Brighton and Hove Psychotherapy

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On rushing towards answers

Take the following situation: a client seeks psychotherapy to deal with anxiety and other related physical symptoms such as heart palpitations, ABS, stomach pains, etc.

They are used to a solution-focused approach and can want quick answers from me.

I feel rushed and pulled to meet them in their anxious place – to offer solutions, set goals, etc. I can easily see the how therapy session could quickly turn into a business meeting.

I take a breath, check in with myself and see how I am feeling (pushed, rushed, slightly anxious to give solutions).

I pause and offer the following:

“It seems you want me to give you more work in addition to what you already have. This seems to be exactly what is stressing you out. What would it be like for us to slow down and focus on your experience right now?”

We both look at one another for a moment and there is a sense of confusion: “I’m not sure what I’m supposed to DO.”

The DO bit is of importance here. Everything seems to be about doing in this person’s life. I imagine most of us can relate to this way of being.

This is because many of us have not learnt to pay attention to our experience. As children we are taught to do well, achieve, win, etc. in order to be loved and recognized. However, real recognition comes from validation of experience. This means paying attention to feelings, thoughts and responses,

Through a focus on doing and achieving, we loose connection to our bodies and our feelings. This means we end up a little bit like performance machines, ticking lists and meeting deadlines. In this process we tend to forget who we are, why we do what we do and how we feel about it.

One of the goals of therapy is to facilitate this process of coming back to oneself and understanding what drives us for good or bad. We then look at what behaviours and ways of being serve you and which really don’t.

Sam Jahara is a Relational Transactional Analysis psychotherapist and superviser, working in Hove and Lewes. Sam is also one of the founding partners of Brighton and Hove Psychotherapy.

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

In this trio of blogs, three of our therapists – a psychologist and two psychotherapists – of differing modalities will be sharing their views on how to work with a fictitious client. The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.

Client background

The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.

He comes from an upper-middle class background where there was a family culture of not talking about feelings and difficulties. He was sent to boarding school ages 6 – 13. He is eldest of 3 children and his parents divorced when he was 13. There’s has been other traumatic childhood incidents that he is yet to disclose.

He presents well dressed, competent, practical and wants quick solutions. He is very busy and wants to know what therapy can do for him and how long it will take

A transactional analysis / psychodynamic approach

I’m interested in James’s past, present and hopes for the future. Also relevant here is James’s attitude towards emotions. What has he learnt from his parents or caregivers about the role of feelings and emotions? Here, clearly there is a culture of not talking about feelings. I would imagine there was little encouragement for James to develop a relationship with his inner-world, given academic achievement was the main focus and what James would have been rewarded for.

In boarding school there is usually a culture of suppression of emotions, including suppressing the distress of leaving home at such an early age. The developmental stage of 6-13 years is also relevant. It is a transitional period for both girls and boys linked with identity development and moving from dependence to independence. Without a ‘secure base’ (parental presence, support and encouragement), this is likely to be compromised.

Why now?

Starting a new relationship can trigger feelings around early bonding and attachment. Inner conflicts to do with dependence versus independence will likely resurface, causing anxiety about the future of their relationship.

The divorce of his parents at age 13, followed by years in boarding school would have invariably shaken his world. Early separation from parents is traumatic for children, and so is divorce. We don’t know yet about the other traumatic events of his childhood, which will no doubt emerge as the therapy progresses.

I would be led by the person’s telling of their story. The process of telling one’s story and being heard by a present and supportive other can be transformative in itself. This might be an alien concept to James and something that he may find both pleasant and strange.

Wanting quick solutions is part of the driven environment of his family, profession and background. A therapist who is willing to be both understand and challenge his worldview, whilst exploring healthier ways to relate to himself is needed here.

Working relationally in the ‘here-and-now’

I would encourage James to begin paying attention to his experience, rather than on the demands he is likely to impose on himself and others. I imagine that James has never been allowed to experience his feelings and receive comfort and support when distressed, sad, angry, etc.

