between the personal and professional. In the psychodynamic model if the therapist’s life comes too much into focus the client’s therapeutic potential can be compromised. It is a commonly held belief that therapy should ideally happen in a neutrally private room. However we would want to avoid any resemblance to anything cold, clinical or cell like. Freud is well known for his iconic rug covered couch and his large collection of figures that stood like a group of silent watchers in his consulting room.

A positive approach to the objects and disclosure can provide opportunities for working things through. Let’s think about books on display in the consulting room. A collection of psychotherapy books could be reassuring, showing that the therapist is well informed and takes their professional development seriously. If a client shows an interest in a particular book it can open up an area for exploration.

The impact of objects in the room can become important when a counsellor moves or there is a change in the room. Lapworth describes how when he introduced a sculpture into his consulting room, a client re-saw the room and noticed the books that had been in the room all along. When her attention was drawn to the books by the arrival of a new object, they resonated with her father and she talked about him for the first time (Lapworth, 2012:8).

Field notes the need for counsellors to take transitional objects with them, for example a rug on the floor. When she moved her consulting room a client was relieved to see the rug reappear in the new room. “We came to understand that it was symbolic of my perception of him: that I accepted him as he was; in his words ‘scruffy, imperfect, colourful and well travelled!’ ” (Field, 2007:174).

Therapists can use objects and images to support themselves in their work. A small sculpture or photograph with personal associations or special memories can help a therapist keep an open mind and feel connected with their own resources. Clients can sooth themselves through difficult times by finding reassurance when looking at familiar elements in the room.

 

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.

 

References

Bachelard, G. (1958/1994) The Poetics of Space.

Field, R. (2007) Working from home in independent practice.

Lapworth, P. (2011) Tales from the Therapy Room.

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What is Relational therapy?

A central idea of relational psychotherapy is that our thoughts, feelings and behaviours (healthy and unhealthy) are directly related to our interpersonal relationships. Relational therapy is therefore about our self-with-other experience. We are all creatures of familial, social and political contexts, continuously formed (and forming) through our interactions with others.

Relational therapy can be an effective treatment for a whole range of psychological and emotional problems, understanding as it does that so many of them are rooted in troubled relationships past and present. Telling one’s own relational story in the presence of a carefully attuned empathic listener can be a powerful experience, generating shifts in self-understanding and ultimately in symptoms.

Relational Therapy is Not a medical model.

A relational therapist is not a doctor, there to administer a cure to someone’s emotional pain. This may seem disappointing to some clients. Rather s/he is a fellow human being, ready to engage with and understand the longings and the losses, the hopes, fears and struggles that might have brought a client into therapy.

Not individualism.

Relational therapy does not hold with the notion that each of us is responsible for our own happiness. It rejects the tyranny of self-help models that suggest that it is only by “working” on ourselves will we claim our power, increase our self-esteem, become fully evolved etc.

Instead it believes that we all need good connections with others in order to feel good about ourselves. Individual power, agency and wellbeing are only achieved in the context of healthy interpersonal connections.

Not Rationalism.

Relational therapy does not subscribe to rational, linear, cause and effect explanations of how change happens. We are complex systems of thoughts, feelings, beliefs, self-states and energies, all interconnected. Relational therapy takes a systemic, non-linear view of change. Having a new experience of oneself in the context of the therapeutic relationship may lead to new experiences of self and others outside of therapy as well.

Who needs Relational Therapy?

Anyone who has questions like “How do others see me?” “Am I good enough for them?” “Am I worthy enough?” might consider seeking a relationally oriented therapeutic approach. When your own answers to the questions above aren’t good, you feel bad about yourself and when you feel bad about yourself you are diminished.

A relational therapist will look at your everyday relationships with people in your life right now and seek to understand what it is that happens there that leaves you feeling bad about yourself.

Understanding the (repetitive) patterns of feeling bad in your life might be a reminder of earlier relationships. Consideration of these earlier relationships may help in developing an understanding of the sense you made of them, the sense of who you are, and what you’re worth.

The here and now relationship between therapist and client is also kept in mind and attended to as part of a relational approach. As a relational therapist, I am always noticing the subtle shifts within and between myself and my client(s). The moments when a client might feel misunderstood or judged by me are important to “catch.” Understanding what goes on between “us” might be useful in understanding what goes on “out there” with “them.”

