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What do dreams mean?

We all dream – whether we remember them or not. And there is plenty of fascination about dreams and what they may mean, ranging from nothing at all, to being a means and method of understanding a patient’s unconscious.

In 1899, Sigmund Freud wrote The Interpretation of Dreams outlining his theory of the unconscious and describing dreams themselves as being “the royal road to the unconscious activities of the mind’. He therefore found dreams to be hugely relevant.

Is there an unconscious?

If dreams matter, they only do so if we believe in an unconscious and, by extension, unconscious process. Which is to say we believe that we are all, to a greater or lesser extent, driven by repressed ideas; thoughts and feelings that have been repressed – pushed out of consciousness – but that nonetheless make themselves known in our behaviours.

Analytical depth psychotherapy (psychoanalysis) believes and works with the patient’s unconscious. While the means and methods of doing so may have morphed and shifted over time, us analytically trained  psychotherapists believe that the unconscious holds the key to understanding a patient’s inner world.

Freud was a neuroscientist and whilst our collective understanding of the mind was limited in the late 19th century, modern neuroscience confirms that most brain processes take place without conscious awareness and that all brain regions are involved in both conscious and unconscious thought. It therefore seems irrefutable that we all have an unconscious.

Do dreams have specific meaning?

There are plenty of folk who are quick to tell us what our dreams mean based on the imagery present in them. They see the content of our dreams as containing symbolic meaning common to all of us. These are people who often do rather well from their version of ‘interpreting’ dreams, as so many of us have a fascination with dreams and wish to see them as prophetic.

Freud and all those who have trained in real psychotherapy are suspicious of this ‘one size fits all’ approach and recognise instead that whilst dreams are symbolic in nature, the symbolism is tightly connected to the individual, and their circumstances, experiences and personality.

When working as an analyst, Freud used a method called ‘free association’ to gain an understanding of the patient’s unconscious mind, including what their dreams may mean. Rather than imposing his own view on what their dreams meant, he would instead ask a patient to share whatever associations came to mind in relation to their dreams, and from this suggest what they might mean. His approach was therefore collaborative.

What is manifest and latent content?

In depth therapy we do not take the presented content – the manifest content – literally. We see it as being coded content from the unconscious, which we refer to as latent content. The unconscious both wants and does not want to be known. It is where memories and experiences that are too painful or contradictory for the psyche are buried – repressed. And yet, repression is never perfect, and so at the same time the unconscious expresses the needs linked to this repressed material through behaviours and through dreams.

How can we know what dreams mean?

Anyone who tries to convince you that they know what your dream means based purely on the content is a charlatan. Human beings are far too complex for this and understanding a dream can only be done in understanding a person’s history and experiences, and in the context of a relationship.

Even when a psychotherapist knows you well, I would hope that they would not suggest that a dream has certain meaning without asking you what you make of it, and your associations with the symbolism. A dream can have multiple meanings and many only become clear over time.

All this said, dreams can be both hugely interesting for both the patient and analyst, in gaining deeper insight into what has been repressed and is seeking expression.

 

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

 

Further reading by Mark Vahrmeyer –

Is starting psychotherapy a good New Year’s resolution?

Twixtmas – surviving that dreaded time between Christmas and New Year

How to minimise Christmas stress if you are hosting

How do you get self esteem?

Why is psychotherapy generally weekly?

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Exercise and mental health

We have all heard it: exercise is good for you. Exercise can help combat or improve symptoms of a wide range of health conditions from high blood pressure, cardiovascular conditions, diabetes, some cancers, depression and anxiety to name but a few. It can help prevent some of these conditions in the first place, promoting bone density as we get older, supporting weight control, lowering blood pressure etc. 

But it is a big word, exercise. What does it mean? And what are the benefits to our mental health?

At its most basic, exercise is engaging in any physical activity that involves movement and increasing the heart rate beyond sedentary or resting levels. The World Health Organization for example suggests that for physical activity to become exercise we must add repetitions and a goal. We may have heard of the number of steps that we ‘should’ do daily, or how much exercise per week we should strive for. This may be presented in minutes or indeed intensity minutes. The definition changes fairly dramatically depending on where one reads and who the target audience is, which can be confusing. 

What these generic measures can do is prompt us to increase our level of activity and improve our overall fitness – within the bounds of our physical body. Setting a realistic activity goal can be a great way of starting out, whether it is 3000 or 10,000 steps. As always, if you are thinking of significantly increasing your level of exercise, or starting out on your exercise journey, it is best to consult a medical practitioner first.

Apart from fitness and physical wellness, some of the neurobiological benefits experienced as we increase the amount and intensity of exercise, can significantly impact our mental health. 

