Brighton and Hove Psychotherapy

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A few questions to ask if you are having relationship difficulties

When do you think these difficulties started?

It is important to recognise when things began to change. On the other hand you might realise that to some extent it has always been like this but it is only now that you recognise that.

Think back to the time when things began to change what else was happening around that time?

Life events make different demands on different people and individuals respond differently to the same events, often we don’t realise the impact this can have on how we feel as a couple. These events might include a new baby especially a first baby; changes at work, losing a job or being promoted; a house move to an unfamiliar area; children leaving home; serious illness, caring for elderly or sick relatives or the death of a parent.

How have these events changed how you and your partner spend time together and/or communicate with each other?

Most couples, consciously or not, have regular ways that they show their care for and communicate with each other. These may part of daily life, a cup of tea in bed in the morning, a lift to the station, a chat in the bathroom. These small rituals are important in keeping the relationship ‘oiled’ and for both partners to feel reassured and affirmed.

How did you meet and get together and what was it that first attracted you to each other?

Look back to what was happening for each of you when you met and think about your expectations of each other. You might have imagined each other would bring new opportunities or offer something that was missing in the other. Maybe one of you seemed warm, expressive and sociable when the other was feeling low or lonely or maybe one of you helped the other sort out practical problems or manage a difficulty at work; perhaps you saw each other as very funny, clever or sexy. One of you might have recently been left or left a relationship and have had high hopes that this one would be very different.

 

These questions begin to reveal the underlying hopes, dreams and expectations in a relationship. These may have been unrealistic at the start or they can become fixed and out of date. Thinking about disappointment is painful and it is easy to blame the other person for failing to live up to expectations or for changing, “You used to be thoughtful and sensitive!” “You used to care about me!” Life events make an impact and the picture keeps changing. Things that seemed important have drifted into the background, something new is brightly lit in the foreground and you can sense things emerging at the edges.

As a couple it is important to be responsive to life and what it brings for each of you, to give yourselves opportunities to reimagine what you want to create together as a couple.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

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Men, Sex and Aging in Relationships

I have previously written about women and the menopause, I am now turning my attention to men, sex and aging in a heterosexual context.

Research indicates sexual activity declines with age however as we see older people being portrayed as healthy, attractive and vigorous, we are more likely to acknowledge this age group as sexually attractive and therefore potentially sexually active.

In psychosexual terms feeling healthy, feeling good about your body and being reasonably fit are factors in feeling sexually attractive and of course these are likely to make a partner more responsive. Whilst the recognition of desire, lust and libido in the later stages of life must be a positive shift it may hide some of the struggles that older men are facing in the bedroom.

There are inevitable physiological effects of age on erectile function. Age UK says that 40% of men over 60 experience erectile problems. Erectile tissue becomes less elastic over time, testosterone levels are reduced, blood flow to the penis decreases. Apart from achieving an erection, difficulties in maintaining it, ejaculating too quickly or not being able to climax at all are common problems.

Sexual problems are frequent amongst older adults. In one study about 25% of older adults with a sexual problem said they avoided sex as a consequence. There are links between poor health and lack of sexual activity. In the same study the most common reason cited for a lack of sexual activity was the man’s ill health. Examples included drinking alcohol to excess, smoking, stress and a lack of exercise and conditions like high blood pressure, type 2 diabetes and heart disease.

Sexual problems are infrequently discussed with doctors and communication about sexual problems can be poor. Apart from the fact that sexual problems may be symptoms of an underlying physical condition, undiagnosed and undiscussed sexual problems may lead to depression and social withdrawal.

The kinds of problems that do not get discussed include concerns about medication for other conditions that impair men’s sexual performance, as well as drugs to improve sexual performance that have unpleasant side effects such as headaches and indigestion. Men might choose to stop taking medication if they feel they will have better sex without it and they may give up taking medication to improve their sex lives if they cannot tolerate the side effects.

In 2015 prostate cancer accounted for 13% of all cancers in the UK. The survival rate has been improving over the last 40 years but survivors can be left with lasting changes to their sense of themselves as sexual beings. One of the treatments is hormone therapy, which effects the production of testosterone and reduces the desire to have sex. Men put on weight more easily and can develop man boobs and they may find themselves crying more often. It is no wonder that a man might ask himself, “Am I still a man?”

In a relationship the impact of an older man’s difficulties on achieving and sustaining an erection will depend on their partner’s own experience of sex and aging. A man with a younger partner may feel he is letting his partner down. A couple may feel safer distancing themselves from each other and avoiding even affectionate physical contact in case it leads to unsuccessful sex. Men with partners no longer interested in sex may feel shameful about masturbating using pornography or fantasising about other women.

We do not readily talk about sex, it makes us feel very vulnerable. Seeking support and sharing feelings in counselling and psychotherapy can be a step to rebuilding a sense of self and sexual confidence and the start to thinking about new ways of relating.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with  individuals and couples in Hove.

