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Mental Health in Retirement

Planning

Retirement planning, looking ahead to a time of not working and speculating on what the next part of life might be, is part of our working world. This preparation for retiring acknowledges an approaching ending and begins the transition to a life after work. The preparation for one’s financial future often takes a central position in retirement planning, yet the psychological effects are often not really explored. Can we consider the psychological impact of retiring as part of our retirement planning?

The world after work is an unknown until we find ourselves in it. What is it like to speak of work in the past tense and describe ourselves as being a ‘former’? Work brings us personal rewards and it can also be the source of stress and anxiety. Work pays us and gives our life structure. It gives us social interaction, it might give us a title, a sense of what we are capable of and can also be part of our sense of self. Who we are can be defined by work, which is then lost when we retire.

Transition

The transition into retirement is a period when we think about the shift from a work/life structure into a retirement/life structure. Here we are disengaging from a working life and engaging with retirement, combining both a reflection on what has ended with a sense of what is ahead. Can we find a sense of who we are after working that fits with who we felt that were when we worked?

Regarding our life when we are retired, do we have an idea of what our lives will be like? Is it a time in which we pursue all that hasn’t been possible before? Do we think of it as a time to explore, or does it feel like a loss of much that has been a part of our lives up to this point? The answer might be a combination of all the above. There is a challenge to having a ‘good retirement’ when we might not know what that looks or feels like.

Ageing

Whilst retiring early is not uncommon, so often retirement comes with a reference to ageing. It can be seen as an acknowledgement of a stage in middle to later life. Such milestones are reflections on the passing of time and present us with thoughts about mortality and a give one the opportunity to reflect on what lies ahead with renewed interest.

Choices

In thinking about retirement there are numerous choices and adjustments that must be made. Are we able to hold onto a sense that we are making good choices, when we have so many to make? The challenge of so much to consider is that it can all feel immediate. Is it possible to see retirement as a process that takes time? That one can move into it with a sense of curiosity and not feel the anxiety that comes with making so many adjustments all at once.

Psychotherapy and retiring

So much about retirement is personal and everyone will approach it differently. The people around us, the aspirations that we hold for our retirement, our sense of self as being separate from our work. So many factors as individual as we are.

The factors explored above are a small part of what is going on psychologically in retirement. Psychotherapy gives one the space to understand these changes and what it brings up. The loss of working life can be intense and hard to make sense of, as can the change to our sense of the status that we derive from work. The role of psychotherapy here isn’t to put forward solutions, as with financial planning, but to allow reflection and the space to adjust to change.

Retiring can feel like a time of great opportunity and potentially an experience of loss. Having the space to be reflective about how it feels to retire can be a beneficial part of the process. Psychotherapy, as a means of supporting those about to and going through retirement, can help to ease one into this next phase of life.

 

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove . To enquire about psychotherapy sessions with David , please contact him here, or to view our full clinical team, please click here.

 

Further reading by David Work –

Subjective perception, shared experience

In support of being average

Collective grief

The challenge of change

Thinking about origins

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The Psychological Impact of the Recession

So we are officially in a recession in the UK. And not just any recession, but ‘the longest ever recession’ is predicted ‘since records began’. The word ‘recession’ is one that fills most working-age adults with a sense of dread, only further exacerbated not only by the suggestion that it will be ‘longer’ than ever before, but that it comes off the back of a couple of extremely anxiety provoking years thanks to the global pandemic. Will there be any respite for us all?

Our nervous systems have evolved to protect us from threat and very good they are at it too! We experience increased levels of anxiety and vigilance when our nervous system locates anything in our surroundings that may be threatening to our existence. For centuries, this would involve the literal threat to life resulting from the risk of becoming food for a wild animal or the victim of an attack by a neighbouring tribe. However, the world that most of us now live in is, fortunately, not punctuated by wild animals prowling around us or a neighbouring tribe mounting an attack. This is not to say that there are not dangers around us, but the risk of imminent death has unequivocally reduced as a result of multiple factors such as the rule of law, healthcare and our dominance over nature. Our nervous systems just don’t seem to have gotten the news.