The most well-known one is the release of hormones called endorphins when we are engaged in intense exercise. We may experience a euphoric feeling and a sense of happiness that can last for hours after exercise, sometimes called ‘runner’s high’ although it may be experienced with any intense exercise. Endorphins also act as a natural painkiller, reducing our perception of pain. 

Exercise can also boost the production of neurotransmitters such as serotonin and dopamine, and these can help balance our mood. There may be a reduction in the release of stress hormones such as cortisol, and added to the physical release of tension in the body, we can experience less stress. 

Although it may seem counterintuitive, exercise has been shown to improve symptoms of fatigue and tiredness, promoting oxygen circulation within our bodies, and giving our cell’s mitochondria the oxygen they need to produce energy. Along with this, we also may see an improvement in concentration and alertness.

Exercise can promote quality sleep which is crucial for mental health. After exercise we can fall asleep faster and sleep deeper, meaning we wake up feeling more energised, well rested and better able to tackle the day ahead. 

The psychosocial benefits of exercise are well documented. A team or group exercise gives social interaction and even community. But even going for a brisk walk on our own can improve our mood as we step out of our usual environment and have a sense of the world beyond ourselves. We can take a moment to notice our breathing and perhaps even be thankful that we are breathing. 

We may notice an increase in our self-esteem and confidence as we take control of our bodies and our routines. Seeing physical changes and improvements through setting and achieving realistic goals can be empowering. As we start to get more in tune with our body, we can feel more ‘embodied’ and rooted in the world and this can help us feel more present, taking us away from our distracted lives.

Stepping away from our normal situation and engaging in exercise can help us bring back perspective that might be lost when we are stuck in an anxious or depressive cycle. Exercise can give a release of the tension that anxiety can cause, and take us away from our anxious thoughts, giving us a healthy distraction from them. In terms of depression, research indicates that, for some people, regular exercise can be as effective in reducing depression as some antidepressant medication.

In our technologically remote-controlled world of convenience, our opportunities to have a physically active lifestyle are reducing. No more do we need to run to the bank on our lunch break, or even leave our chair for a doctor’s appointment. Already twenty-first century employees are more sedentary than ever before. In these times when working from home is becoming more and more prevalent, a person who previously at least had their commute, however tedious or not that may have been, to interact in the world, now may not have reason to leave their home, or even bedroom, for days. For many this will mean that they will not get beneficial physical activity, and the psychosocial losses for mental health should also not be ignored as our external engagement shifts. 

Our bodies and our environment offer a multitude of tools and resources that we can use for our wellbeing, and self-care. When we engage in psychotherapy or counselling, and also add in regular exercise, we are taking a more holistic approach to wellbeing and the combination of both can help us toward a more fulfilled life.

So start where you are and do a little, and then a little more…

 

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

 

Further reading by Dr Simon Cassar

Are you too sensitive?

Is spirituality an escape from reality?

Sleep and mental health

Spirituality and mental health

Living with borderline personality disorder

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Practical examples for ‘food and mood’

This blog follows on from my previous one called ‘Food and Mood‘ and provides you with food examples.

Wholegrain cereals, peas, beans, lentils, nuts, seeds, fruits and vegetables are rich in a range of vitamins and minerals that your body needs to function well. They also digest slowly, helping to provide a slow and steady glucose supply to your brain and body.

Start the day with breakfast, such as wholegrain cereal with milk and fruit, multigrain toast with a poached egg, or fruit with yoghurt. Have no more than 150ml of fresh fruit juice or smoothie to drink.

Include some starchy food (such as boiled potatoes, rice, pasta, and granary or multigrain breads) at lunch and dinner. If you are short of time, then go for a sandwich or jacket potato (filled with fish or low fat cheese and salad) or even a bowl of cereal and some fruit.

Between meals include snacks such as fruit, vegetables, nuts, yoghurts, and oatcakes or crackers with low fat cheese, meat or fish.

Caffeinated drinks, such as coffee, cola, energy drinks, tea and chocolate, should be limited.

Other non-caffeinated drinks, such as fruit squash, lemonade or herbal teas are good alternatives.

Limit your intake to no more than two to three drinks on no more than five days per week. It is however important to remember that alcohol itself is a depressant and may contribute towards depression or make your symptoms worse.

Eat regularly throughout the day to make sure your brain has a steady supply of energy.

Include starchy carbohydrates, protein and vegetables or salad at each meal.

Choose wholegrains, pulses, beans, lentils, and fruit and vegetables.

Minimise processed/packaged foods and instead eat a variety of the items listed above to get a range of different vitamins and minerals.

Eat a good balance of healthy fats to maintain the cell structure of your brain. Include oily fish (omega 3 fatty acids) and unsaturated fats in your diet.

Drink plenty of fluid (six to eight glasses non-caffeinated drinks) to keep hydrated and allow your brain to work as best as it can.