Unprocessed feelings usually manifest in anxiety and or depression. These will also resurface at key moments in life, such as new relationships, crisis, having children, etc.

The above are just initial thoughts based on a limited amount of information given about a fictitious client. Although the information presented here will be familiar to quite a few readers.

In therapy, client and therapist will work together in defining their therapeutic work. This usually happens in a spirit of collaboration and mutuality which, albeit challenging, can also be an enjoyable and incredibly rewarding experience.

Sam Jahara is a UKCP Registered Psychotherapist and Certified Transactional Analyst with a special interest in cross-cultural and intergenerational influences.  She works from our Lewes and Hove practices and sees individuals and couples as well as offering clinical supervision.

 

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Lady Bird: a Psychotherapist’s Perspective on Key Themes

Ladybird

Warning – This article contains spoilers for anyone who has not seen the movie Lady Bird.

A critical success, this film about a mother and daughter relationship falls into the ‘coming of age’ genre, however it is also so much more than this in considering the systemic and unconscious processes at work that make this film both poignant and painful to watch.

There are many key themes present relating to those clients bring to psychotherapy, however I would like to pick out a couple that stood out for me which are perhaps better posed as questions we can imagine that Lady Bird (Christine), the protagonist, is grappling with unconsciously:

What is my desire?

How do I leave my family?

These two questions are in reality interconnected, as it is through desire that we leave the family.  However, in a family where the roles are blurred, and for a young woman whose desire has always had to be curtailed to cope with her mother’s envy, the two questions are complex and the unconscious conflict immense.

From the opening scenes, we see a mother who struggles to see her daughter as separate to her.  She clearly loves her, but also invests her own unfulfilled desires in her daughter.  This is suffocating for Lady Bird, to the extent that in an early scene, she flings herself from the car to escape the literal confines of being with her mother: existence is impossible with her mother and hurling herself from a moving vehicle is less a thought-out action of leaving, than a murderous gesture – self destructive to her and to her mother.

As the film unfolds, the usual twists and turns of teenage experience are interspaced and amplified by the complexities of Lady Bird’s family.  Her father is impotent – he loses his job and cannot separate mother and daughter.  However, what he does know is that Lady Bird must leave, and he facilitates this through making financial arrangements for her university education, without involving his wife to whom he seems to be unable to stand up against (or to come alongside).  This arrangement is pragmatically what Lady Bird needs, however, psychically it further undermines her autonomy and blurs any clarity of who she is in the family and who she is in relation to her mother.

An Envious Mother

Lady Bird understands, like so many of us who have had envious mothers, that she needs to ‘split off’ (disavow) her desire and get it met secretly, if at all.  Or she can turn it into something destructive.  Both choices aim to protect her relationship with her mother.

She gets in with the exciting, but bad crowd and swaps her boyfriend (who it turns out is gay) for an aloof boy who, like his friends, is nihilistic in his outlook on life.  Neither her gay boyfriend nor her disinterested one will help her leave her family, as neither contain her true desire.  Here Lady Bird seems to be asking herself less about her own desire and more about that of others: who am I for others and what do they want from me?  A question she asks herself repeatedly in the relationship to her mother.

Owning her Desire

There are two scenes in the film which fill us with hope for Lady Bird: the first when she owns her wish to go to the school prom and be with her old friends, thereby stepping away from her less nihilistic friends who are ‘too cool’ for school, but who in reality actually have no idea about what they want, other than to rebel.

The second scene of hope is at the end of the film where Lady Bird is at an unnamed university in New York.  Lady Bird’s father has slipped a pile of discarded attempts at a letter her mother tried to write to her into her suitcase which she finds.  This is significant as Lady Bird’s father is finally able to help mother and daughter separate: he encourages his daughter to leave but provides her with the evidence her mother loves her; he assumes his rightful position as his wife’s husband by consoling her at the airport when she, as a result of her struggle to let her daughter have her own desire and individuate, misses her daughter’s departure.

