Brighton and Hove Psychotherapy

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Mental Health Problems in Brighton

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

Do different cities have specific mental health trends?

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

The demographics of Brighton

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

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

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

Millennials and mental health

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

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

Drug and alcohol use

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

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

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

The LGBTQ community and feelings of not belonging

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

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

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

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

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

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

 

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

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

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Understanding Sexual Desire

All couples in long term pairings know something of the vicissitudes of desire. The sexual intensity that more often typifies the early stages of a new relationship cannot remain the same over years of familiarity. The up close and personal experience of day to day coupledom means witnessing one’s partner in their least attractive states, both physically and mentally. The intimacy of familiarity is double edged. Whilst bringing a sense of safety and security to a partnership it  inevitably over time erodes an experience of the unknown, of mystery and “otherness” in which early attractions were ignited.

The capacity for surprise enjoyed by new lovers is intoxicating, the investment in pleasing each other extremely high…each person keen to present the best possible version of themselves. This stage of idealisation is both necessary and natural but inevitably gives way to a more complex intimacy as couples get to know each other as whole (flawed) people….for better and worse. A sense of responsibility grows wherever we find ourselves caring about the well-being of another. Discovering the fears, insecurities and sensitivities of someone to whom we are growing close adds a layer of emotional complexity that on entering the bedroom can, over time become a vampire to desire.

 Sexuality and Shame

A shameful secret in many relationships today is a lack of sex. Diminution of sexual desire has become a source of shame (and blame) in a cultural context in which desiring and being desired are highly valued. The idealisation of sexual intensity becomes a burden to many people who experience its absence as a private and very personal failure. Many couples are plagued by the doubt that they are not having enough sex or at least enough of the right kind of sex. All too many people believe that something about their sexuality is either abnormal or wrong. With the exception of new lovers at the height of their infatuation vast numbers of people in our culture feel less than happy with their sexuality.

Our sexuality is forged in the cauldron of family life and cultural context. So attuned and wired are we to the feeling states of our early carers that it is virtually impossible to imagine a childhood utterly free from any feeling of guilt or rejection. Our sexual fantasies and preferences are always creative solutions to unconscious problems. They arise from a need to transcend feelings of guilt, worry, rejection and helplessness. To a large extent these feelings are an inescapable part of the human condition and sexual desire will always have to navigate the complex landscapes of our internal subjectivities.

Pleasure and Pain

Beset, as is so often the case by painful judgements, it would seem a courageous enterprise to seek a greater understanding of our sexuality. We might develop greater tolerance and compassion both for ourselves and others when we learn more about the very important personal (and cultural) meanings in our sexual responses and attitudes. Taking the shame out of sex and broadening the conversation about our appetites need not be a passion killer….  The unrelenting grip of shame over time undoubtedly will be. At the end of the day, sex will most likely always remain complicated but understanding its dynamics need not put a dampener on pleasure. A failure to do so may make pleasure far harder to share.

 

To enquire about psychotherapy sessions with Gerry Gilmartin, please contact her here, or to view our full clinical team, please click here.

 

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 –

Reflections on freedom and security in a turbulent year

Reflections on getting back to normal

The Passage of Time and the Discipline of Attention

Intimacy: pillars and obstacles

Love and Family

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Pornography and the Online Safety bill

Having just come off a phone call with the Child Sexual Abuse and Exploitation Policy Lead, my thoughts have been drawn to the enormity of the problem we face with pornography and the ‘pornification’ of society, particular the world of young people.

Pornography use has become ubiquitous and normalised to the extent that increasingly the world of pornography seems to influence and infiltrate wider society through body shape, appearance, hair removal, sexual behaviour, dating, all the way through to the core of our identity.

From my perspective as a clinician, I have no particular moral take on what consenting adults do behind closed doors and indeed, it is my job to hold curiosity about this as with any other aspect of my clients’ lives.  It could be argued that pornography falls into this category.  However, whilst I have no particular moral take on (some) aspects of pornography (consumed by adults), I have a strong healthy perspective on the issue much like I do on the consumption of alcohol for example.

A person may choose to live their life drinking a bottle of wine per night.  Other than this they don’t negatively impact society, they maintain a job and pay their way in the world.  However, I would hold a health perspective on this issue and whilst as a lay person I am as aware as anyone else about the physical health risks of excessive alcohol consumption, I believe that in my role as a psychotherapist I can claim an expert position on the mental health impact of excessive alcohol use extending to the wider social context.  And so it is with pornography.

It is easier for anyone to access pornography via the internet than it is to buy alcohol.  At the very least, alcohol must be physically purchased and paid for whilst porn is free – in the monetary sense.  However, I believe that what seems free to consume is in fact a Faustian deal in which the consumer sells their soul – in this case their mental and emotional health.

It is also extremely disturbing and concerning that it is easier for children to access pornography of virtually any description than it is for them to be able to access alcohol.  Let’s be clear, I am not advocating children have access to alcohol, however surely it should be at least as well regulated and policed and the risks considered? To date, the impact of pornography use by children, teenagers and young people has been vastly underestimated and as a mental health professional, I and my colleagues see the fallout of this.

We face a pornification of society whereby the young now trade in sexual pictures of each other and sexual acts that would until very recently have been considered ‘fringe’ at best, have become normalised such as non-fatal strangulation.  The effects of this pornification of our young is leading to enormous self esteem issues, relational problems and mental health conditions such as eating disorders, depression and anxiety.

As a society we therefore need to safeguard children from child abuse – and to be clear, permitting children to view pornography constitutes child sexual abuse.  The online safety bill aims to do just this – it is imperfect and won’t solve the problem in that legislation can never solve social ills, however the first port of call is to safeguard children and then a more nuanced consideration of the insidious effects pornography is having on society can take place.

