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Popping a bluey – young men and Viagra

Following on from my earlier blog about the physiological effects of Viagra, in this blog I am going to discuss some of the psychological and social issues that make young men pop a blue pill.

There is common notion that young men are constantly getting erections and always up for having sex. Various sources indicate the reality is different. Peggy Orensteins’s recent book ‘Boys and Sex’ cites a General Social Survey study showing young men between 18 and 29 are having less sex. This is indicated by the increase in the number of men who declare themselves abstinent, which rose from 10% in 2008 to 28% in 2019.

Orensteins’s conversations with young men reveal the extent of their performance anxiety. They fear that girls would be more knowledgeable and experienced and in contrast they will be unsatisfactory sexual partners. They are anxious that any inadequacy, such as not being able to undo a bra strap or coming too quickly will be broadcast to their peer group on social media and result in humiliation. They are also concerned that girls will take it personally if they can’t get an erection. Young men seem to feel that they are responsible for the success of a sexual encounter.

At the same time online pornography has set up unrealistic expectations about opportunity, performance and satisfaction. The Reward Foundation is an educational charity that focuses on the internet, love, sex and relationships; they have found a correlation between erectile dysfunction in young men and an increase in access to internet porn. Whether or not young men actually believe that the sexual relationships and encounters they view on screen are ‘real’, these representations have an impact. As a young presenter on VICE online magazine said, “In my head I’m thinking that girls will be expecting me to fuck them like a porn star.”

First dates or sexual encounters can be extremely anxious events. Dating apps like Tinder and Grinder make it easy to move on to a new sexual partner if the sex does not meet expectations the first time. This may increase pressure on men to have a prolonged erection or several erections and Viagra can be an ‘insurance policy’ or a ‘booster shot’ to ensure a good performance the first time they have sex with a new partner. If the relationship continues they may continue to take Viagra to maintain their performance and hide the fact that they took it in the first place.

So what’s the problem with young men using Viagra to perform better? If young men believe that the standardised notion of good sex is a good performance as Orenstein’s study suggested, we can see that taking Viagra would be a way to avoid some of the stress about being a good performer. Unfortunately this can create a psychological dependency making it more and more difficult to stop taking Viagra and harder to open up the subject with a partner. Like any kind of emotional withholding keeping Viagra a secret is likely to be a negative factor in a sexual relationship.

Good sex can be whatever is good for each couple and is far more nuanced and complex than a good performance. In a relationship of mutual consent sex can bring physical and emotional intimacy but sex does not always go smoothly, misunderstandings and disappointments happen. Exploring sexual dissatisfaction and difficulties makes people feel extremely vulnerable. By using Viagra to focus on performance, young men are avoiding the opportunity to speak honestly about what they expect and want from sex as well as finding out what pleases their partners. Trusting each other and exploring differences and desires together can build a stronger relationship as well as a more satisfying sex life.

 

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.

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Relationships, networks and connections

How many of us are seldom more than an arms length from our mobile phone? Our bags, clothing, even our sports wear is designed with special pockets for its’ safe keeping. For most of us it has infiltrated every sphere of  life, a constant companion. Staying connected has never been so easy. Mobiles are for people (like us) on the move – always contactable – but never confined. As long as we are never too far from a power source and a signal we can bridge the gap between together and apart. It is a familiar modern experience to encounter, in a public space, a café, a bus, a pedestrian walkway, others, eyes down ensconced in their device. For many of us it feels jarring, not least because we know that we are not immune to the same behaviour. We no longer seek the eyes as a point of entry into the world of another.

Virtual proximity

Ours is a time when proximity no longer requires physical closeness just as physical closeness no longer determines proximity. Virtual proximity renders human connection simultaneously more frequent and more shallow, more intense and more brief. Getting in touch is no obstacle to staying apart. Notions of community have shifted with the tides of of socio political, economic and technological time. So too has our relationship to home. We now slip into our separate houses, more often our separate room’s bypassing the shared spaces, seeking ‘our own space’. The virtual ‘network’ is now the place we gather, the new village square, the new community, residing behind each closed door. We are lonelier than ever… more connected than ever.

Reflection

This is not a a condemnation of technology or technological innovation, how ignorant and foolish that would be. Rather it is an expression of concern about a gradual erosion of social and relational skills, of face to face, up front and personal human interaction. The more our attentions are absorbed in a virtual kind of proximity do we risk losing these skills ? Might we fail to learn them in the first place or reject them all together. Are we choosing to replace intimate proximal partnerships with virtual networks – and where may it lead us?

Quantity v quality

The language of ‘connections’ subtly usurps the language of ‘relationships’. Connections are ‘virtual relations’ entered and exited at the press of a button. In a virtual network connecting and disconnecting share the same status, are made on demand and broken at will. In a virtual network we are free to roam as we please and to terminate those connections which no longer interest or satisfy us. The old fashioned networks of ‘kinship’ and ‘partnership’ and ‘committed relationship’ are far more slow moving, clunky and messy than their virtual counterparts and certainly far more difficult to exit. Turnover is the cardinal measure of success in the consumer world. Consumer life favours lightness and speed. Variety and novelty are valued over durability. Commitment and sharing in this context lose their meaning and our appetites for interpersonal risk taking (relating) decline.

There is no doubt that in infinite ways technology improves and enhances our lives as individuals and communities. It is true too that wherever there is something gained there is inevitably something lost. So let us all remember to keep the bonds of human connection alive. Look up, make eye contact, maybe smile or say hello to the next person we stand next to in a queue or a lift. Face time for real! Let’s switch off our devices from time to time and not automatically grant them space at our tables when we commune with real life friends and family. And let’s leave them outside the bedroom door at the end of the day and reclaim that space for rest, restoration and good old human connection.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin –

Paying attention to stress

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

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Termination and endings in Psychotherapy

We have just celebrated the ending of the year, welcoming in a New Year. It provides a shared / collective opportunity to reflect on the past, think ahead to the future. Likewise, psychotherapy invites us to think about the past, how it contributes to who we are, what is important to us, how the past can provide an understanding of previously unconscious material that has been repressed in order for us to reconcile the past and choose what is taken into the future.