 

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

 

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Food and mood

The links between mood, mental health, sleep quality and nutrition are areas of research interest. Associations between the type and quality of a person’s diet and risk of anxiety and depression are increasingly described in literature. Complexities around the multidirectional relationship between diet and mental health are becoming more understood (Firth et al 2020) and it has been long established that poor sleep increases inflammation and stress hormones in the body.

Brain function requires a steady supply of glucose as its primary fuel which comes mostly from starchy carbohydrates. Energy which is slowly released, such as low glycaemic index carbohydrates, provide the optimal energy release for use by the body https://glycemicindex.com/. The brain also requires dietary fats as it is made up of 50 per cent fat, with brain cells needing fats to maintain their structure. Data supports unsaturated fats and omega-3 helps to ensure the brain is well nourished. Whereas trans-fats found in processed and packaged foods (meats, cakes, biscuits) seem to be harmful to brain structure and function.

Protein is essential for the growth, maintenance, and repair of all body cells, including the brain. Total protein intake and the quality of protein intake is important to ensure the body receives all the essential amino acids required for health. Good sources of protein include fish, chicken, lean red meat, meat substitutes, beans, quinoa, and nuts. Furthermore, protein contains tryptophan, an essential amino acid which is a precursor of serotonin synthesis and is thought to help with less depressive symptoms and anxiety. Tryptophan sources include fish, poultry, eggs and game, some green leafy vegetables such as spinach, pulses and seeds.

Specific evidence looking at nutrients directly linked to mental health include B vitamins (including folate) and zinc with research suggesting that these nutrients are important in managing depression. Vitamin D has also received attention as to whether vitamin D deficiency causes depression. There is no evidence that this is the case, however there is a correlation between people who have depression and low levels of vitamin D. This is likely to be a causal effect from the social withdrawal and isolation from feeling depressed. There is evidence that not having enough vitamin D leads to depression symptoms. Eating a colourful variety of fruit and vegetables at least 5 portions per day (1portion = 80g), consuming foods fortified with vitamin D and getting safe sun exposure helps provides a wide range of vitamins and minerals sufficient for health and well-being. In addition, some researchers think that omega-3 oils, found in oily fish, may also help with depression. Oily fish twice per week such as salmon, sardines, mackerel, and trout is recommended.

A healthy brain contains up to 78 per cent water, therefore dehydration may also affect mood. Caffeine can lead to dehydration, withdrawal headaches and to low or irritable mood when the effects wear off. Drinking too much alcohol causes dehydration and can lead to B vitamin deficiencies, which increases depressive feelings or anxiety. Alcohol should be limited to within safe limits of units per week along with at least two alcohol free days per week.

Eating and drinking pattern is also important. Regular eating ensures optimal blood sugar control and as described above, links to our body’s functions, including brain health.

Avoiding over-eating and eating a main meal by 7.30pm encourages better sleep quality, which in turn supports our body’s natural circadian rhythm or body clock. Lack of good sleep also affects how much we eat. Research at King’s College, London, found that even partial sleep deprivation increased daily calorie intake of the equivalent of four slices of bread.

A recent area of interest is the link between our gut microbiome and mental health. As well as supporting our gut health, the microbiome is linked to stress and sleep quality and conversely sleep deprivation is known to negatively affect the gut microbiome after only two days of reduced sleep quantity and quality.

Such preventative measures to help with optimising mental health, gut health and overall well-being is key to maintaining a long-term positive lifestyle and will pay dividends in your overall health and happiness.

For further food examples, please refer to the blog called ‘Practical Examples for Food and Mood‘.

 

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

 

Resources:
• https://www.bda.uk.com/resource/fat.html
• https://www.bda.uk.com/resource/omega-3.html
• https://www.bda.uk.com/resource/fruit-and-vegetables-how-to-get-five-a-day.html
• https://www.bda.uk.com/resource/vitamin-d.html
• https://www.bda.uk.com/resource/probiotics.html
• https://www.bda.uk.com/resource/the-importance-of-hydration.html
• https://www.bda.uk.com/resource/depression-diet.html
• https://www.bda.uk.com/news-campaigns/campaigns/one-blue-dot/sustainable-
september/nutritional-considerations-for-dietitians.html
• https://www.nhs.uk/live-well/alcohol-advice/the-risks-of-drinking-too-much/

References

Al Khatib HK, Harding SV, Darzi J, Pot GK (2017) The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr;71(5):614-624. DOI: https://doi.org/10.1038/ejcn.2016.201

Appleton KM, Rogers PJ, Ness AR (2010) Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. American Journal of Clinical Nutrition. 91(3):757-70.