Psychotherapy is about relationships and at its core it is about helping clients to have a healthy relationship with themselves and others in a two-person world.  Pornography is by its very nature perverse – it is narcissistic and is about voyeurism and exhibitionism rather than relating.  It is therefore by its nature in conflict with the very essence of the psychotherapeutic journey and a healthy society.

 

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

 

Further reading by Mark Vahrmeyer

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

 

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I Never Thought My Son Would Watch Pornography

It was a decade ago that was listening to the radio when I heard this line being spoken for the first time by a mother who was describing the time the police came to her house to enquire after certain pornographic material which had been downloaded using the family IP address. She described the early morning raid by the police, the taking away of the family computers, the suspicion hanging over her husband – until it was discovered that it was the couple’s 14-year-old son who had viewed the material in a curiosity-driven trawl through multiple pornographic internet sites.

That may have been the first time I came across that line, but I have heard it many times since in the intervening period as I have moved into work supporting young boys and men in their efforts to free themselves from their addiction to online pornography.

Pornography and the Adolescent Brain

There has been considerable research in recent years into the effects of consistent use of pornography on the adolescent brain and, indeed, on the brain in general. To summarise a complicated process briefly, the plasticity of the adolescent brain (with all brains, actually), combined with a leaning towards hyper-arousal when it comes to matters of sex, leaves the teenage child prone to a vulnerability of dependence, which can be frightening in its speed and grip. The reward centre of the brain is hard-wired to be stimulated and demanding when certain things connected to the propagation of the species are on offer. Food and drink come to mind – but sex is important, too. As a species, we need to have sex to survive.

For the young adolescent, perhaps still some years away from a sexual encounter with a real person, the online world offers instead a kaleidoscope of sexual experiences at the touch of a button. In the secrecy of their bedrooms they are free to explore material that would have been unimaginable (certainly illegal to print) just a few decades ago. The brain does not know the difference between a computer and a real person. It just knows that its owner is excited sexually. Its reward centre is activated, and it releases that precious drop of dopamine, which will prove to be both curse and blessing, the first step on the road to addiction. To put it bluntly, for the child, it feels good – and the brain will begin to lay out the neural pathways which will make it easier to access that feeling in the future. As in all things – from football to depression – the brain gets better at what it practices.

As the boy becomes more habituated to the use of the pornography, so it becomes more difficult to achieve the level of arousal that was easily done on first viewing. In essence, the brain is developing a level of tolerance. The user has to find newer forms of stimulation – generally much riskier, more challenging sites – in order to satisfy the brain’s demands and to receive that precious dopamine hit. It becomes more difficult to focus on one item. The user will begin to hop from site to site in an effort to find the ‘best bits’; the whole purpose will become about gratification, generally marked by masturbation, which once achieved, is the signal for the whole cycle to start again. It all feels so natural. There are no drugs involved – apart from the delicious ones supplied by the brain. The parts of the body that react are doing so naturally. What can be wrong with something that feels so right?

Boys and not girls

The research on girls’ use of pornography is scant, but what does exist points to their usage as being considerably lower, and less frequent, compared with that of boys, something supported by anecdotal dealings with young people. Although many young girls (estimates suggest as high as 40%) will have viewed pornography, this is more likely to be out of curiosity rather than habitual usage. This might be partly cultural, partly to do with the way arousal works and develops in adolescents, partly to do with the interest in internet activity shown by girls generally (interestingly, figures in gaming addiction, a process which ‘piggy-backs’ on to the reward system, has similar figures in favour of boys’ dependency), and significantly to do with the type of pornography available, which is overwhelmingly produced for the gratification of men, with women in the role of the passive provider. Even the dominatrix – which alludes to a degree of power for the female – is a male construction, designed to gratify male desires. Given this context, it is no surprise that even into adulthood, the vast majority of pornography is consumed by men.

Meanwhile, in the real world

At the young man develops, they will want to practise their sexuality in the world around them. The difficulty for them is that their brains, accustomed now to being aroused by digital sexual-stimulus, will already have an idea of what sex looks and feels like, how their partner should behave and, significantly, they will already have internalised an idea that sex is something that involves their gratification. The notion that giving pleasure to others might be a fulfilling part of sexual engagement is something that is beyond their experience – even though their experience in some respects is a considerable distance ahead of where it might be in a non-digitalised world. For the habituated user of online pornography, it can be very difficult to come to terms with the fact that the person within their arms has feelings and desires which are unlikely to conform to those who have aroused their senses online. The online world will often present an exaggerated view of sexuality: breasts and penises are larger; bodies are firmer; all imperfections (and hair) are removed. For the habituated user, it can be very difficult to achieve any kind of arousal, and desire is lost – only to be found again back in the online world, where the brain, comfortable, primed and ready, can once again be gratified.

There is another difficulty that habitual users have to face. Their online experience will have normalised certain aspects of sexual behaviour that in the real world would be considered shocking or taboo. Even on the blandest pornographic sites freely available to all, one will find countless ‘sex with my stepmother/ sister/ etc’ as titles. It is as though it is the most normal, routine practice in the world. There really are no boundaries.

Disadvantaged Parents

It would be easy to be judgemental with parents whose children become habituated to online pornography. But there are a number of reasons for their ignorance and then denial regarding the habits of their sons. Firstly, unless they have used pornography themselves, they will have no idea how much is available – unfiltered, free and without the requirement of age verification – at a simple click of a button. It is hardly their fault that they just don’t know what they don’t know. Secondly, as pornography and issues more widely to do with sex are practised in areas of secrecy, there is often a barrier of shame which makes any non-judgemental discussion of the subject impossible for parents and children. Thirdly, and linked to the former point, the image of their children that many parents carry in heads often allows no room for an activity they themselves would find abhorrent. It is why so often when parents come to see me with their sons, they are in a state of shock. It is not unusual for them to apologise for the fact that their son is in this position, claiming plaintively that they ‘never thought their son would be using pornography.’