To Individuate or Rebel?

Towards the finale, there is a perfectly ordinary scene with Lady Bird, at what me must assume is her first party in New York, she drinks, meets a guy and they end up at his or hers.  She then becomes ill and the next scene is at a hospital where we learn she has drunk far too much.  This scene is a reminder of the powerful unconscious forces at play in Lady Bird – whether she can find a way to individuate and own her desire or create distance from her internalised mother through self-destructive acts (think back to the hurling herself from the car).

Ultimately the viewer is left with hope as she seems to have enough psychic distance to claim her birth name – Christine – and to find ways to be like her parents (visiting a local church), without having to be defined by being them, or not being them.

Christine  makes a call home to speak to her mother but she gets the answerphone.  The message here?  That her mother and family can survive her going and that they can too move on with their lives.  She is free.

Sam Jahara is a UKCP registered psychotherapist, certified transactional analyst and clinical supervisor. She works with clients and supervisees in Hove and Lewes.

 

Image copyright: A24

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Psychotherapy supervision

The relationship between a psychotherapist and their supervisor is a very important one. Supervision is a vital place to reflect on clinical dilemmas, talk about professional issues and learn from someone more experienced. It can also be a self-care exercise. It feels good to talk to a trusted colleague about our work in a confidential setting. As I learn and reflect more on psychotherapy supervision, it has made me think about the supervision I’ve received throughout my career so far. During a recent group discussion with other professionals, we asked ourselves, “What constitutes good supervision?”

From my own learning and experience, including trial and error with supervisors who did not meet my needs, I thought about the importance of the following elements in supervision:

  • Education
  • Ethics
  • Political and social awareness
  • Relationship to power and authority
  • Self-awareness
  • Supervisor/therapist compatibility
  • Theoretical and philosophical values
  • Trust

Education

I want to be able to learn from my supervisor and absorb the knowledge of someone more experienced who will positively inform the work I do. Therefore, I have chosen to work with supervisors who keep up to date with the latest research and enjoy both learning and developing others.

The way supervisor and supervisee think together is vital for a productive relationship. This doesn’t mean always agreeing with one another, but having a strong alliance where difficult issues can be discussed and resolved.

Ethics

Ethics and client safety is paramount to the work we do. Therefore, an ethical supervisor needs to be able to explore, question and reflect honestly with their supervisee whilst always holding the client’s wellbeing and safety in mind.

Political and Social Awareness

We all exist in a social, political and cultural context. Therefore, this surely needs to be a part of supervision. Like in psychotherapy, a politically and socially aware therapist and supervisor will think about the place in society of their client and supervisee through their culture, sexuality, gender, age, class, ability and relationship to their identity.

Relationship to Power and Authority

This takes me to the supervisor’s relationship to power and authority and how they use, or potentially abuse, their role. A supervisor needs to hold their authority and personal power in a way that acknowledges the power imbalance in the supervisory relationship, whilst being open to being challenged and learning from others. Granted, this is a fine balance to strike and one which is entirely possible to hold if the supervisor him/herself is willing to have an ongoing enquiring relationship to their power and authority and be honest with themselves in these areas.

Self-awareness

This relates to the point above. For a practitioner to be able to supervise others in an ethical way, they need to practice what they preach. Senior practitioners can fall into the trap of thinking they know it all and don’t need to be professionally supervised or have therapy. In my opinion, this attitude can lead to a fall in professional standards, and even to professional negligence or malpractice.

Supervisor/therapist compatibility

Lack of compatibility between supervisor and therapist can have significant consequences for career development. Often, trainee therapists end up with a supervisor who is allocated to them, rather than actively choosing the right practitioner for them. As a trainee therapist, this experience led me to staying in supervision with an allocated supervisor for way longer than I should have. In the end I left feeling resentful and frustrated with the lack of compatibility between us in theoretical approach and professional direction. My learning had stalled and was hungry for someone that could help me grow professionally. I was lucky to then find the right person from whom I learnt immensely as a professional.

