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May 4, 2020 by Brighton and Hove Psychotherapy Leave a Comment

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 defen ces

April 27, 2020 by Brighton and Hove Psychotherapy Leave a Comment

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.

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 defen ces

April 6, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Back to ‘BACE’ics

Work life balance is fundamental to our mental wellbeing and can easily become out of sync without us even realising it, particularly when we are feeling stressed. This imbalance can lead to depression and anxiety. Going back to basics and keeping an activity diary for a week or two can provide us with useful information. Broadly speaking we are interested in 4 different areas:

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

2/ Achievement – this would include work, study, housework, any tasks / activities that gives us a sense of having achieved something.

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.

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

Each day categorise how you are spending your time into each of the 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 our activity according to these categories we can gather information and gain a sense of where there are gaps, where we might need to make some changes in our lives.

In my work as a CBT therapist I see all too easily how we can forget to enjoy ourselves. 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 and see whether they are tending to their mental wellbeing. To help us do this we 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 an acronym for the four areas.

Once we have gathered information and highlighted the areas that need to be addressed we can use the same form as a daily planner to set ourselves small goals to address the gaps.

Sometimes the simplest strategies are the most helpful.

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults. Rebecca is available at our Brighton and Hove Practice.

Further reading by Rebecca Mead –

Interpersonal Therapy (IPT) explained

January 27, 2020 by Brighton & Hove Psychotherapy Leave a Comment

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

In this blog, I wanted to write about Loss and try and explain a bit about what the hell we are supposed to do with it! I think loss is perhaps one of the things that I find it hard to think isn’t a feature of almost every encounter I experience as a Psychotherapist, and perhaps as a human, it is a pervasive part of being human, a painful part but a part none the less.

I encounter loss in the therapeutic encounter in a huge range of experiences, from the sudden tragic losses due to bereavement; due to the more ambiguous everyday losses of identity due to the on going vicissitudes of life and changing circumstances. These include the loss of who we are when our situations change, the loss of childhood experienced by parents and their children, due to adolescence, the loss of a much loved work identity in retirement and of course the frequent and painful losses when relationship change or end. So what do we do when, as a colleague poignantly put it, “ the glue dissolves”.

During my training, and in the literature, there is much talk of processing these losses, the need to mourn etc. and about what can happen when these things get stuck, but what do these things actually mean?“

I think a lot of what I’m doing as a therapist is trying to reflect mentally through my experience and the sharing of my experience of being with someone, a mirror to them so they can come to understand what it is they are doing. Often in grief, there is pain and this pain has to be managed, feelings have to be managed. I will seek through this reflective process to help clients understand what they are doing to manage their grief, not to judge it as good or bad but simply to bring some awareness to it, so it can be thought about. Often, through this exploration of these important-survival strategies, and over time, the experience of grief often so raw and frightening can start to be experienced, to allow it bit by bit to be felt, the good and bad of what has been lost to be experienced and allowed to pass, or at least survived. Sometimes a loss has to examined from many different angles, many times over. Loss is painful and hard to stay with.

Darian Leader in his excellent book, The New Black, revisits Freud’s concepts of Mourning and Melancholia, to explore a more nuanced experience of loss and argues that, modern society has created a pressure to package and treat loss and that this has created a simplistic definition that can be biologically defined and then treated by adjusting the chemicals within the brain via medication. This has led to the many complex and often unconscious causes of depression being narrowed and linked to biological markers that can be targeted via drugs. That’s not to say drugs can’t be helpful, they can be, but they rarely resolve the underlying causes.

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 the way in which they share the process of mourning.

For me I am struck by the Musician Nick Cave and his wife; Susie’s, much documented loss of one of their twin boys, aged 15. Nick Cave, has since that loss and after a period of retreat, sought to engage with his audience and to open himself to the experience of loss, he writes a webpage called the Red letter diaries, has gone on speaking tours and often engages and shares in the stories of loss with his audience. He cites this as an essential part of what has helped him survive this tragedy. As he says there are an awful lot of mourners out there.

Both Cave and Leader cite the Buddhist story of a Mother who loses her baby and has the dead baby strapped to her chest, a monk says that she must find some mustard seeds from a house that has experienced no loss and as she goes from house to house in search of these, never finding a house that has experienced no loss, but as she comes into the contact with the various losses of each house and in the sharing of their grief’s she is eventually able to lay her baby to rest.

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

Further reading by Paul Salvage –

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconsious

A Nation Divided

Adolescence: the trials and tribulations

September 10, 2018 by Brighton & Hove Psychotherapy Leave a Comment

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.