As youngsters become men

Unfortunately, many adult men who have to deal with addiction to pornography fail to do so until they are much older. Many of the clients I have worked with on the issue have endured many years of habitual use before being forced to seek help by circumstance rather than because they see it as a problem. It might be to with failed relationships; it might be because of worries to do with their increasingly poor sexual performance in real relationships – often manifested in low mood, anxiety or depression; or it might be that their sexualised treatment of a partner or friend is not appropriate for one reason or another and they feel a strong sense of shame. This last is perhaps worth highlighting as it has been the topic of national debate recently.

One of the dangers facing habitual users of online pornography is that they must deal with a blurring of the lines between what is real and what is imagined. Of course, we all do this to some extent when we watch a television show: we are adept at sorting what lies either side of that line between the real and the imaginary. But these television shows are not tapping into the reward centre in our brains; they are not linked to our areas of desire, gratification and reward as is the sexual instinct. On top of this, for many young people, they will have no experience outside of their online practices to guide them as to what is appropriate or not. They haven’t yet learned what is normal. If they make a mistake in this area, they could be left with a legacy of shame and regret – or much worse if their actions pass into illegality.

What can parents do?

My advice to parents is always very clear on this. Before you do anything else, contact your internet provider to make sure your controls are locked down – and never share your passwords with your children, or even enter a code when the child is in the same room. It is another story, but never underestimate the ingenuity of young people for discovering their parents’ passwords! Then talk to your child. Be curious. Take a parental interest in their internet history – not in a judgmental way, but one which seeks to understand what is going on for that young person. If your son is using pornography habitually, seek support for yourself and for them. Do not ignore it, for in any number of cases it will not go away. Research indicates that those who become addicted to online pornography are likely to be prone to low mood and depression, not surprising given that they may well be living a kind of double life, a part of which exists in a place of secrecy and shame. Those last two bedfellows are hardly the harbingers of happy, fulfilled lives.

 

Kevin Collins is a UKCP registered Psychotherapeutic Counsellor with an academic background in the field of literature and linguistics. He worked for many years in education – in schools and university. Kevin is available at our Lewes Practice.

 

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

 

Further reading by Kevin Collins –

Why is it hard to make decisions?

Communication, communication, communication

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Care for a Dance?

The considerable volume of writing on relationships is littered with metaphors to explore the intricate connections between people. Most frequent might be images of journeys (‘we had come to a crossroads – an obstacle’, ‘it always seems uphill’); of chemistry (‘I felt the spark had gone’; of sport (‘out of my league.’ ‘own goals’); even, of war (‘battles, bombs and victories’). There are many such in the lexicon, each proving useful in examining particular aspects of the emotional engine of relationships.

Dance as Metaphor

One of the most useful metaphor in working with couples is dance. It is an analogy which allows many of the complexities of a couple relationship to be examined. We might think about the negotiated ‘choreography’ – the way in which the individuals move symbolically in relation to each other and how distance and closeness might change according to the dance being played out. Or we could consider aspects of control, of who wants to take the lead (or give it up) and what this tells us about the relationship overall.

You do not need to be an expert on dance to understand that being in the moment and moving with some other person in the same space is going to take a degree of synchronicity. At times it will require that one leads as the other follows. And, inevitably, in keeping all things in balance, there will some testing periods in maintaining a consistent distance between the two protagonists, particularly as the music undergoes a change of dynamic. What seemed quite manageable in one context, can feel overwhelming in another.

What’s Your Role?

The roles agreed by the dancing couple are contracted quite consciously, but within a relationship that negotiation is often unconscious. As skills and desires change or grow, so the individuals might feel uncomfortable in their prescribed role – no matter how happy they might have been in that role previously. In the initial stages, one partner might have been happy to cede control, to allow themselves to be led and to enjoy the feeling of a protective and guiding presence. However, what once felt protective, might now feel smothering; what once felt guiding, might now feel controlling; where once we were happy to follow, now we want to lead. Understanding and making conscious these roles is important in avoiding resentment and anger.

When the dance gets difficult

When the dance flows, it feels effortless – but it can feel hectic. So much change, so much required – and on the hoof! It feels overwhelming at times – and may even make us think that giving up dancing altogether might be the answer. Perhaps we need a re-set – one where we would do well to remember that dance – like relationships generally – is one of the most natural, most primal of human activities. Our oldest human ancestors would have swayed in time to the beat of a drum – and they would have moved symbolically in likewise rhythm with family, friends and partners.

Learning to accommodate change – or doomed to repetition

The threat to us is not from the dance itself – after all, we well know how joyful and life enhancing it can be. The real threat is change. As the inner worlds of the protagonists seek to find meaning and expression, so the relationship plays out and the couple move around each other – closing and distancing, leading and following, taking and ceding – in a figurative dance within which both participants are testing and exploring their worlds. Change is likely – but it will not necessarily be synchronised. And neither will it necessarily be well communicated. Toes will be stepped on; profanities will be muttered. We may even believe that, with another partner, our dancing would be so much better. And so, we do that: we choose another partner. We begin another dance – closing and distancing, leading and following, taking and ceding – our inner selves being acted out repetitively until we learn to better understand ourselves and how we relate to the people around us – until we learn how to dance better!

 

Kevin Collins is a UKCP registered Psychotherapeutic Counsellor with an academic background in the field of literature and linguistics. He worked for many years in education – in schools and university. Kevin is available at our Lewes Practice.