Arens U (2018) Authorised EU health claims for carbohydrates and maintenance of normal brain function. In: Foods, Nutrients and food Ingredients with Authorised EU Health Claims – volume 3. Woodhead Publishing.

Cuomo A et al (2017) Depression and Vitamin D Deficiency: Causality, Assessment, and Clinical Practice Implications. Neuropsychiatry. 7(5) 606-614.

Firth J, et al (2020). Food and mood: how do diet and nutrition affect mental wellbeing? BMJ; 369;m2382 doi:10.1136/bmj.m2382.

Gomez-Pinilla, F (2008) Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci 9 (7) 568-578.

Kraguljac NV, et al (2009) Efficacy of omega3 Fatty acids in mood disorders – a systematic review and meta analysis. Psychopharmacology Bulletin. 42(3):39-54.

Lespérance F, et al (2011). The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry. 2011 Aug;72(8):1054-62. doi: https://doi.org/10.4088/jcp.10m05966blu

Letchumanan V, Thye AY, Tan LT, et al (2021) Gut feelings in depression: microbiota dysbiosis in response to antidepressants. Gut;70:A49-A50.

Lin PY, Huang SY, Su KP (2010) A meta-analytic review of polyunsaturated fatty acid compositions inpatients with depression. Biological Psychiatry. (68(2):140-7.

Lindseth G, Helland B, Caspers J (2015) The effects of dietary tryptophan on affective disorders. Arch Psychiatr Nurs. 29(2):102-7. doi: https://doi.org/10.1016%2Fj.apnu.2014.11.008

Martins JG. (2009) EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. Journal of the American College of Nutrition. 28(5):525-42.

Mischoulon D et al. (2009) A double-blind, randomized controlled trial of ethyl-eicosapentaenoate for major depressive disorder. Journal of Clinical Psychiatry 70(12):1636-44.

Murakami K, Sasaki S. (2010) Dietary intake and depressive symptoms: a systematic review of observational studies. Molecular Nutrition & Food Research 54(4):471-88.

Penckofer S, et al. (2010) Vitamin D and depression: where is all the sunshine? Issues Ment Health Nurs. 31(6):385-93. doi: https://doi.org/10.3109%2F01612840903437657

Pouwer F, et al (2005) Fat food for a bad mood. Could we treat and prevent depression in Type 2 diabetes by means of omega-3 polyunsaturated fatty acids? A review of the evidence. Diabet Med. 2005 Nov;22(11):1465-75. doi: 10.1111/j.1464-5491.2005.01661.x

Rocha Araujo DM, Vilarim MM, Nardi A (2010) What is the effectiveness of the use of polyunsaturated fatty acid omega-3 in the treatment of depression? Expert Review of Neurotherapeutics 10(7):1117-29.

Rogers, PJ. (2007) Review: Caffeine, mood and mental performance in everyday life. Nutrition Bulletin 32, pp.84-89

Rondanelli M, et al. (2010) Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr 29(1):55-64.

Royal College of Psychiatrists (2019) Alcohol and depression. [online] Available at: https://www.rcpsych.ac.uk/mental-health/problems-disorders/alcohol-and-depression [Accessed 27 March 2023]

Somer E (2000). Food & Mood: The Complete Guide to Eating Well and Feeling Your Best, Second Edition

Walker JG, et al (2010) Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial. Br J Psychiatry Jul;197(1):45-54

Wurtman, RJ., et al (2003) Effects of normal meals rich in carbohydrate or protein on plasma tryptophan and tyrosine ratios. American Journal of Clinical Nutrition 77 (1) pp.128-32

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Why am I feeling more anxiety with Covid-19?

During the last 100 days, all of our lives, across the globe, have been turned upside down. Whilst scientifically overdue and rationally unsurprising, the pandemic has shaken the foundations of our outer, and thus, inner worlds. What we came to see as normal has been curtailed or removed; what we relied on for our own sense of normality has been fractured. 

Is everybody feeling more anxious? 

No, but that does not make those who are wrong or ill. Some people are feeling less anxious as their ‘ordinary’ level of anxiety (which may be quite high) now have an outlet – something tangible to attach to. Think of the example of a soldier who is able to thinking function efficiently in a war zone but who, upon returning home to an ‘ordinary’ environment, struggles to function as they locate threat behind every corner. 

There are also some who have a healthy relationship with their ‘anxious’ selves and are able to recognise the source of their anxiety and to use it whilst holding onto a thinking mind – such folks may feel a broader and deeper range of all their emotions at present but would not describe themselves as ‘more anxious’. This is possible for us all. 

We are all going to die! 

It is a fact – no way round it – we are all going to die. Though probably not from Covid-19. In fact the likelihood of death from Covid-19 is statistically very low. 