This segmentation of time helps to contain a complex worldview. I suggest the break or holiday from psychotherapy offers us a chance to reflect on how we manage our internal world in the absence of the secure base represented by the clinical setting. The break provides an opportunity to see how we feel without the weekly hour or hour and a half in the session or group.

How important are endings in psychotherapy?

The therapeutic alliance between the therapist and the client provides a safe, secure and consistent base for attachment to a reliable figure for working through trauma. Childhood experiences of adult caregivers, depicted most vividly in fairytales of giants and powerful forces that impact on our emotional security; in adulthood leave traces of emotional trauma that can distort our judgment of reality haunting us as adults. Trauma inhibits the development of neurological pathways that lead to self-regulation of emotional states. Attachment styles will influence how we react to stresses in the environment, the challenge of psychotherapy is to find a way of reaching our fears and understanding how these shape our lives. The biological changes in the brain required to establish new pathways takes time and can leave us feeling confused and bewildered.

Neuroscience has given us a greater understanding of the effects of child hood trauma’s and a method of working that bring about changes in how we process feelings and thoughts.

Through our interactions in the therapeutic setting, either individual or group, enables us to experience /observe our defenses at work in a safe and containing space/ in the individual session or through the group matrix of interactions. This results in a re-working of the internal working model originally created to cope with trauma to enable change to occur. We begin to integrate more adaptive responses to our emotions and feelings. To gain mastery over long held ways of relating, the internalized working model that shaped our attachment style is revised.

What part then do breaks and endings play in this process? Jeremy Holmes suggests that different attachment styles require different approaches to endings. (See paper European Psychotherapy on termination of psychotherapy /psychoanalysis)

I suggest that some knowledge of the theory is useful to clients like a comforting diagnosis helps people feel more in control. It is what mindfulness can do for all of us used in the service of our need for regulation during times of heightened arousal / stress.

Whenever we make an attachment be it to a therapist, a working environment or an intimate relationship we are faced with separation. This is why falling is love is so disorientating; the object of our love leaves us fearing loss, jealousy, envy etc. etc. If our love is reciprocated then we are both preoccupied with one another. It becomes a joke when the love struck people are in a group of friends and only have eyes for each other.

So attachment and separation are present and unavoidable; we are social beings who seek closeness and intimacy throughout our lives. (The exception is when we are preparing for the end of life.)

Ending a relationship or needing to adjust to changes in others in our lives such as our children going from being a child to an adult requires an ability to face the often painful and difficult process of change.

Breaks in therapy offer an opportunity to try out our internalized therapeutic capacity for self-regulation. Ending therapy or a good ending requires work on understanding the capacity we have to deal with life outside of the safety and security of the therapeutic alliance.

 

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.

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Parenting Styles

Since the early 1960s, psychologists have been interested in the relationship between parenting and the emotional, social and behavioural development of children. 

Of particular significance to this field of study, is the early work of psychologist Diana Baumrind and colleagues, who conducted the first longitudinal study of more than 100 preschoolers through to their adolescence, specifically examining the impact of their parents approaches towards them on their subsequent development (Baumrind & Black, 1967). This study, which used a combination of naturalist observations and parental interviews, identified four ‘dimensions’ of parenting – (a) disciplinary strategies, (b) warmth and nurturance, (c) communication and (d) expectations of maturity and control. More than this, however, this influential study identified three ‘parenting styles’ which have since stood up to considerable empirical scrutiny. 

The first of the parenting styles identified by Baumrind is now more commonly referred to ‘authoritarian parenting’. This an approach to parenting which is generically low in warmth but high in control. Parents who fall into this category, typically hold very high expectations for their children’s behaviour and develop strict, non-negotiable rules for which they must live by. They are described as “obedience and status-orientated and expect their orders to be obeyed without explanation” (Baumrind, 1991). Failure to abide by their rules, or to meet their behavioural expectations, is typically met with punishment rather than with empathy or understanding. This type of parenting is often seen in adults who they themselves were raised by parents with a similar style of parenting [see my earlier blog on ‘family scripts’] and who therefore hold an authoritarian working model or ‘blueprint’ of what it is to be a parent. This style can also sometimes be seen in anxious parents, who respond to a fear of losing control of their children by exerting total control. The implications for their children, however, is that they are often left feeling angry, confused or upset internally, but have no capacity to process or make sense of these emotional experiences as they develop. Their children are also often limited in their opportunities for free play and exploration of the world, which is equally important for healthy emotional and social development. 

The second parenting style identified by Baumrind is that of ‘permissive parenting’. This style can be broken down into two further parenting styles – ‘permissive-indulgent’ and ‘permissive-indifferent’. A ‘permissive-indulgent’ parent is broadly defined as a parent who is very high in warmth, but very low in control. In direct contrast to their authoritarian counterparts therefore, permissive-indulgent parents make very few demands on their children, rarely discipline them and typically seek to avoid confrontation. They are described as “generally nurturing and often take on the status of a friend more than that of a parent” (Baumrind, 1991). The implications for their children, however, is that whilst their internal worlds are largely attended to (although negative emotions can still be feared), they lack the developmentally appropriate structure, boundaries and expectations that they need in order to develop into healthy, socially-adept adults. ‘Permissive-indifferent’ parents on the other hand, present as very low in control AND in warmth. These parents offer neither structure and boundaries nor warmth and affection for their children. They are what we typically consider to be emotionally neglectful parents, who in extreme cases, may actively reject their children, leading to inevitable attachment difficulties as their child develops.  

The third parenting style initially identified by Baumrind’s study is known as an ‘authoritative’ parenting style. This style bridges the gap between authoritarian and permissive parenting styles and is known in research circles as the ‘gold standard’ for child development. This is because parents who are able to approach caring for their children with this style of parenting are able to establish developmentally appropriate rules and boundaries, but can at the same time, remain responsive to and curious about their children’s internal worlds. This means that they can be open to trying to understand a child’s internal world (e.g. their thoughts, feelings, motivations, perceptions, beliefs, etc.) even if they do not accept their behaviour. Indeed, when their children fail to meet their expectations, an authoritative parent is more likely to respond with forgiveness, nurture and find structured opportunities for new learning, rather than with punishment. Similarly, they can remain democratically open to questions and challenges from their children about their rules. They are defined as being able to “monitor and impart clear standards for their children’s conduct. They are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive. They want their children to be assertive as well as socially responsible, and self-regulated as well as cooperative” (Baumrind, 1991). The benefits for children raised with this type of parenting style is clearly evidenced in their later performance on a broad range of emotional, social and behavioural indices. These include social responsibility, the ability to cooperate with peers and adults, independence, assertiveness, problem solving and high self-esteem. Support for this ‘middle ground’ approach to parenting is also offered by recent research which has identified that children with a history of severe developmental trauma and attachment disruption, respond most effectively to an ‘authoritative ++’ approach to nurture whilst in care – a specific type of parenting approach which is very high in both control AND warmth and nurture – also known as the ‘two handed’ approach to parenting (Hughes, Golding & Hudson, 2019). 