 

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

 

Further reading by Kevin Collins –

Name that Tune

I never thought my son would be addicted to pornography

Why is it hard to make decisions?

Communication, communication, communication

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Why do ex-boarders find intimate relationships difficult?

What is the purpose of intimate relationships?

This is a question I often ask couples who come to see me for couples therapy. Most cannot answer the question beyond the superficial. However, it is an important question to ponder: relationships are not easy for the most well-adjusted of us and so there has to be a fundamental reason why we (generally) choose to pair bond (be in a committed intimate and romantic relationship with one other person).

I believe that we choose to pair bond as on an unconscious level it is the closest that we can come as adult humans to replicating the ideal) experience of childhood where we had a parent who was there for us, who would listen to us and who, most importantly, would help us make sense of our feelings so that we knew we were not alone. This is essentially what strong functional couples do – they listen to each other and try and work out what feeling their partner is trying to convey to them. The general term for this is empathy.

I therefore believe that this explains what we all want and why we all go into relationships. And also why so many of us keep on trying to find ‘the right person’ even after so many disappointments.

What happens to boarders?
Ex-boarders also harbour hope of a good relationship, however, may be at odds in identifying one. The attachment damage they have sustained and the abandonment (couched in privilege) that they have experienced, leaves them unconsciously yearning for that idealised mother who will be there unconditionally for them. Of course, what they eventually find in any relationship with another adult is that they are not in an unconditional relationship (no such thing exists) and then they withdraw to avoid being hurt or disappointed.

What does it look like?
We are all different and so are ex-boarders, however, many have some traits in common which I shall list:

Ex-boarders tend to-

  • Withdraw emotionally from relationships in order to keep themselves safe and default to their indolence survival strategy;
  • Struggle to make sense of what their emotions are telling them and lack the ability to navigate them without becoming overwhelmed: ex-boarders are good under pressure until they are not;
  • Have an over-reliance on logic and rationality to make sense of the world – this does not work when confronted with a partner who is trying to share their emotions;
  • Regulate (read manage) their emotions by controlling their external world – exercise, career success, sex, alcohol, drugs etc. Some may be less harmful than others but all show an inanity to be in contact with their inner world;
  • Live a pseudo-life where they can never really allow themselves to feel alive as that can only happen through bringing themselves fully into relationships and navigating their needs through communicating boundaries.

What can be done?
The effects that the abandonment a child suffers from being sent to boarding school can be enormously significant. Often ex-boarders will only resent for therapy when they have ‘hit a wall’ in some way.

Psychotherapy can help and indeed is the only way to remap the brain and help ex-boarders come to life. As the damage is relational, the only remedy is a therapeutic relationship where the cut-off feelings of loss, abandonment and emptiness can be retrieved and experienced in the safety of a psychotherapeutic frame.

 

The term ‘Boarding School Syndrome’ was coined by Jungian analyst Professor Joy Schaverian around a decade ago. Since then, it has gained significant traction as a model for explaining the experiences and symptoms of adults who were sent away to boarding school as children.  Please refer to Mark’s previous blog.

 

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

 

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 ready by Mark Vahrmeyer –

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

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Understanding Sexual Fantasy

The exploration of sexual preference and fantasy in therapy can be a portal to our inner psychological landscape. Unlocking the unconscious logic of sexual fantasy is one way of casting  a light on our internal world and of understanding the emotional and psychological difficulties that may have prompted us to seek therapy in the first instance.

Our sexual scripts are formed in infancy, long before the onset of mature sexual desire. Our early attachment experiences and the familial and cultural context into which we are born inform the psychological maps and templates for being (in the world) to which we both consciously and unconsciously refer as we develop and grow. We are evolutionarily wired and sensitively attuned to the moods and feeling states of our caregivers absorbing them all through a process of psychological osmosis.

The conflict of growing up

Whilst our lust and capacity for pleasure (according to the Freudian account) are instinctual, the road to pleasure is more often than not a complicated one. We are likely to experience myriad obstacles along the way (many that will later inform our sexual fantasies) guilt, shame, fear, rejection may all stand in the way of our experience of pleasure. We all (consciously or otherwise) feel guilty about something. Life is fraught with conflict – and from the get go. The conflict (for example) between our attachment to our families and to the developmental imperative to grow up, individuate and leave them is fraught with guilt and worry. We bring these unresolved and largely unconscious conflicts into our erotic lives.

The creativity of fantasy

The child of a depressed parent may grow up with a powerful sensitivity to and identification with the sadness of others. It may be hard for such an individual to fully connect to their own aliveness and vitality as sexual excitement is fundamentally incompatible with depression. In the imaginative realm of fantasy such an individual may be released from the burden of caring by populating their fantasies with dynamic carefree people, aroused, excited and turned on. It is not hard to understand, in this scenario, that when everyone is having a great time (and no one is depressed)  the fantasy serves as a creative permission to connect, without guilt or shame to one’s own desire.

An antidote to trauma

Many sexual fantasies can seem puzzling and hard to understand. One person’s turn on is another’s turn off after all. Arousal for some may come through being tied up and whipped, another’s from phone sex, group sex, sex with a stranger(s), etc, etc. All are plots of desire, many are attempts to draw on and transform past trauma. When someone is cruel or aggressive  in their sexual fantasy or practice it is not because they are inherently sadistic but rather that they are trying to solve a problem. It may be useful and illuminating to consider and understand why the normal pursuit of pleasure may require a particular imaginative scenario in order to be safely experienced.

Empathy and ruthlessness are important aspects of a healthy sexual relationship. Too much empathy (for the other) may be a dampener to our own desire and too much ruthlessness may render sex mechanical and devoid of emotion. Sexual fantasies can be attempts to counteract or transform beliefs and feelings that may interfere with sexual arousal and can provide an elegant ( if not always politically correct) solution to the problems of ruthlessness , guilt and shame.