Therapy offers the possibility to reflect on what forms us and to make room for the changes we hope for. A relational approach understands the relationship itself between client and therapist to be a fundamentally important element in realising such change.

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.

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An Interview with Mark Vahrmeyer – Viva Lewes March ’19

Mark Vahrmeyer was recently approached by Viva Lewes for an interview on ‘Mending the Mind.  Below is a scanned copy of the full interview:

 

Mark 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.

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How Psychotherapy Taught me to Live Life

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

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

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

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

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

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

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

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

How have I changed

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

My relationship with myself

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

My relationship to others

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

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

In summary

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

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

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So what exactly is Mindfulness?

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

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

How do I practice mindfulness?

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

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

And for how long?

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

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

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

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

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‘Where Should I Start?’ – On the flow of a psychotherapy session

Starting psychotherapy can be a daunting prospect.  Researching the right psychotherapist; making contact; booking the appointment; finding the practice; waiting in the waiting room; and then…. you are invited in.

You enter and sit down.  Water is on the table.  Perhaps you help yourself as you are suddenly unexpectedly thirsty. Or perhaps, unconsciously, the thirst delays the awkwardness of starting the session.  Eventually that moment arrives and you are unsure where to begin and so ask ‘ where should I start?’.

In fact, my experience is that this is a question that, for some clients, will repeat over and over again in the relationship and it becomes a significant part fo the work: how to work out where to begin each week.

On taking space

Whilst it is conceivable that someone with a perfectly good childhood should choose to enter into psychotherapy, it is in practice highly unlikely. Especially if we differentiate between short-term counselling or psychology, and open-ended psychotherapy.

All of us can fall victim to the uncertainties of life and can find ourselves struggling to make sense of a difficult event – perhaps a divorce or an accident.  These would be perfect examples of events that may require a period of focused counselling. However, as troubling as these experiences can be, it is only if they throw our whole existence into doubt or bring down the edifices of our defences, that psychotherapy would be required.

Therefore whilst it is possible that someone with a good childhood would come into psychotherapy, most of those who do are coming (unconsciously or not) to work-through and repair attachment damage, neglect and trauma in their early relationship(s).

And for children who have been neglected, and thus not held in mind, it can then be hard to suddenly find themselves in an environment where the Other (the psychotherapist) is fully holding them in mind and is interested in everything they have to think and say.  Where in the world should they start and how can they learn to feel comfortable taking up the space for themselves?  Being truly seen when one has not been seen can feel very exposing.

Knowing where to start, is all about desire

When a client asks me where they should start a session I will mostly hand this back to them in a gentle manner.  I invite them to be curious about how they might work out where they want to start.

I then quite often get a relaying of the week’s events, if the client is one I have seen before.  Once again I will hand this back and ask them what it is that they want me to know about how they are feeling about their week.  Often this is then met with a blank stare and then we can perhaps address the issue at hand: how can they work out what they want to share with me as someone they are in relationship with?

Knowing where to start is all about desire.  It is about having a relationship with ourselves and working out what we would like to think about in the therapeutic relationship.  It is akin to choosing what to eat off a menu – in order to know what we want to eat, we need to get in touch with what we ‘feel like eating’.  We try the different dishes on in our mind and then choose which we will focus on – which becomes the dish we will order and eat.  Therefore desire tells us about what matters to us – what is important to us.

And yet choosing were to start has a further complexity – we must choose what we want to talk about and then bring this onto the relationship which means acknowledging that our psychotherapist will have thoughts, feeling and perhaps judgements about what we tell them.  That can bet very confronting!

From a duet for one to a dance of two

Psychotherapy is a relationship and as in all relationships, they are not static.  They follow a trajectory of, if the relationship is positive, deepening over time.  It shifts and moves, develops and cements as a relationship, where two people are in dialogue with each other and who matter to each other.

Where we start a session then is about allowing ourselves to accept that we are in a relationship with someone who not only holds us in mind and to whom we matter, but crucially, letting our psychotherapist matter to us.  The question of where to start then simply becomes, ‘what do I want Mark to know about me?’.

Mark Vahrmeyer is a UKCP registered psychotherapist and co-founder of Brighton and Hove Psychotherapy.  He works with couples and individuals using an psychoanalytically informed integrative approach and sees clients in Hove and Lewes.

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