As alluded to earlier, the type of parent we become will be influenced in part by our own experiences of being parented. Whilst we can adapt this to a degree, however, when we are under stress, it is likely that we will move closer towards our ‘blueprint’ of what a parent is. For this reason, it is extremely important that as parents, we take the time to notice for ourselves when we are starting to a more extreme type of parenting style (authoritarian or permissive) as an indicator or ‘red flag’ that we need to take some time out to recharge in order to be the parents that we want to be, and which our children need us to be. If you are co-parenting, it can also be helpful to think about where you and your partner each naturally fall on the continuum between high warmth and high control as parents, and to spend some time thinking about the strengths and weaknesses of these respective similarities or differences in your parenting styles, as well as the impact that the combination of your parenting styles has on your child. When challenges or parenting styles feel unhelpful or entrenched, however, it can be worth seeking professional help. 

References – 

Baumrind, D. (1991). The influence of parenting style on adolescent competence and substance use. Journal of Early Adolescence, 11(1), 56­95. 

Baumrind, D., & Black, A.E. (1967). Socialization practices associated with dimensions of competence in preschool boys and girls. Child Development, 38, 291­327.

Hughes, D., Golding, K. & Hudson, J. (2019). Healing Relational Trauma with Attachment-Focused Interventions: Dyadic developmental psychotherapy with children and families. Norton

 

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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Viagra: Some ups and downs of the little blue pill

The arrival of Viagra (sildenafil citrate) came on the market in 1998 as the first drug to treat impotence. Impotence is the consistent inability among men to achieve and sustain an erection sufficient for sexual intercourse and/or to achieve ejaculation. Like the contraceptive pill in the 1960s it was greeted as a life changer giving men a chance to enjoy more and better sex when they wanted it. Of course it was never going to be that easy and the complications would take a while to emerge. In this blog I will share some thoughts on impotence and Viagra mainly in physiological terms; I will explore further psychological and relational aspects in later blogs.

There are other drugs for erectile dysfunction such as Cialis and Levitra as well as generic versions for example Kamagra. For simplicity I will use the term Viagra to refer to all the different versions.

Key findings from a 2018 survey of 2000 men, carried out by Atomik Research and sponsored by Co-Op Pharmacy, showed 43% of men between 18-60 were suffering from impotence and only 28% of those surveyed had discussed it with a GP. These are worrying figures and we can see why Viagra has been such a success story. Millions of men have taken Viagra apparently without any major incident or serious drawbacks. Although given the reluctance of men to talk to their GPs about sexual problems there may significant numbers who are suffering side effects that impair their sex lives.

Impotence is caused by reduced blood flow to the penis and Viagra works by increasing blood flow. A study of 23,000 men, cited by Pfizer the pharmaceutical company that manufactures Viagra in 2019, claims that 72% – 85% of men taking Viagra (the differences relate to the dosage 25 mg, 50mg and 100 mg) achieved erections hard enough for sex compared to 50% of those men on a placebo. This looks encouraging.

It can take around 15 minutes to one hour for Viagra to bring about an erection suitable for intercourse. On average these effects last 2-3 hours, may be up to 4-5 hours depending on your body’s metabolism. Viagra can help maintain an erection after ejaculation and can reduce the time it takes to achieve another erection following ejaculation. Some men say it can be more difficult to orgasm with Viagra, which may or may not be an advantage for their partners. Pfizer advise Viagra only works when you are sexually aroused, it does not make you feel aroused or cause instant hard-ons. In theory you will not be left with an unwanted erection if you are no longer horny.

A higher dose does not necessarily mean a better hard-on but it is likely to produce more side effects. These can include headaches, flushes, indigestion, abnormal vision, stuffy or runny nose, muscle pain, nausea and dizziness. There are also negative interactions with prescription drugs, over the counter medications and natural supplements. Viagra does not work well following a fatty meal or alcohol, which is tough for those who like to wine and dine as a prelude to sex.

There are men who do not have erectile problems who use Viagra to improve their sexual performance. However the recreational use of Viagra can be dangerous, especially if combined with other recreational drugs as in chem sex; this is an issue because chems can make it difficult to achieve and sustain an erection. Taking Viagra at the same time as recreational drugs such as chems, ecstasy, cocaine, crystal meth, poppers, and speed can produce a range of side effects including serious risks of a fatal drop in blood pressure and/or additional pressure on the heart. There are instances of men taking large doses of Viagra and enduring erections that last many hours. These are often painful and if not treated can damage the penis. In 2013 a Columbian man took a large dose and ended up with an inflamed and gangrenous penis that had to be amputated.

We have to recognise the benefits for men who can buy Viagra without a prescription, however apart from the recreational risks outlined above there are concerns about self-mediation and missing the signs of serious illness. High blood pressure and diabetes are two conditions that diminish the blood flow and therefore impotence can be a symptom. In the US diabetes is the most common cause of erectile dysfunction and impotence can be the first sign of heart disease especially in young men. If left unchecked these conditions can have long term and tragic results.

Viagra has undoubtedly helped many men and couples regain a sex life or find sex more satisfying, however this little blue pill is not always an effective treatment for erectile difficulties. Men who cannot tolerate side effects or for whom Viagra is not medically advised may want to explore other ways of enjoying sex if they are and their partners are able to talk about it. Viagra often reduces spontaneity and mean partners have to plan when to have sex, which again requires talking about it. Openly discussing the impact of impotence on a relationship is not easy; sometimes the conversation never happens. This is where counselling and psychotherapy can help by offering a safe space to have these conversations as individual or as a couple.