When we  understand our sexuality we understand ourselves.

 

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

Fear and hope in the time of Covid

Relationships, networks and connections

Paying attention to stress

Why does empathy matter?

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What is Andropause and what happens to men when their testosterone levels decline?

Schools will soon have menopause on the curriculum. Largely due to the efforts of psychotherapist Diane Danzebrink and her #MakeMenopauseMatter campaign. In 2019 Education Secretary Damian Hinds confirmed menopause will
become part of the Sex and Relationships curriculum for teenagers in the UK in Autumn 2020 alongside periods and pregnancy.

With the recognition that menopause needs to be better understood in the broader context of sex and relationships perhaps now we can begin to talk about men’s experience of changes in their hormones. Testosterone is the main sex
hormone (androgen) in men and the symptoms that men can experience as a result of reduced testosterone are called andropause. The hormone testosterone plays a role in the production of sperm, in the drive to have sex, in building muscle and bone mass, in the way fat is deposited around the body, in the facial and body hair patterns found in males and their deeper voices.

Men will experience hormonal changes as they age, levels of testosterone will start to decline from around 30 at approximately 10% every decade. It is important to note that testosterone reduction can also be affected by other
factors such as injury, cancer treatments, medication and chronic conditions including diabetes, obesity, kidney and liver disease. Symptoms include a lower sex drive, loss of body muscle and an increase in body fat, decrease in bone
density, fatigue, insomnia and difficulty attaining and maintaining erections*.

From research by the Centre for Men’s Health Clinic in Manchester, looking at men over 50 in the UK, Dr Malcolm Carruthers says: “Of the ten thousand men surveyed actually 80 per cent had moderate or high levels of symptoms suggesting they had testosterone deficiency. This shows that its not the rare condition that some doctors claim but actually its very common and almost totally untreated.”

Symptoms described by two patients attending the clinic and suffering from low testosterone, defined as Testosterone Deficiency Syndrome, share features with women’s accounts of menopause.

“Well I was 55 or there abouts and I was getting perspiration in my shirt and was getting really wet, I’m talking serious perspiration, tiredness and I had a lot of muscle aches particularly in my legs”.

“I was a fishing skipper for 23 years and was the type of person that woke up in the morning and rolled out of bed and was on the job, something to do” …  Then when I reached the age of 55 I began to feel that I was flagging and I got all sorts of strange to me symptoms, aches, pains, horrendous sweats and uncontrollable temper.”

What about the mental and emotional aspects of andropause? We need to acknowledge and better understand andropause and the impact on men and their lives and relationships. Symptoms of andropause include mood swings,
irritability, low-self esteem, memory and concentration problems and depression. These are familiar menopausal symptoms for women, however it may be harder for men to acknowledge these symptoms and to ask for help
because they are associated with female menopause.

 

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

 

Further reading by Angela Rogers –

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

 

References –
Diane Danzebrink
https://twitter.com/hashtag/makemenopause

Centre for Men’s Health Clinic
Associated Press Television 11.3.2011
https://youtu.be/33aCzR4U9l4

*See an earlier blog about men’s use of Viagra here.

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What is it like being in a Psychotherapy Group? Case study – Joe

In my experience, when exploring joining a therapy group, people often ask what it will be like. I thought it might be helpful to write a fictional narrative to give a flavour of the therapeutic experience of being in a group. This ‘case’ is not based on a real individual although some of the conflicts and difficulties will undoubtedly feel familiar to many. To keep this blog as a short read, I have simplified the details, and have focussed on just one aspect of a person’s history, difficulties, and group experience.

Joe

Joe would always say his childhood was fine. Nothing bad or traumatic happened. No real problems. As an adult, however, Joe felt increasingly alienated in his life and relationships.  In particular, he had struggled to maintain long-term relationships, which was causing him pain, disappointment and worry about the future. 

After his last relationship ended in a familiar way, Joe came into therapy with a sense of loneliness and emptiness. Through discussing this with the therapist, Joe came to feel that a group might be helpful for his difficulties.

Early stages

Once in the group, Joe found that by listening to the way others talked about their experiences, and hearing their feedback to his own, he could start to formulate some different perspectives on himself. 

Particularly new for Joe, was an insight into the ways he had felt neglected as a child. Joe began to connect old memories and recall new ones which gave a picture of a lonely child overlooked by two busy and distracted parents. It was a shock to recall this vulnerable and neglected younger self.

Joe was immediately struck by the supportive and open atmosphere in the group. At first, he found the curiosity and empathy that other group members showed towards him strange. Over time the other members pointed out how often he dismissed his emotional experiences, and the ways that he avoided being taken care of in the group.  Joe realised this was the first time in his life where he felt his emotional needs might be important. 

New Insights

Accepting that his early experiences might have been difficult and impactful was the first step for Joe. He began to realise how he had developed an emotional independence as a means of survival and had therefore set out to deny the needy part of himself. Keeping his needs at bay also required creating a distance between himself and others. Joe was desperately fearful of this defensive system falling apart, and of being thrown back into the loneliness of his childhood. 

A few months in to being in the group, Joe had an important insight that his relationships often began to fall apart around the same time that he started to feel an emotional commitment. Joe’s break-through was heightened by being able to link this to what he was discovering about himself and the feedback he was getting about the way he pushed people away in the group.

As time went on, Joe was able to open-up more in the group. He explored the patterns of relationships failing and was also able to learn from others who also reflected on their own historical and current relationship struggles, as well as developments and successes. 