I am not interested in getting into the actual mortality rates etc. for Covid as they have little to do with the anxiety I am addressing – suffice to say that Covid is real and each death is a personal tragedy – like deaths always are. 

However, there is more than meets the eye in the sub-heading of this section of my blog which may shed some light on heightened anxiety levels which I shall attempt to explain. 

Let’s start with the premise that human beings, generally, have a strong biological drive to live – like all other mammals. 

Back to Freud 

Freud posited that the majority of our decision making and therefore emotional work remained largely unconscious to us. He was right about this as has been evidenced in neuroscience experiments. 

Freud also suggested that we have a profoundly unconscious fear of death linked to our consciousness of self – we know that we are alive and therefore we also know we must die and this presents a dilemma. 

All anxiety is death anxiety 

Anxiety is not like the other emotions. It is free floating and pervasive. We all must live with anxiety whether it dominates our experience or is just a flicker on the horizon. 

All other emotions are ‘attached’ to something in that we generally know or can work out why we feel a certain way. We generally know what we feel happy or sad for example – and if we don’t the psychotherapy can uncover the reasons. 

Anxiety is different in the sense that it ‘seeks to attach’ to something. So, rather than being anxious about a presentation, a flight, an exam or a date, our anxiety ‘finds’ something in our environment and then attaches to that convincing us that that thing is what is causing our anxiety. 

Of course real things cause anxiety, however, on a profound (ontological) level, all anxiety stems from an unconscious but ubiquitous knowledge that we are going to die. It is therefore death anxiety. 

Covid represents the perfect vehicle to which our anxiety can attach – it kills. Just not very many of us. It is not a Hollywood movie like Independence Day where the enemy will destroy us all unless we mount a global war (and towards an enemy that we can see – and is monster-like). Covid is invisible to us but nonetheless has triggered a profound death anxiety in all of us – we are primed to feel anxious in the face of death as though we are hard-wired. 

What can I do? 

Earlier I mentioned the term ‘a thinking mind’ and this is one I have written about before. Even though are all primed to feel more anxious when reminded of death (check our Terror Management Theory for empirical evidence of this), it does not mean we need to lose our rational minds and succumb to the anxiety and the accompanying acting out. 

Your mind is capable of thinking and scanning for evidence. For example, if you are reading this piece right now, stop breathe and look around you. Look out of a window and notice that in this precise moment, you are not dying. You can use your sense to ground you: 

  • What can I see; 
  • What can I hear; 
  • What can I smell; 
  • What can a taste; 
  • What can I seen – my breath, my heartbeat, tension in my body etc. 

I must buy toilet paper! 

Much has been made of the compulsive need to purchase toilet paper as the pandemic emerged and took hold. And this seem to be a global rather than local phenomenon (though Americans seem to have a compulsive need to purchase firearms – but that adds confirmation to the theory below). 

So why toilet paper? Well, when anxious humans would rather do something rather than just sit there – and what we often need to do is stop and just sit there. Particularly when we are not about to immediately die. 

Toilet paper is intricately linked to a biological need that we would prefer didn’t exist. The need to defecate. The need to defecate links us to nature and to being, at least in a significant part, animal. Being linked to nature and thus being an animal means that we are mortal – something that is unconsciously unbearable for the part of us that is ‘God-like’ and able to project ourselves back into the past or forward into the future. In short, toilet paper became a manic defense against death but ensuring that we had the ability in the face of death to ‘wipe away’ any evidence of our animal nature. 

Briefly returning to the questions of guns and our American friends – I posit that guns are the way Americans take responsibility for avoiding death anxiety – by protecting themselves against the enemy. Perhaps thank Hollywood for this (even though Covid-19 cannot be shot). Oh, and I am fairly sure they also stocked up on toilet paper.

 

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 –

Why psychotherapy sessions should end on time

Coronavirus Induced Mental Health Issues

Coronavirus (Covid-19) Counselling

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

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Coronavirus Lock-Down – Physical Health vs Mental Health

As I write this blog, we are entering into the fourth week of so-called ‘lock-down’ across the UK. Despite daily speculation, nobody has any idea how long the restrictions on life will last for. 

Everything has changed and this has been hard to cope with in a society where stability and the ordinary continuity of life has been severely disrupted and curtailed; the UK population is currently in limbo, isolated from the wider community and possibly in closer physical contact with family than ever before. 

We know why we are doing this – we are reminded multiple times per day – to ‘save lives’ and ‘protect the NHS’. 

There has been much talk of the compelling priorities of the health of the nation vs the health of the economy. Arguably initially it was the later that took precedent in this country meaning we are now facing large numbers of fatalities. However, beyond the obvious economic costs of ‘lock-down’ and social distancing, the mental health impact seems to have been largely overlooked. 

Why start now? 