References-

https://www.atomikresearch.co.uk/case-studies-archive/co-op-pharmacy-erectile-dysfunction-pr-survey/

http://www.tradesexualhealth.com/sexual-health/sex-drugs/viagra.html

TRADE – Free, confidential health advice, information, services and support for the lesbian, gay, bisexual and trans communities of Leicester, Leicestershire and Rutland.

https://www.viagra.com/learning/is-it-right-for-me

Pfizer, 2019

https://www.usrf.org/index.shtml

Urological Science Research Foundation

https://www.independent.co.uk/news/world/americas/man-s-penis-amputated-after-viagra-overdose-8835146.html

 

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.

 

Face to Face and Online Therapy Help Available Now

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Leaving the Family

Long-term Psychotherapy is all about leaving the family – not literally – but in the psychological sense.

This is a much more complex process than it sounds. Why? Because it takes years of back and forth, and it is a journey which although slow, in my view essential for psychological health.

If you were lucky enough to have had a secure attachment relationship to your main carers – meaning an upbringing with parents who were secure in enough themselves to support your natural development throughout life – even if you experienced challenges or significant losses, you will feel enough security (real security, not an inflated one) in yourself to navigate life’s challenges.

For the rest of us, probably the majority – we will probably need to come to terms with the reality and aftermath of growing up in dysfunctional families, with parents or carers who were at best unskilled, and at worst abusive.

Leaving the family in the psychological sense can result in leaving in the physical sense too – such as choosing to have limited or no contact with an abusive or toxic family member.

This can be a difficult and painful decision to reach because of feelings of guilt, and expectations/ ideas of what a family should look like. For example, in some cultures it is taboo to cut contact with close family members (especially parents). Also, the person who is choosing to not have contact is usually accused of being difficult, making up stories, etc. Putting the blame on one family member (usually a child) is also a way of denying systemic dysfunction within the family.

Status Quo

Being in Psychotherapy can be risky because of what can get uncovered. Ideas about family which were not true, love which wasn’t there, destructive behaviour which was condoned or kept secret, etc. It is often painful to come to terms with reality. However, it is much more painful to live in denial.

Things which are denied or suppressed, remain unaddressed. What remains unaddressed affects us anyway because we can’t make links between our experience (past and present), feelings and behaviour. This is confusing and can cause a lot of unnecessary suffering.

As children we may have tried hard to keep our family together, because we depended on them for survival. And whilst some families are held together by love, compassion and humanity, other family relationships are held together by denial of serious dysfunction and/ or secrecy around abuse. This is not to say that love isn’t possible in dysfunctional families. There are degrees of how much harm dysfunction in families will cause.

Short Cuts

The reality is that there aren’t any short cuts for this type of work. Many people come into psychotherapy having tried to bypass their pain through short-term fixes, and shallow pursuits. Maybe after a string of failed relationships or a life that feels empty. Unaddressed, long-standing issues can also manifest as chronic depression or anxiety.

Of course, there needs to be a certain readiness and willingness for this type of work to take place. Maybe a certain level of maturity even (not usually related to age).

Aims and goals

The destination is unknown because it depends on each unique individual’s circumstances and hoped for outcomes.

The aim could be to finally become an adult in an emotional and psychological sense. This means to take more ownership of one’s feelings, thoughts and decisions. To be more present in one’s body. To have more fulfilling relationships and a more meaningful life.

Who wouldn’t want this?

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.

 

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

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Home is in my Head: Rediscovering your Identity in a New Culture

The urge to migrate twists through the marrow of our bones; the restless energy moving our ancestors across vast wastelands in search of a better life mirrors our journey to self-actualisation.  With global migration on the rise what happens to your relationship to yourself and to others when  you leave your birth country for a different life? How do you fit yourself to a culture that is both exciting and un-lived and yet as closed as an unread book?

Years ago my mother an economic migrant and native french speaker, studied French A Level at my school together with my peers. Back then I didn’t understand and was embarrassed by her presence in the school corridors.  Now I see how courageous and important it was to navigate, and excel in, a world of English teenagers (she achieved Grade A).  Undoubtedly she struggled with her inner voice that continues to taunt ‘you are a guest in this country’.  How much I ingested of her shame I can’t say. It is impossible to separate the hidden toxicity of shame from my identity – the me who lives, breathes and continually adapts to the pull of three different cultures: my parents’ and the British culture I was born into.

Whether through choice or forced migration the traumatic consequences of relocation can include rootlessness, alienation, difficulties in relating to others and disconnection to yourself – it requires emotional investment to redefine yourself in an alien culture, to start to fit in, to feel a sense of belonging.  Dislocation leads to a sense of disease, of being ill at ease with the person you thought you were, without a clear sense of yourself in relation to others. Says Gestalt theorist Yontef (1993)  ‘Living that is not based on the truth of oneself leads to feelings of dread, guilt and anxiety’.

You might ask who am I in this new place I inhabit, how do I move, talk, occupy this alien environment? Whose space is it? Am I allowed in? Will the other give up some of their space for me in the territorial dance between us?

“I can’t stay in one place, my home is in my head”* state A-wa, an Israeli pop group who sing in Yemeni as an homage to their grandparents.  This sentiment is felt as a spiritual and physical load, the burden of those who carry the heart and soul of their homeland with them wherever they go.

I hold inside me poignant stories of others’ longings for a secure base: the European man who seeks love looks for a woman who understands the food he used to eat at his mother’s table.  The woman whose future lies in repeated migrations – whose only home is her partner.

Perhaps a way to reorient yourself to a new country is in finding allies in people from your own culture or embracing your partner’s family. In the therapy room you may want to explore finding a way back to yourself, the you who hasn’t stood still but hasn’t yet found a way to fit in.  Therapy can support you to restore the sense of who you are, what you want to say, what you want to ask for.

By rooting yourself in your own identity, you can re-build self esteem and ultimately risk new and exciting relationships in the world around you – your colleagues, peers, future friends and family.

 

Resources: 

*  A-wa, (2019) from the album Bayti Fi Rasi

Yontef, G (1993) Awareness, Dialogue & Process: Essays on Gestalt Therapy. Highland. N.Y: The Gestalt Journal Press

 

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.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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How being ordinary is increasingly extraordinary – On the role of narcissistic defences

Who wants to be ordinary? The word has unpleasant connotations; like something that offers little that is good or substantial. And yet it is a word I often think about and return to in my clinical practice. It could even be one of the primary goals of therapy: to become ordinary.