Making External Changes

After about 18 months Joe was feeling settled in the group. He had started a new relationship, and with the support of the group was more conscious of what was getting stirred up in him and mindful of his impulses to escape the intimacy this person offered him. 

Crisis

The group had helped Joe get in touch with the painful experiences of his childhood that he had tried to deny and avoid. He found himself increasingly in touch with emotional needs that he had not had sufficiently met as a child. This made it harder to tolerate the times in the group where he felt unheard or overlooked. The more Joe opened himself up to his need, the more he felt wounded and frustrated when it was not met. 

Joe announced very suddenly that he was going to leave the group. The group members questioned the timing of this decision and Joe agreed to give it more time and thought.

The group and therapist helped Joe to think about the parallels with the times in his life where he tended to finish a relationship just as it was beginning to be. Joe realised that the frustration and upset he had been feeling in the group was bound up with intimacy. He started to see that leaving at this point was another way of avoiding the frustrations of having intimate relationships. Being able to make a link between what was happening to him in the group and his pattern of relationships helped Joe to properly understand himself on a profound and deeper level. 

3 years on, Joe is still in the group. Last week the other members and therapist were delighted when he told them he and his partner have decided to get married. 

Discussion

Joe benefited enormously from the therapy group from the outset and had been able to make significant progress and changes in his life, However, it was when his ‘problem’ manifested in such a live way in the group that something was able to transform on a deeper level. Joe’s frustration with the group was a turning point in his therapy as he had to confront pain reminiscent of his childhood and see how his habitual strategies of ‘ending’ relationships was a way of avoiding the reality of intimacy. 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

What is loneliness?

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Love in the time of Covid

I admit the shameless plagiarising of the title of Gabriel Garcia Marquez’ – ‘Love in the Time of Cholera’ as it fits as a Segway into considering the tresses and strains of both finding love, and holding onto in, in the current pandemic. 

The statistics

Disturbing statistics are emerging of surging rates of domestic violence, sadly predominantly perpetrated by men upon women, exacerbated by the circumstances brought about by the ‘lock-down’. A surge of somewhere between 25% and 35% in the rates of reported domestic violence hide all that goes unreported. 

Alongside the extremes of domestic violence lie other statistics such as the reality that many couples have suddenly been catapulted from spending a couple of hours per day together, to inhabiting the same space (indoors and out) for the entire of the day. A young couples dream has become many seasoned couples challenge (and for some a nightmare). 

On finding love 

The old rules of dating have gone through a revolution in recent years from what dating constitutes, through whom we date (gender fluidity) into how we date revolutionised by the internet. 

However, suddenly, the seemingly endless supply of opportunities to physically meet others has dried up with us being left with all the tools and little of the substance. We can swipe left or right, however, we cannot meet those we like (unless we risk social judgement and our own physical health – both of which may paradoxically make the whole encounter that much more exciting). 

Referring to statistics, there has been a surge in pornography use as those who are isolating alone seek out some virtual simulation and those isolating with partners seek out some sense of novelty. Throw into the mix the likely enduring requirements for ‘social distancing’ and it raises questions around what dating may look like going forward? 

On keeping love 

Coping with ‘lock-down’ can be challenging on any relationship whether new or old, robust or fractured. That is because relationships all rely on certain key ingredients that make relating possible – all of which have been outwardly challenged during lock-down.

Space 

It is abundantly obvious that for all of us, our physical worlds have shrunk down. Socialising, leisure trips and the distractions of shopping have all been taken away. And many of us find ourselves cooped up for 24 hours per day (bar the ubiquitous exercise sorle) with our partners. 

Negotiating physical space is always a part of a healthy relationship involving discussion, negotiation and compromise. The world of Covid lock-down has amplified this and with it the requirement to communicate effectively around personal space. In lieu of healthy communication, some couples find themselves acting out and reacting to what they perceive as intrusions by the partner, when their partner is probably trying to carve our a little space for themselves too. 

Boundaries 

Boundaries are similar to space though in this context I shall be referring to them as the management of internal space – emotional closeness and distance. In any relationship, no matter how healthy, it is very unlikely that the two protagonists (or more if you are polyamorous), have the same needs for emotional intimacy. This is inherently frustrating. More so now than ever, but remember, it is also a simple truth of being in an adult relationship with another adult (rather than regressing to the fantasy of a union between mother and infant). 

Boundaries need to be explicitly named and negotiated and naming how one is feeling (taking turns to do so) is a key foundation in managing boundaries: if we know what we are feeling then we can communicate it. 

Difference 

The two former headings bring me neatly onto the concept of difference. One of my pet hates is when couples refer to their partner as ‘my other half’ or some iteration of this fantasy merger. 

Being in an adult relationship with another adult means having to tolerate reality – the reality that our partner is different to us and therefore has different views, thoughts and feelings to us, irrespective of how odd we may find them. 

When tensions are heightened (cue the Covid lock-down), humans can find difference threatening and will seek out consensus and similarity. This happens of a national scale where many differences are (temporarily) put aside for the common good and presents itself in relationships too. The problem is – it is an illusion. 

Sure, we can all agree to put aside differences in challenging times in order to achieve a goal, however the differences remain. And in lock-down, those differences are far less likely to be ‘life or death’ issues between couples and far more likely to be around an opinion about a film, a meal, or some other triviality that when mixed with anxiety, becomes evidence that just perhaps our partner is rather mad and not the right person for us to continue our journey through life with in the post Covid landscape. 

Couple who genuinely fare well in daily life in terms of negotiating and compromising; in observing difference no mater how hard it is – the cornerstone of empathy – will fare better in this crisis. 