Theoretical and philosophical values

I believe that supervisor and supervisee need to be on the same page on the fundamental basics of what constitutes effective psychotherapy or counselling. Also, on the level of training and skill needed to offer an ethical and professional service which is of sound therapeutic value to the client.

Trust

Arguably, without trust there is no relationship which can withstand the challenges of this key professional alliance. The supervisor’s role is, in my opinion, the most important support system of a clinician. Hence, there needs to be enough trust for the therapist to be open and honest, and feel able to navigate through difficult issues with their supervisor. Both are required to acknowledge and respect that mutual trust is vital for the benefit of all involved: supervisor, supervisee and, ultimately, the client.

Sam Jahara is a UKCP registered psychotherapist, certified transactional analyst and clinical supervisor. She works with clients and supervisees in Hove and Lewes.

Further reading

Clinical Supervision

Self Care 101 for Therapists

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Burnout and compassion fatigue

Therapists, counsellors and anyone in the helping professions can appreciate both the rewards and hazards of their respective career choices. We can give people advice on how to care better for themselves, while at times not applying the same self-care principles to ourselves. At the worst, a lack of self-care can lead to burnout and compassion fatigue.

I believe that a lot of the difficulty lies in our deep-rooted beliefs and values about work, leisure and what constitutes self-care. ‘Helpers’ generally work hard, tend to focus on other’s wellbeing above their own, and want to make a difference. It’s our job to offer an outside professional perspective to our clients/ patients, but it can be challenging to approach our lives with the same objectivity. That’s why therapists also need therapy!

We are required to engage in continuing professional development, supervision and personal therapy and to abide by rigorous ethical standards. This is all in the service of ethical practice and self-awareness. These are valuable tools to help keep us in check and maintain an outside perspective on how we are doing as professionals. However, self-care goes beyond this and needs to extend to our lives outside work.

Achieving a well-balanced life is a work of art and an ongoing process. Knowing the principles of self-care is just the beginning. I’ve recently re-read an old article which was handed to me when I was still a trainee therapist. At the time, I couldn’t fully appreciate what it meant to self-care and have a balanced life. Now I believe it’s a fundamental part of my work, and ironically, one I had to work hard to put in place.

How to prevent burnout and compassion fatigue

The article, written by Vivian Baruch, cites research by other authors into prevention of compassion fatigue and burnout. For therapists (and other professionals) to stay motivated, an interest in activities unrelated to their work, engagement in spiritual and personal development and social support were some of the main factors cited. In addition to this, she listed some of the strategies for prevention of burnout below:

Don’t go it alone

Developing a sense of community and belonging both in our professional and personal lives to combat isolation and ‘refuel’.

Maintain a beginner’s mind

Learning something new such as a sport or hobby relieves us of the burden of being experts. Maintaining a beginner’s mind helps us stay open and curious in relation to our clients, loved ones and the world around us.

Prioritise

As a society we increasingly work harder and for longer hours. Simplifying our lives involves a shift in mindset from economy-driven fears to prioritising a less stressful life.

Heal and nurture yourself

Looking after ourselves physically and emotionally is a daily task. Recognising when it’s time to go back to therapy when old issues resurface, eating well, exercising and having a spiritual/mindful practice are all ways to ‘keep in check’.

You are not ‘it’

Ultimately, burnout involves losing touch with our needs and our centre. We all need ways to reconnect with ourselves and a sense of meaning and purpose. We are responsible to and not for others.

Sam Jahara is a UKCP Registered Psychotherapist, Certified Transactional Analyst and supervisor, working in private practice in Hove and Lewes.

Further reading on the theme of self-care:

Four domains – maintaining wellbeing in turbulent times

Steps to a calmer mind

A daily practice to manage emotions

On having a daily practice

Self-care

Click here to download a PDF version of this post.

Click here to listen to our podcast on this post.

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