In the world today there is more and more in place to protect us from being ordinary, that is, to protect us from being ourselves.

We have an almost infinite number of television channels, live streaming of every conceivable film and box-set and console games set in technicolour virtual reality.  The whole world is modelled on making us all feel special. And it is within reach for us all, if only we have just enough about us to win the latest talent show broadcast at primetime, or to garner enough Youtube followers or win the Lotto – after all ‘it could be you’.

All this presupposes that being simply ordinary is wrong; that being ordinary is settling for something less than. However, being ordinary in the truest sense of the world means being able to be in relationship with our inner world and make decisions and life choices – choices based on desire rather than the need to shore up our defences.

What is ordinary?

If being ordinary has little to do with accepting the mundane or second-rate life, then what does it mean?  Being ordinary means being in the real world, rather than retreating to a ‘fantasy world’ each time the real world becomes uncomfortable.  Or in some cases retreating from the real world to avoid it even the anticipation of discomfort.

On defences

I have previously written about manic defences enlisted in order to protect us from discomfort.  And whilst this blog in essence remains about manic defences, the use of certain defences to avoid ordinariness and strive for the extraordinary are a particular subset in the cluster of manic defences known as narcissistic defences.

Neglected children always construct a story of specialness

Whether it is story of being ‘special’ to a parent who leans on them for emotional support, or it is specialness born out of surviving a difficult childhood, being special or extraordinary can be a short-term invaluable solution to feeling helpless, hopeless, enraged and depressed. Or even mad.

Being extraordinary shores up the empty core of the neglected and abused child.  It enables them to cope and to construct a ‘pseudo-self’ so they can navigate the world. At least for a while.

A special kind of defence

There is an argument that as a society (western), we are becoming increasingly narcissistic: focused on consumerism and fantasy rather than connection and relationship.

The consumer world makes it easy to ‘sell’ specialness or the attainability of extraordinariness.  Even in the western spiritual model specialness is promoted through maxims such as ‘you are unique’; ‘you have a special gift to offer the world’ and so forth.

What’s so bad about being extraordinary?

Life should not be a choice between being extraordinary or being nothing (feeling like one does not exist).  Being ordinary is not the contrary of being extraordinary, at least not in psychotherapy. Being ordinary is the third position.

Being ordinary is a mature position of being able to withstand and navigate real life without flights of fancy; it is a position whereby we can make decisions from a position of strength and desire rather than from an ongoing defence of the fragile self.

In tangible terms, being ordinary means living a real and fulfilling life without a constant need for external validation and approval.  Without being defined by Facebook or Instagram ‘likes’.

Being ordinary is an authentic position and one through which we may have extraordinary experiences if we are lucky, but they will be rooted in reality.

All in all, it seems to me that being ordinary has really become something extraordinary in the modern world.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer –

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

What is the difference between fate and destiny?

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Death Anxiety

This blog follows on from my previous blogs – Existential Therapy and A consideration of some vital notions connected to Existential Therapies.  

In Existential Therapy reflecting on death anxiety would not be the same without a consideration of Heidegger. Heidegger (1927) regarded human beings as always ‘being towards death’. He asserted the significance of anticipating death as a vehicle to address the possibility of being itself.  Heidegger (1927) described the earnest recognition of our being towards death and its possibility in the following way:

“Impassioned freedom towards death – a freedom which has been released from the illusions of the ‘they’ and which is tactical, certain of itself, and anxious”

(p. 266) [1]

To me it seems Heidegger postulated that by confronting our finitude we can take responsibility for our existence and be released from the illusions surrounding a life of conformity.  However, this does not remove anxiety from living but reframes it as something inherent in being.

To a greater and lesser extent ‘death anxiety’ is considered by existential therapists as a central theme. One’s mortality is recognised as a continuing condition of human beings. It is perhaps the only thing that belongs to us,  and we can knowingly and unknowingly be living in the anticipation of its possibility and eventuality. This theme holds much uncertainty and reflects back to us the pervading uncertainty of life. It gives birth to the existential angst inherent in the human condition. This angst is generated by the fragility and unreliability of a life lived in this existence.

This does not have to be a pessimistic view. It is in fact allowing an exploration of the boundaries of life. By confronting our mortality, and in fact any pain and suffering experienced along our path, we have the opportunity to clarify our limits and identify that which is out of our reach rather than evading it. Simultaneously it can support us to become aware of our potential and the elements in our lives that it is possible to do something about. It can make us feel more adventurous and alive.

Existential Therapy frequently espouses the importance of facing up to our life and death and all that is experienced between the two poles of our existence, whether it be inevitable suffering or joy. We must find the capacity to confront our difficulties in living and permit the experience to feel it, without needing to linger for too long.

Equally we must see the good in our existence and recognise these times as they happen. Allow learning to ensue so that we can augment this in our lives, but without getting caught in the pursuit of unending happiness. Ultimately all aspects experienced, wherever they fall on the spectrum of suffering or joy, do not stand alone. They are all parts of the same indivisible perspective that each individual experiences as they travel within their existence.

So whether or not death anxiety is viable to consider, angst or anxiety is seen as an inevitable part of existence by Existential Therapists. Many will emphasise the significance of valuing, understanding and tolerating anxiety. Many recognise anxiety as a sign that something in our life needs our energy and attention rather than it being a threat or something to be eliminated. Perhaps it may be the very thing that unshackles us from conformity and seeking validation or permission from others. Perhaps it is the vehicle within which we may feel our aliveness, engagement,  and vital connection.

 

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

 

Further reading by Susanna Petitpierre –

A consideration of some vital notions connected to Existential Therapies

Existential Therapy

Being embodied in Therapy: Feeling and listening to your body

 

Resources –

[1] Heidegger, M. (1927) Being and Time (transl. J. Macquarrie and E.s Robinson) Londo: Harper and Row, 1962 edn.  

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Post Natal Depression in Mothers & Fathers

In this blog, we explore postnatal depression and summarise a classic paper by Lawrence Blum, an American psychiatric and psychotherapist. It was originally written in relation to postnatal depression in mothers, but also explores the conflicts that appear when becoming a parent and applies to fathers, same-sex couples and couples where caring for the child is more equally shared.