Despite a strong history and legacy of psychoanalysis and psychotherapy in the UK, mental health provision has long-since slipped from the forefront of policy-makers minds. Gone is the aptitude to be curious and instead a culture of symptoms has emerged increasingly oblivious to the fact that symptoms are communicating emotional and psychic distress. Depression has ceased to be seen as an inability to mourn and is instead an illness to be medicalised – as if it can be caught from the air like Coronavirus. 

So, in the midst of the pandemic, it is not surprising that any meaningful discussion on the impacts of quarantine, lock-down and social distancing will have on mental health, not to mention the ongoing rhetoric of how the socially interactive parts of our lives will be ‘changed forever’; today the WHO suggested that wearing a face-mask in public must become the long-term norm without the being any consideration to what the psychological impacts on self and others would be from such a policy. For example, where healthy development of an infant is contingent on them constantly scanning their care-givers face for reassurance and validation, what will the effect be of masking these quite literally behind a surgical mask? 

Compelling needs 

Whilst some of us may remain in denial, there is no question that social distancing is the only real means available at present to combat this pandemic. It is the oldest method in the book for dealing with epidemics and remains all we have (at present). 

However, for relational beings (which is what humans are) the strategy is psychologically and emotionally challenging (and for many catastrophic). 

Humans understand themselves and gain a sense of meaning through relationships with others. This is not a luxury – it is essential both as we develop and throughout our lives. Not only do humans needs to be able to communicate verbally, but we also require contact that is ‘non-verbal’. 

The mortality of isolation 

Isolation may keep us safe from the Coronavirus, however isolation is linked is not the cause of many mental health problems such as depression and anxiety and is fatal, particularly for the elderly (who, it would seem, are also being most impacted by Covid-19). Indeed, some studies have shown that loneliness is, indirectly, the biggest killer of the elderly. 

Virtual connections 

We live in an age where we can make use of virtual connections and video conference software to stay in touch with each other – my profession – psychotherapy – has overnight shifted to online working to ensure the continuity of therapy sessions. This is a positive, however, it will not migrate the tsunami of mental health and relationship problems that will arrive in the wake of the health crisis. 

Meaning making propositions 

For many, our daily lives, often revolving around work, provide us with a profound and anchoring sense of meaning and purpose. Not only has the ‘treadmill’ stopped, but with it much of the sense of purpose and meaning that many of us have. These two combined can be difficult to manage contributing to anxiety and depression – a literal crisis of meaning. 

Anxiety 

In the absence of meaning and purpose, and with the distractions of ‘ordinary’ life removed, anxiety can bubble up. It can leave us with a profound sense of unease and discomfort in our own skin and the wider world. And at present, it is hard to escape from. Of course, in reality anxiety can never be escaped from – it is part of us. It can, however, be faced and used to ask difficult questions about how we live our lives. 

Depression 

We are faced with a narrative from the media and politicians that ‘things will never be the same again’. I am unsure really what this means other than that it sounds like a warning or premonition of some kind. Being alive means accepting that things cannot remain the same and that we adapt. Change is hard and it forces us to be confronted with difficult emotions that many of us would rather run from. In the current climate of Covid, running from emotions has simply become harder. 

Whilst there simply cannot be a national or state managed balance between physical and mental health needs at present, this does not mean that as individuals we cannot be staying with our discomfort and asking ourselves what we ultimately want from this precarious life. 

 

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 –

Why psychotherapy sessions should end on time

Coronavirus Induced Mental Health Issues

Coronavirus (Covid-19) Counselling

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

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Back to ‘BACE’ics

Achieving a work – life balance is an important aspect of mental wellbeing and can easily become out of sync without us even realising it, particularly when we are feeling under significant pressure from one of these two areas – in other words,  stressed.  This imbalance can lead to feelings of depression and anxiety .  One useful tool you can use to get some perspective and move back into a position of feeling like you have some control is by keeping an activity diary for a a week (and ideally longer) which can provide us with useful information on where the loss of balance in our life lies.  It can be helpful to separate out the different needs we have into four distinct areas:

1/ Bodily Self Care – this includes how we look after our physical body, i.e. exercise, nutrition, rest and sleep, self-grooming, medication, etc.

2/ Achievement – this includes work, study, housework, any tasks / activities that give us a sense of having achieved something concrete.

3/ Connecting with others – this can be family, friends, work colleagues – in person, over the telephone or social media.  It can simply be being in an environment where there are others as long as we feel connected. It can also include connecting with animals.  Our pets can be very therapeutic in helping us to feel calmer.

4/ Enjoyment – hobbies, interests, fun activities, relaxing activities – anything that gives us a sense of pleasure and joy.