The third table leg 

We all know that in order to build a stable table a minimum of three legs is required: two leads to instability. The same goes for relationships – not that we need a third person in the relationship – just the spectre of a third. Let me explain: 

Relationships are a complex balance of wanting to be one with our partner and suffering the frustration of knowing that that cannot happen. To get too close kills the relationship as the couple can no longer see each other and the relationship becomes a merger – a fantasy re- enactment of the womb experience. Too distant an intimacy and connection is not possible – this the the couple dance. 

For many couples their partners interaction with the outside world makes them interesting and enables each to see the other as a separate person who has a life outside of the relationship. Couple work, play and socialise, at least in part, separately. And this is the way it has always been and remains in tribal communities such as, for example the Aboriginal communities of Australia where ‘men’s business’ and women’s business’ was culturally and ceremonially embedded so observe difference. 

Under Covid, many of us have lost jobs, are being paid to stay at home or are trying to work from a co-living space with our partner – we no longer have to wonder about the ‘mysteries’ of men’s and women’s business as we are exposed to it 24 hours a day. The third table leg has become decidedly wobbly. 

On kindness 

Just like ‘Love in the Time of Cholera’ is not actually about cholera, nor are the current relationship challenges really about Covid and the lock-down. They are about who we are and how we navigate adult to adult relationships sacrificing the certainly or a pseudo infant- adult relationship for one that is real and therefore difficult and frustrating. Marquez’ book is ultimately about the reality of relationships in all the glory and pain and that is what is being brought to the forefront in this crisis for many couples. Being kind to each other is harder than it sounds when so much of what we rely on externally to manage our relationships vanishes in a lock-down.

 

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 –

Coronavirus Lock-Down – Physical Health vs Mental Health

Why psychotherapy sessions should end on time

Coronavirus Induced Mental Health Issues

Coronavirus (Covid-19) Counselling

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Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

The medical definition of sexual dysfunction in women is hypoactive sexual desire disorder (HSDD) that is low or no libido. Like men, women’s desire for sex is effected by all sorts of factors such as relationship issues, bereavement, physical illness and the side effects of medication, job loss or work stress, depression and anxiety, recreational drugs, hormonal changes through aging and pregnancy, child birth, miscarriage.

There are conditions such as vaginismus where penetration is too painful for women to have sex but for the moment I want to look at chemical attempts to address women’s loss of sexual desire.

Unlike Viagra which treats the mechanics of erectile dysfunction, new pharmaceutical treatments in the US that aim to improve women’s sexual problems act on the brain rather than the genitals because blood flow has nothing to do with sexual function in women. At the moment there are no licensed treatments for women’s sexual dysfunction in the UK, but two in US are available for pre-menopausal women, these are Flibanserin (Addyi) and Bremelanotide (Vyleesi). They work by enhancing the neurotransmitters in the brain that support sexual arousal, reducing inhibition and encouraging sexual excitement.

These medications demand some commitment from users. Filbanserin is taken orally every evening whether you plan to have sex or not and Bremelanotide is injected into the thigh or stomach about 45 minutes before sex, no more than once every 24 hours or 8 times in a month. There are side effects such as tiredness, nausea, headache, dizziness dry mouth and these medications should not be taken with alcohol or grapefruit juice, as this may lower blood pressure to a risky level.

HSDD treatments do not claim to make sex any better rather they claim to promote an increase in women’s desire to have sex. The research determines a positive result as a limited increase in sexual activity measured as one more sexually significant event per month.

I have looked at the anecdotal experience of US women posting online. HSDD medication is extremely expensive costing several hundreds of dollars and the jury is out on its efficacy. Many women commented on the side effects, for some there was no improvement and/or the side effects were intolerable but others were extremely grateful for the difference it had made to their sex lives.

In the UK Prelox, a herbal supplement, is marketed as improving sexual function for late reproductive and post-menopausal women. There were no adverse effects during the trials but there it was noted that any improvements maybe due to a placebo effect.

 

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

 

Further reading by Angela Rogers –

New Year’s Resolutions – why change might be so difficult

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

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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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A Couple State of Mind  

This is the first in a series of blog posts about couples therapy.  In this post I want to talk about what Mary Morgan from Tavistock Relationships calls a ‘couple state of mind’.

Why if our partner is ‘right’ for us don’t they understand us completely? There are limits to how much we can ever fully understand or know another person. As we move from away from the early stages of being in love or infatuation it can be disappointing when our partner doesn’t live up to our expectations, ‘You aren’t the person I married!” or “You’ve changed since we first met.”. What we mean is “You haven’t become the partner I imagined you would be.”

When we become a couple we are two separate people with our own ideas of what it means to be a couple and what each of us should be prepared to offer and can expect to receive. These ideas are likely to be based on how we experienced our parents’ or carers’ relating to each other, as well as the community and culture we grew up in. As a couple we will inevitably be sharing psychic space as well as physical space, the tension between wanting to be held and close and wanting our own space and freedom can be challenging.

At times, we might find our sense of our self and our reality is threatened by our partner’s version of what is happening. For example, we might feel our frequent phone calls and texts show how attentive and caring we are but our partner may feel overwhelmed and claustrophobic. One of us may feel it is important to regularly spend time apart to not become tired of each other, but this might make our partner might feel rejected and isolated. These polarised positions highlight the difficulties of holding two perspectives on what it means to be in a couple relationship.

Couples coming to therapy often do not have a sense of themselves as a couple. Thinking about what your relationship needs is not the same as thinking about what you need. This may sound obvious but it is easy to lose sight of when you are finding life is a struggle. One role for the couples therapist is to help partners contain or tolerate their differences long enough to create a shared space to think, a couple state of mind. A couple state of mind can be understood as a third perspective, a position which gives a couple a chance to step back, look at their relationship and explore what they could hope for and create together.