How Postnatal Depression Can Affect Fathers as Well as Mothers

Although understandably, we focus on new mothers in the postnatal period, dads and other co-parents also need support.

Dads have a lot to take on board when a new baby arrives due to the huge life change. Money problems, sleep deprivation, new responsibilities and new relationship dynamics can leave dad feeling overwhelmed, emotional, and even depressed. On top of this, it’s easy for dads to feel guilt for not being able to take on the responsibility of breastfeeding as their partner is still recovering from labour and birth.

It’s important to seek help if you’re a father feeling the negative effects of new parenthood, or if you’re a mother who has noticed a negative change in your partner. Talking therapies can be a great help in overcoming depression.

The Difference Between ‘Baby Blues’ And Postnatal Depression

In the paper, Blum explains the difference between ‘baby blues’ which is a hormone-induced depression, and postnatal depression which more closely relates to depression. Many factors contribute to postnatal depression, including:

  • Lack of external support
  • Stressful life events
  • Difficulty conceiving
  • Previous mental health issues
  • Low self-esteem
  • Anxiety

To help with postnatal depression, supportive counselling, CBT, and psychodynamic psychotherapy were the most effective in controlling the issue.

What Is Psychodynamic Therapy?

Psychodynamic therapy had the biggest impact on depression. This type of therapy focuses on the psychological roots of emotional suffering. This approach combines many different types of analytic therapies and works on the idea that each person’s unconscious thoughts and perceptions are developed through their childhood.

When working with a psychodynamic therapist, a mother will be encouraged to talk about relationships with their parents and other people to uncover the unconscious reasoning behind their depression.

There are different psychodynamics of depression which we will outline below. There are three principal emotional conflicts, these are:

Dependency Conflicts

When you become a new parent, you are completely depended upon by your new child or children. This is extremely tiring, emotional and in some ways, draining. Support at this stage of becoming a new parent or carer is extremely beneficial, however, if there is a lack of support, parents may feel a sense of denial of their own needs which can result in depression.

Anger Conflicts

Anger is a normal part of depression, and it can make parents feel guilty for feeling this emotion. Anger can be felt towards the baby as a projection of past hurts or for how their lives have changed in terms of money, sleep, jobs, social life and sex life.

The dangers of feeling anger as a parent are that when these feelings are denied and controlled, the feelings can build up and eventually be released which threatens the relationship with the baby or, more commonly, the partner.

Parenthood conflicts

Becoming a parent and caring for a baby can bring unresolved and unprocessed feelings about a parent’s own experiences of being cared for to the surface. Negative childhood experiences can positively affect how you raise your own child as you want more deeply to give your child what you didn’t receive, however, on the other hand, it can also stir up old wounds which can heighten the risk of depression.

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.

 

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Is Love a Tameable Force?

Death like birth is a one off life event. We cannot learn through our experience of either to “get it right” next time. Love on the other hand (or the act of ‘falling in love’) is an event amenable to repetition. As such it is also available for re-definition by the forces of culture – political, philosophical and economic.

We no longer imagine or indeed contract for that (romantic) notion of love “till death do us part.” A vision in part predicated on (now outdated) kin-ship structures. These days it seems we care less to tie ourselves into lifetime contracts, or at least not without the freedom to change provider.

Love in a consumer age

One factor involved in the consideration of any investment is the risk attached. The ‘hookup’ model of relationship is a way of keeping (emotional) risk to a minimum. Its strategic focus is on convenience and short term satisfaction. It requires a particular vigilance to any (unruly) emotional undercurrents, with cost/benefit analysis consistently calculated and reviewed. When the initial (emotional ) investment is small there is protection against future insecurity in what can be a highly volatile market.

In his book, ‘The Art of Loving’, Erich Fromm describes how satisfaction in love cannot be attained “…without true humility, courage, faith and discipline” a vision at odds with the consumer age. Now the structures and forces of the market place promise something different. We can barely move for ‘expert’ relationship advice and books, articles and podcasts abound to coach us in the practice of relationship consciousness. In the online marketplace, the otherwise busy consumer may choose from an extensive menu of mouthwatering relational options. Available with an ease of access (and exit) and an abundance of choice, previously unknown. The new ideal of instant satisfaction takes the wait out of wanting with all risk insurance and money back guarantees there to catch us if we fall.

Love and uncertainty (uncomfortable bedfellows)

Love though is an unruly force and resists attempts at mastery or design. Love finds its own meaning in a continual state of becoming. Its creative forces are fraught with risk and like any creative force, we may never be sure where it will end. When we ‘fall’ in love, we enter into a great unknown, we  feel untethered from our usual moorings and suddenly vulnerable in the force field of another’s freedom. Indeed, love navigates a fine line between security and freedom and is threatened by both. ‘Too much security’ may feel like fusion or possession, stifling the creative urge. ‘Too much freedom’ (and a deficit of security) may lead to an overwhelming and agoraphobic sense of uncertainty.

There is then an inescapable duality in love and any attempt to surmount it ends only in its destruction. This paradox lies at the heart of loving. Eros forever haunted by Thanatos like an iron hand clad in a velvet glove.

Love seduces and emboldens us (at least in its opening gambit) to dive into the uncharted waters of ‘otherness’ and engage with the unknown. Love as an antidote to death soothes the ever present human dilemma of separateness. The blessing and the curse of individuality makes a mockery of us and all lovers seek to foreclose the space that separates them from their beloved. It is though in this very act that the death knell to love is sounded. Whatever else love might be a commitment to it inevitably involves the certainty of uncertainty.

To love is to risk and there is no algorithm to square that particular existential circle. The last word on love may perhaps always be best left to the poets.

Source – Erich Fromm, The Art of Loving(1957; Thomson’s, 1995)

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin –

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

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Attachment Styles and How They Affect Relationships

The way we relate to others, including our partners is complex and multi-layered.  It is developed over time and although we can to an extent control what we say and do within our relationships it is more difficult to understand why we behave and feel the way we do in relation to others. 

One way of describing how we function within relationships, is to talk about our style of ‘attachment’. How we attach to others affects everything from the partners we choose, to how well our relationships progress and how they end.  Once we recognise our attachment patterns we begin to understand our strengths and vulnerabilities within our relationships including those with friends and family. 