Categorise how you are spending your time each day into the four areas.  Sometimes one activity may fulfil more than one category, e.g. walking the dog can be exercise so would meet bodily self care, it could also be an achievement if you really didn’t feel like going, it could be connecting with others as you may have met other dog walkers, and you may have enjoyed it.

By monitoring your activity according to these categories it will give you a useful overview of how you are spending your time and gain a sense of where there are gaps – where it might be necessary to make some changes to re-balance your life.

In my work as a CBT therapist one of the areas that I frequently see my clients neglecting is under the category of enjoyment, and specifically, in having fun.  We can get so caught up with work and what we think we should be doing we can lose sight of enjoyment and connecting with others.  Or we may have crammed so much into our day that we have no time to stop and just be.

Activity monitoring can be a useful tool for anyone who wants to take stock of their life and see whether they are tending to all the different areas in their life which, when combined, create a sense of positive mental well-being.  If you would like a structure in undertaking this activity then you can use a form called BACE (https://www.get.gg/docs/BACEdiary-weekly.pdf)  which is a daily activity monitoring form.  You will notice that the word BACE is the acronym for the four areas.

Once you have gathered the information and highlighted the areas that need to be addressed you can use the same form as a daily planner to set manageable and  achievable goals to shift the balance and address the gaps.

Sometimes the simplest strategies are the most helpful.

 

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

 

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Loss

You can hold yourself back from the sufferings of the world, that is something you are free to do and it accords with your nature, but perhaps this very holding back is the one suffering you could avoid.”? Franz Kafka

Loss is a feature in almost every encounter we experience as psychotherapists. It’s a common part of being human. In this article, we will look at what loss is and what we can do with it.

What Is Loss?

Loss is a term we use to describe many experiences and not just death. Although bereavement is what we associate with loss, more everyday losses that we experience include loss of identity, the loss of childhood experiences, the loss of friendships or relationships or simply the loss you feel from a change in situations. Loss can be experienced in a range of different ways, and if not properly processed, it can have a profound impact on your life and mental well-being.

How To Cope with Loss

Experiencing a loss can make you feel like you have a lack of control. It’s therefore helpful to look at the things you do have control over and do things to make you feel more in control. Breaking things down into smaller, more manageable pieces ensures you don’t overwhelm yourself. For example, maintaining a routine and slowly introducing smaller goals can give you a sense of purpose.

Therapy is also a great tool for working through your loss, whatever that loss may be.

How Therapy Can Help With Loss

Talking to a professional psychotherapist can help you understand your feelings of loss and support you in overcoming them. As therapists, we reflect mentally through our own experiences and mirror them onto our clients, so they feel understood. Grief and loss cause pain, and this must be managed to ensure a healthy life.

This reflective process helps clients understand what they are doing to manage their grief. We’re not here to judge, but to bring awareness to it so it can be looked at more in-depth. Over time, through exploration of these survival strategies, the frightening experience of grief will pass. Sometimes, a loss must be examined from different angles to be able to move forward.

As therapists, we don’t judge. We provide a safe, calm space to listen to you. We understand that people who have experienced loss have so much going on in their lives and can struggle to make sense of it. We help you reflect on what is happening and help you to navigate through it.

Darian Leader’s book, The New Black, revisits Freud’s concepts of Mourning and Melancholia and explores the more subtle experience of loss and argues that modern life holds pressure to treat loss with medication. However, this adjusts the chemicals within the brain which has led to complex and unconscious causes of depression. Although drugs can be helpful, they rarely resolve the underlying cause of loss and depression.

Leader while praising Freud’s new thinking about depression, argues that he misses a vital element of mourning, its communal aspect and looks at various cultures and how they share the process of mourning.

In the book, Darian Leader argues that Freud missed a vital element in mourning: its communal aspect. In different cultures, many share the process of mourning, and mourning should be shared whether it’s a death or more everyday loss.

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

 

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What is loneliness?

Loneliness is an experience that people coming into psychotherapy often talk about struggling with. It is an uncomfortable and often painful state and usually linked with feelings of sadness, loss and emptiness.

But maybe loneliness isn’t necessarily just a bad experience. Below, I will explore possible causes and suggest there are some positive and helpful aspects to feeling lonely.

Loneliness through circumstances

Loneliness could be characterised as feeling disconnected from others and profoundly alone. This might well be circumstantial – for e.g. someone who has just moved to a new city and doesn’t know many people could reasonably be expected to feel lonely. Their loneliness might indeed help push and motivate them into making some social connections and friendships.

Feelings of loneliness can also be triggered by losing a significant other through separation or death. In these circumstances loneliness will feel bound up with the loss of this person and part of the experience of grieving.

In both these examples we would think a loneliness as a normal response to circumstances of being suddenly alone or losing someone close.