Couples therapy also gives each of us the chance to see our partner relating to the therapist, showing ways that two people can think together in a close and trusting way. Seeing someone as familiar as your partner connecting with another person can be surprising, they can be revealed in a different light. The therapist offers a safe and supportive environment where a couple can think together and explore a couple state of mind, to see if they can continue to develop as individuals whilst enjoying the closeness and intimacy of being a couple.

Morgan, M. (2018) A Couple State of Mind: Psychoanalysis of Couples and the Tavistock Relationships Model. London. Routledge.

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

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Couples Therapy In Practice

Couples can often get into familiar and fixed patterns of relating which can be deeply unsatisfying to both parties. This style of relating is one which can eventually seriously threaten the health and longevity of a relationship. In this brief blog, I open a window onto a session which explores a particular dynamic which I frequently encounter in couples work.

Take the following anonymised example:

A domestic crisis had arisen. The wife responded in her typical style : hurried, worried and outwardly emotional.

The husband responded in his typical style: slow and detached.

The wife read his response as insensitive and abandoning.

The husband read her response as over-the-top and reactive.

The outcome was that he withdrew from the situation, while his wife became more distressed and demanding. This was an unsatisfactory outcome for both.

Swapping Roles

I asked if they would be willing to replay the event exactly as it happened. Then I suggested that they swap roles and again replay the event.

This is what we discovered together. The wife would typically become highly reactive as a way of getting her husband’s attention, of which she was uncertain. The outcome was exactly opposite to that which she wanted. Her husband would withdraw and she would again experience feeling abandoned by him.

The husband would typically become unreactive as a way of protecting himself from his wife’s emotional expression, which he feared.  The outcome was exactly opposite to that which he wanted. His wife became more emotional resulting in him feeling overwhelmed and needing to withdraw.

I chose this intervention as a way for each of them to experience the trigger point which propelled them into their typical ways of relating to each other when under stress.  In other words they both got to not only see, but to feel the ‘game’ which they typically re-played together.

Therapy and Real Life

Research shows us that what is experienced in the therapy space can become real in our outside lives, (Gersie, A., 1995). My experience of working in this active way with clients is that can bring powerful and surprising insights. These insights into our typical ways of behaving, facilitated by a skilled therapist, can lead couples to experimenting with healthier and therefore more mutually satisfying ways of being in relationship.

 

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

 

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The Menopause: Women of a Certain Age

For many women in the 21st century, the menopause leads to a sense of freedom, independence and creativity. Of course, I want to celebrate this, but I also want to talk about less welcome aspects. Culturally, the menopause is still somewhat feared and is something of a taboo. It is also open to derision and often referred to with euphemisms or jokes.

Sharing the experience

Things might be changing. Recently, a few women celebrities have used the media to share their physical and mental struggles through several years of the menopause. I believe that sharing these experiences publicly is especially important in a culture that does not take the reality of the menopause seriously. Think about the photographs of post-menopausal celebrities on the front pages of women’s magazines, looking glamorous with their obligatory bobbed and highlighted hair, subtle yet sexy make-up and carefully co-ordinated outfits. I do not want to dismiss women’s aspirations for wanting to look good at any age, but the demands for women to look sexually attractive can be punitive. The hostility Mary Beard received for appearing on television apparently unmade-up and with her hair worn long and grey is telling.

Physical symptoms and emotional wellbeing

Physiologically, the menopause is the cessation of menstruation and is medically defined as one year with no bleeding. Other physical symptoms include hot flushes, night sweats and insomnia, dry skin and hair and weight gain. We are likely to feel less sexually attractive, whatever our sexual orientation. There may be a drop in libido and physical changes in the vagina can make sex difficult or painful.

Fortunately, there are hormonal and medical interventions that can treat these physical symptoms with some, but not complete, success. Along with the physical changes in our bodies, psychological symptoms related to the menopause can affect our emotional well-being and leave us feeling vulnerable. Changes in how we experience ourselves, such as being unusually grumpy or depressed, voicing our frustrations or losing our temper can be disconcerting and make us wonder if we are going a bit crazy. This is especially so in a culture where women are rewarded for being nice, kind and caring.

The menopause, life events and relationships

The physiological and psychological effects of the menopause coincide with inevitable life events for women in their 40s and 50s. These include decreasing fertility and the end of child bearing or the hope of ever giving birth. In an age of increased life expectancy, the hope of having time in later to do what we have always wanted may vanish as we see ageing parents need care and support. It is also a stage in life when children leave home, another kind of painful loss that can throw the focus onto the dissatisfactions of a marriage or partnership. Long-held resentments towards a partner can be a factor in a lack of sexual desire. If both partners feel less interested in sex, a less active sex life is part of growing older together. However, clinical research tells us that a decrease or cessation of sexual desire and sexual activity is one of the most pressing and distressing concerns for menopausal women (Kolod 2009). It is probably the most difficult to talk about because of a sense of shame and a feeling the situation is hopeless. Depression is an understandable result. For women not in relationships or without children, or affectionate children, the menopause may be an acute reminder of the lack of an intimate or physically loving relationship.

How counselling and psychotherapy can help

Exploring these questions in a safe and supportive environment is a chance to think about and express the experience of the menopause without judgement. In this setting, losses, regrets and unrealised dreams can be grieved without recrimination. Working with a counsellor or psychotherapist can help us come to terms with these physical and social changes and lessen the emotional distress and negative impact on daily life. It is an opportunity to look at what getting older means for us and the choices and freedoms we have to live our own futures.

Reference: Susan Kolod (2009) Menopause and Sexuality, Contemporary Psychoanalysis, 45:1, 26-43, DOI: 10.1080/00107530.2009.10745985

Angela Rogers is an Integrative Psychotherapeutic Counsellor working with individuals in Lewes and Hove.

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