Attachment patterns are established in early childhood. The developing infant builds up a set of ‘models’ of themselves and others based on repeated patterns of interpersonal experiences with their caregiver (usually the mother and/or father).  These repeated patterns continue to function as ‘internal working models’ for relationships in adulthood. The problem is that much of this is happening at an unconscious level and as such we remain unaware of these models leaving us likely to repeat unhelpful patterns which may, in turn leave us feeling frustrated and hurt.

According to Attachment Theory there are four attachment styles. 

Secure attachment:

Securely attached people tend to have satisfying relationships. Broadly speaking their internal working model gives them a core sense of being safe and secure within themselves.  These people feel more or less good about themselves and their capacity to be effective and create positive relationships. This can also be described as having good self-esteem. This allows them to believe that if they experience a rupture or a falling out with a friend or partner it’s OK. The relationship can be repaired and things will get back on track between them.

Anxious-Preoccupied attachment

These people are often described as being clingy and needy.  Their internal working model does not provide them with a core sense of safety and security.  They look to others to provide this for them. Therefore when they experience a rupture or falling out they feel insecure and unsafe and in their attempt to feel secure and safe again they become demanding and possessive of their friends and partners because they cannot provide themselves with these feelings. Unfortunately this behaviour tends to push people away confirming their worse fear and so the cycle is complete. 

Dismissive-Avoidant attachment

People with this style of attachment tend to distance themselves from others emotionally.  Like people with an insecure-ambivalent attachment style their internal working model does not provide them with a sense of safety and security but they protect themselves from this by becoming ‘pseudo-independent’ and telling themselves that they do not need people.  They have the ability to shut down emotionally and turn off their feelings even in heated arguments with friends or partners. Their relationships often end because their friends and partners experience them as detached and unemotional.

Fearful-Avoidant attachment

A person with this style of attachment fears being both too close or too distant from other people and moves between these two states.  They often feel overwhelmed by their feelings over which they feel they have little control. Their internal working model is that in order to achieve any sense of safety and security they need to move towards people but that if they let people get too close they will get hurt.  This leaves them in a state of confusion as to how to get their needs met although this may not be entirely conscious. What they are conscious of are feelings of being trapped when they get close to people and clinging to people who reject them. Their relationships can end up being abusive.

How psychotherapy can help

By becoming aware of your attachment style, over time you can challenge the insecurities and fears that have formed your ‘internal working model’ and develop new styles of attachment for sustaining more secure and satisfying relationships with others.  This sounds easy but in reality it is more complex. Exploring and understanding your internal working model and resultant core state can be challenging as defensive strategies which have come into play to protect you from psychological pain are hard to change and can leave you feeling vulnerable.

However change is possible within a relationship of trust with a skilled and experienced therapist.  On a very basic level the relationship with the therapist provides a space where repeated patterns of interpersonal experience occur and can be thought about.  The therapist will be able to stand back and reflect what is happening between you with the intention of helping you identify the patterns which so far have remained unconscious and out of your awareness.  In this way over time you are able to choose to do things differently – bit by bit.

 

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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Family Therapy for Beginners

Professor Richard Layard, one time ‘Happiness Tsar’, wrote, ‘in every study, family relationships, (and our close private life) are more important than any other single factor in affecting our happiness’.

It’s hard to grow and feel safe and content in the world if our family stories are causing us distress and discomfort. This is especially true for children, and young people when their family is their world. When they are struggling with emotional and behavioural problems or maybe unexplained physical ailments a ‘systemic’ approach can be revealing.

Systemic therapy is relational, that means looking at the spaces in between people and their relationships with others, as opposed to looking inside individuals. Systemic therapists are interested in the ‘systems’ that people belong to, such as our families, school, work places, peers and friendships. Exploring the context of tension, distress and unhappiness can help us illuminate the possible causes.

For example we may find stories of divorce and separation, estrangement, sibling rivalry, family illness and disability, bullying, academic struggles, financial problems, loss and bereavement, or drug and alcohol use Family therapy is about having conversations that can be difficult, exposing, controversial, and upsetting.

But also about reconnecting, understanding, sharing and being surprised. Feeling heard, understood, loved and believed. Explaining your side of a story, hearing family stories that help you understand current struggles and appreciating other people’s point of view. Feeling proud and united, relieved and supported and wondering together how you can move on.

Any therapy involves taking a risk; family therapy provides an invitation to be brave and accept that families may be worried, sad or confused about someone they love. Or maybe family relationships are feeling tense and strained, or they are missing someone who played an important role in your lives.

Established, repaired and revisited relationships give families a rich resource for healing.  Family Therapy sessions usually last 90 minutes, and as many family members who are available are welcome.  Work would begin by exploring why it had been decided now was the time for family talking and noting individual and family goals to help focus the work. Some family members may be initially reluctant to attend, its important for them to be aware that just be attending they are showing their support. They do not have to contribute verbally if they do not want to – this could be agreed at the beginning of the session. By just turning up they are able to listen to other expressing their views and will usually join in when they feel comfortable and safe within the process.

A genogram or family tree is usually constructed looking at the current family structure and remembering older generations. This provides a map of the family and a cultural context for the current problems. It generates stories, sometimes forgotten, about how positive and negative patterns and traits may have been inherited by the family in the room. This can be a revealing and emotional, with younger people hearing about relations that may have died before they were born and older ones remembering stories that help build to a clearer understanding of the family’s identity. A time-line constructing a chronology of family births and deaths and other family events is also useful. Again, this begins reveals its own narrative, which can help a family begin to plot the life story of a problem.

Family Therapy is always driven by the goals of the family and continual feedback allows the therapist to ensure that the family are having the conversations they want and need to have. Sometimes it may feel useful for family members to meet individually, in couples or sibling groups as part of the therapy.

It is not necessary to meet weekly; sometimes families find one or two sessions are enough to feel they are able to move forward. In my experience family therapy can be a powerful process with the family leaving more connected with and appreciative of each other.

 

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.

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Emotionally Focused Therapy: For Couples in Distress

Emotionally Focused Therapy (EFT) is a short-term evidence-backed therapy with a high success rate in supporting clients to move through difficulties in their relationship. This includes one or both partners who have experienced early trauma. It is shown to to be an extremely effective way of helping distressed couples strengthen their attachment bond, particularly where one or both partners have experienced early trauma.