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The role of ‘attunement’ in relationships with babies and young children

Babies are not born with the neurological capacity to understand distress, or even to differentiate between discomfort and mortal danger. To ensure their survival therefore, babies are biologically programmed to communicate all forms of distress to their primary caregivers through very primitive means (e.g. crying, screaming and reaching out).

Under ideal circumstances, these ‘signals’ from the baby will elicit a sensitive (‘attuned’) response from their caregiver, whereby their caregiver will utilise their more developed brain in order to empathise with the infant’s distress, to soothe them and overtime, to give them words to better understand and communicate their distress. Repetition of this pattern over time, coupled with a deepening joy of the relationship, is not only the foundation for a secure attachment relationship, but the building blocks for other important skills such as developing empathy and emotional regulation.

When working well, attunement enables a child to feel truly understood, accepted and ‘felt’ by their caregiver. Inevitably however, “getting it right” all the time is not possible and sometimes signals will be missed or responded to incorrectly (‘mis-attunement’) – also known as a ‘relationship rupture’. Ruptures are normal and actually present opportunities for a child-carer relationship if the carer is able to repair the relationship appropriately. Indeed, it is estimated that for a secure attachment to develop, carers need to attune correctly around one third of the time (Hoghughi & Speight, 1998), which is reassuring!

Over the years, researchers have examined the importance of attunement on an infant’s mental health. This includes Ed Tronick’s (2007), ‘still face experiment’, which illustrates the distressing disintegration of a young child, whose parent temporarily stops responding to their cues (Youtube link). It also includes the work of Lynne Murray, who demonstrated that even warm responses to infants are not regulating unless they are exactly timed with their cues. This is important as for some parent-infant dyads, ruptures can be severe and chronically prevent the carer from being able to sensitively attune to their infant – ‘toxic mis-attunement’. This might occur when factors specific to the child get in the way of them being able to communicate their needs effectively (e.g. speech and language difficulties or neurodevelopmental difficulties), or when factors specific to the parent stop them being able to receive and process the child’s distress signals appropriately (e.g. mental health difficulties or substance misuse problems). There may also be external stressors impacting on the relationship (e.g. domestic violence or poverty). In these cases, it is imperative that mental health and social support services are proactively mobilised to offer early support to both the child and the carer.

Hoghughi, M. & Speight, A. (1998). Good enough parenting for all children – A strategy for a healthier society. Archives of Disease in Childhood, 78, 4, 293-296.

Murray, L. & Trevarthen, C. (1985). Emotional regulations of interactions between two-month-olds and their mothers. In T. M. Field & N. A. Fox (Eds.),Social perception in infants (pp. 177-197). Norwood,NJ: Ablex.

Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes practice.

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How are you going to Spend Your Emotional Currency in 2019?

Perhaps it seems odd to you to even think of emotions having an intrinsic value, isn’t it all rather cold and controlling.  However, alongside purchasing a house, a car or other valuable object our relationships will need energy and investment of time to make them work well.  

So in the next twelve months, wherever you are in the partnership process, there will be things to consider that will require the investment of emotional energy. If you are single you maybe considering looking for a partner or hoping love comes along, whichever way you approach this, a life-long partner will be one of the most important emotional investments you make. 

Un-yet many of us go about this in a haphazard way, without giving sufficient thought to what we need to make a commitment to another person.  Often we are under pressure from parents or peer group and the ever-present biological clock to get on and find someone or consolidate an existing relationship.

Some of us who are members of a religion will have priests or clergy to go to for advice and preparation before entering into a full commitment.  However, this usually occurs after the couple have met and decided to enter into a long-term relationship.  At this point the intention has been shared with family and friends, when it is more difficult withdraw, if the preparation phase uncovers areas of incompatibility in the relationship.

I have wondered, through working with couples, whether this should be done earlier in the relationship as soon as couples find they are talking about their future together.

Falling in love is an intense emotional, biological and physical experience, at times expressed as akin to madness.  Delightful though this period of time is, it does hinder good decision-making.

Couples will come after a crisis, wanting help to mend a relationship after an event or betrayal has injured the mutual trust in the relationship.  Or they come when a life event, such as the birth of the first child, loss of a job, children leaving home, retirement, illness or bereavement.  All of these events put demands on the relationship, and people handle them in different ways.  It helps to have a supportive family or friendship network around to contain and hold the couple as they navigate their way through these life-changing processes. All require the expenditure of emotional energy to maintain the relationship on an even keel.

So ideally we could envision a couple coming to relationship counseling before they finally decide this is the person they feel able and want to make this commitment to for the rest of their lives.

Dorothea Beech is a UKCP-registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst providing long and short-term psychotherapy to both couples and groups in Hove and Lewes.

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A Nation divided

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

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

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

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

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

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

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

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

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

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

As Carl Jung said :-

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

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

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