Loneliness and disconnection

Chronic loneliness is often caused by an intense and ongoing sense of disconnection from others. This may not necessarily bear any relation to the presence of other people. In fact, it is often reported that this kind of loneliness is most painfully felt in the company of others.

Becoming so disconnected and lonely is usually linked to a history of emotional withdrawal. Often this comes about originally as a form of self-protection. Self-isolation can be a way of avoiding the painful and difficult feelings that interactions with others can bring. This defensive strategy might start early in life and create its own momentum. It may be deployed all the time – leading to extreme isolation – or at certain times or in more nuanced ways.

In some people, this emotional withdrawal might be obvious, e.g. a literal keeping away from others. In many cases though the withdrawal is more of an internal distancing which may not be obvious at all, even to the person themselves. So, although the individual may have relationships, the quality of all or most of these relationships – i.e. the level of intimacy and genuine closeness – may not be enough to create or sustain feelings of real connection.

While this describes more entrenched or extreme experiences of chronic emotional disconnection and loneliness, it’s important to say that of course we can all find ourselves at times emotionally withdrawing from others and becoming lonely as a result.

Can loneliness be healthy?

Loneliness can be a horrible even desolating experience, but it can also be helpful to pay attention to it.

Earlier, I suggested it might motivate someone to seek out social connections in a new situation. On a socio-political level, a general state of loneliness can be generated by living in an, arguably, increasingly alienated and alienating world. Recognising our own experiences of social disconnection may move us to reach out to others in local and wider communities.

In my view, loneliness most importantly reveals a longing for greater intimacy and closeness and at the same time the absence or loss of this. Loneliness reminds us of our innate connectivity as human beings and its importance to our wellbeing. Where people have a pattern of disconnecting or withdrawing internally to deal with emotional pain, an awareness of lonely feelings can be a positive sign. It can mean the beginnings of a realisation that defensive distancing is no longer working.

Loneliness can indicate something needs to change, or is already starting to.

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

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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

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Click here to listen to our podcast on this post.

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Student mental health – how to stay healthy at university

After the long summer, thousands of new students are heading to university. The start of the academic year is an exciting time for many, but it can also be a difficult, worrying time for some. Students today are subject to different pressures from earlier generations – financial, academic, social – that didn’t affect previous students to the same degree. Higher study costs means that an increasing number of students have to balance their study with part-time work. This means that they have less time to form and nurture close friendships and a social support network with their peers.

For those leaving home for the first time, it can be a stressful transition towards independent adulthood. If we look to wider society, the uncertain and competitive job market can put an inordinate amount of pressure on students to perform well as they face an uncertain future. In addition to this, many serious mental health conditions manifest themselves for the first time in young adulthood. The Higher Education Statistics Agency recently revealed that the number of students who drop out of university with mental health problems has more than trebled since 2009-10, with a record 1,180 university students with mental health problems abandoning their studies in 2014-15, the most recent year for which data was available.

It is important, therefore, to keep yourself healthy if you are heading off, or back to university. There are many good resources out there that will give good tips on how to look after your mental health while studying at uni, and here are a few tips that might point you in the right direction.

Physical health

Looking after your physical health is key, especially when you are entering a potentially stressful situation and experiencing big life changes. Having a regular routine of physical activity can be a great help in maintaining good emotional health. This could be team sports, the gym, walking rather than getting the bus – whatever works for you. Also, having a healthy diet and adequate nutrition will also help maintain the energy level that is needed when you are studying and partying hard!

Social health

Going to uni is a social experience. Creating new social networks is part of the attraction of studying in a new area. It can be a lot of fun, and a good social network is intrinsic to having good mental health. But don’t underestimate the impact of not being around your close friends. Keeping in contact with your existing friends who know you well is important too, as building deep friendships where you can open up about your inner world takes time.

Psychological and emotional health

Looking after your psychological and emotional health is obviously a key part in maintaining good mental health. Spend some time noticing your thoughts – what are you telling yourself? Notice also your emotions – how are you feeling on a day-day basis? Being able to identify your thoughts and feelings and to express them in some manner, whether through talking to friends or writing them down, can help you maintain a healthy inner world.

Spiritual health

People often forget about their spiritual health, but this is an important part of our lived experience. Looking after your spiritual health can be simple. You could spend some time alone on a regular basis, spend time in nature, or learn to meditate. Of course, if you are religious, then engage more with your religion. Spiritual health doesn’t need to be about religion, and can be just spending time by yourself and noticing the amazing world that is around us.

Staying healthy at university

Keeping these four areas in mind on a daily basis can go a long way to maintaining a healthy lifestyle. However, when things get a little more difficult, then use the support services that will be available at your university. There will invariably be counselling services and learning support services who will be able to help in your university journey.

Kate Connolly and Simon Cassar

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