As a couple in distress you might feel you’ve reached the end of the line, or you are struggling to get past your partner’s infidelity. Perhaps you can’t seem to get your point across without a descent into conflict.  When this becomes a habitual pattern it becomes destructive, affecting how safe you feel which can erode intimacy, desire and emotional connection.

Emotional, or attachment bonds in our relationships are physiological and therefore potent.  Neuroscience is uncovering how important these attachment bonds are to our sense of safety: distance and separation is perceived as threatening and we go into fight-or-flight mode to get what we need.  This emulates our early life experience when we relied on caregivers to survive.  It might not feel like it but arguments are often a way to draw our partner closer when we feel they are not attuned to us.

Modern couples are subject to different stressors than previous generations. Socio-cultural shifts means we have higher expectations that both partners provide for all our emotional needs  as well as the financial and practical elements. Children may or may not be part of the way we configure our relationship.  Paradoxically we also expect to maintain excitement and passion throughout as we strive to emulate the sexually exciting worlds of the movies.  Yet though we know there’s a dissonance between fantasy and reality, disappointment follows and we may wonder if there’s someone better out there.  EFT considers the wider context that affects relationships, looking at the systems  around the couple that influences their relationship.

How does it work?

Our emotions play a key part in making decisions and in signalling to others our desires, feelings and intentions. Paying attention to our emotions can support us to gauge a situation and act in a way that benefits us and others.

One of the strengths of EFT is that it places emphasis on the negative cycle of conflict couples get pulled into rather than apportioning blame to either person.  The therapist works in collaboration with both partners to identify this dance of ‘pursue-withdraw’ or ‘criticise-defend’ as the couple interact in the room. This here and now focus illustrates the triggers, escalation points and underlying feelings that erode attachment bonds but often remain unspoken.

The therapist supports the couple to listen effectively, witness and ultimately validate the other person’s underlying feelings, emotions and desires.  Partners learn to express feelings from a place of vulnerability and ask for what they want and need from each other.

The ultimate aim of EFT is to reduce conflict and  restore a sense of safety, connection and  intimacy.  Whatever the outcome you will learn new skills of communication, increase compassion for each other and re-establish trust and safety.  It isn’t always an easy journey but you will learn a lot about each other and yourself in the process that will help you make clear decisions about your relationship.

If you would like to try out EFT please get in touch.

 

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.

 

Resources –

Susan M. Johnson (2019) Attachment in action — changing the face of 21st century couple therapy  www.Sciencedirect.com

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Existential Therapies

“A rich tapestry of intersecting therapeutic practices, all of which orientate themselves around shard concern: human lived experience” (1)

What is existential therapy? I’m asked this a lot. I even ask myself from time to time. In some ways it could be described as an attitude held by the therapist. It is certainly, in my experience, a continually unfolding enterprise due in part to its emphasis on relationship, non-directive stance, non-structured framework and an openness to wonder and mystery rather than reduction and categorisation.

In this blog, and future blogs I will begin to reflect on some understandings within existential therapy.

It is perhaps safe to start with reiterating what many have said before: there are as many ways to be an existential therapist as there are existential therapists (2) (and clients may I add). I am aware how vague that sounds, however, I believe it is actually what makes existential therapy so valuable. Its variety and openness invites connections and relationships to be developed in an authentic and unique way with each client. It also challenges some illusions regarding life (and therapy) including that it is and can be objective, manualisable and unambiguous.

Existential therapy is framed around a variety of existential thinkers, and other philosophers. Many have been influential in its development. At times the diversity of understandings about human existence reveals contrasting understandings which can be confusing. However, this is also the very ingredient that permits the aforementioned subjectivity, diversity and disagreement.

Existential therapy recognises the significance that each individual interprets from their particular context, therefore rejecting the notion that one size fits all. It invites every individual to recognise and bring forth their unique potential. Its very nature permits consideration of life in all its complexity and nuance and recognises how uncertainty is intricately connected with living life.

What underpins existential therapy is the starting point: May (1958) (3) described existential therapy as an exploration that seeks to understand individuals as being. It invites a person to experience and have awareness of their own being, their own existence, their own aliveness, their own relation to one’s self and one’s world as a precondition for unravelling and working through their difficulties. Its focus is on the existence of each individual is sitting with the therapist, and what occurs between them. It does not disparage investigations about behaviour patterns or dynamisms but it recognises these elements are only really understood in the context of each individual’s structured existence. It is existence, or as May (1958) described the ‘I am’ experience, that underpins everything else.

So what does this mean in practical terms? Typically, existential therapy does not employ diagnostic frameworks to label or categorise personal characteristics or experiences. Abstract knowledge about a person, an assessment report or a theoretical understanding about a certain type of experience or behaviour is less important than the reality and experience that emerges between two people (client and therapist for instance) encountering each other in a room.

How else does this show up in an existential therapeutic session? In other ways, and always depending on the client’s needs, clients may be encouraged to understand their relationship to, and come to terms with, the ‘four ultimate concerns’ of existence as understood by Irvin Yalom (1980). Yalom described these as death, freedom, isolation and meaninglessness.

Additionally, clients may be invited to consider how they are being and relating to four basic existential dimensions (4). This may take the shape of exploring their relationship to personal, spiritual, physical and social aspects of their existence.

As mentioned in other blogs what has been written above and before is not a blueprint for what to expect in existential therapy. It is also not an exhaustive discussion of ideas within existential therapy. However, if you are interested in reading about other significant ideas in existential therapies, as I understand them, please read my other blogs.

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

 

Further reading by Susanna Petitpierre –

Being embodied in Therapy: Feeling and listening to your body

 

References

(1) Cooper, M. (2003) Existential Therapies. London: Sage. (p. 1)

(2) Cohn, H. (2002) Heidegger and the roots of Existential Therapy. London: Continuum

(3) May, R., (1958) Origins of the existential movement. in Existence. (Eds: Rollo May, Ernest Angel & Henri, F Ellenberg) USA: Rowman and Littlefield Publishers, (p. 31).

(4) Van Deurzen, E. (2012) Existential Counselling & Psychotherapy in Practice. London: Sage

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