Anxiety, which is the predominant emotion we feel when initially under threat is unlike other emotions in that it seeks to attach to an external event (rather than always being triggered by an external event). Thus, our ancestors would have an underlying level of anxiety they would navigate the world with and invariably when they felt a threat their anxiety levels would shoot up and they could appropriately respond to the threat. The same process happens with modern humans, however, the anxiety we feel is now often unhelpful when facing ‘modern threats’ as these, whilst real, are not imminently life threatening and even if they do represent a sort of existential threat – like a recession may – they are not something we can run from, fight, freeze up against or fawn; these are the four options our nervous system presents us with when we feel under extreme threat.

The psychological impact of the news of a recession can be similar to that of the psychological impact our ancient cousins would face when confronted with a sabre tooth tiger. And this stops us being able to think things through calmly. We then become reactive rather than able to take action.

What can you do?

I am no financial adviser and it is important to remember that each and every one of us will be impacted differently by economic events such as a recession, just as we are all impacted differently by all other events happening around us. But what I do understand is the human nervous system and anxiety.

Firstly, remember that ‘The News’ irrespective of the outlet, is designed to grab your attention – much like that sabre tooth tiger sticking its head out of a bush and into our face. News headlines are designed to sell newspapers, or in the modern world, to get ‘clicks’. This does not mean that it is ‘fake news’ but the devil is in the detail, not the headline. Take time to read the whole article and digest what it means. Think about whether you will actually be directly impacted and if so in which ways. Then you can take the time to take action methodically.

Remember that recessions are a part of the ordinary cycle of an economy and that each time one has arrived, it has once again passed and followed by a period of growth. People are affected but again, like the headlines, the news will report these effects from a ‘newsworthy’ perspective, rather than as a balanced view or perspective on society as a whole.

Limit your exposure to too much ‘news’ even though you will likely be drawn to ‘consume’ more.

This is human nature – your nervous system has signalled that this is a threat and so you are inclined to gather as much information as you possibly can. However, a recession, unlike a marauding tribe, is something that is approaching slowly and will also unfold slowly in relative terms – you do not need to get into a panic.

Focus on helpful ways of managing your anxiety such as taking time in nature, sharing your feelings with friends, practicing mindfulness, doing exercise or anything else that both brings you into your body, into the ‘here and now’, and calms your nervous system. Why is this important? It’s not about denying reality – on the contrary, it is about calming you enough so that you can once again think and if you can think you can make plans, rather than simply react to the news.

It is also worth bearing in mind that at present, what you are reading about the recession is a prediction. In other words, not may not be as bad as predicted or pan out quite as predicted.

We have all, collectively, got through the pandemic and coped with the anxiety of the unknown – the virus – that we all faced. This is likely to be the same.

 

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

 

Further reading by Mark Vahrmeyer – 

Can couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

How do I find the right psychotherapist?

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What makes us choose our Career Paths?

In both coaching and psychotherapy I am always fascinated by the reasons people choose certain career paths or lines of work. It is also interesting to see how career paths develop and change because of personal choices and how people’s personalities interact within organisations and changes in the job market.

These explorations can be vital to our personal fulfilment and sense of satisfaction, after all most of us spend a significant amount of our lives in work.

For instance, a surgeon may have chosen to go into medicine because this was what was expected of them. However, on further exploration it turns out that the demands of being a medical doctor in a public hospital, combined with the repeated reward of saving lives and a certain clinical detachment are very all significant factors in further exploring this choice of career.

Working hours and shift patterns, type of work, setting and level of responsibility, employment status (self-employed, employed, or unemployed), relationship to work, etc can generally be traced back to the weight of status and education in the family, sibling hierarchy, types of relationship, life-changing or traumatic events, gender and sexuality, level of family support, parent’s line of work, and family expectations, just to name a few.

There are other environmental and biological factors as well such as migration, displacement, political and societal influences, personality traits, life circumstances and opportunities, etc.

The role of psychotherapy and coaching can be helpful and exploring one’s motivations and drivers for following a career path, realising when that path no longer suits or making necessary changes to one’s work life. For instance, gaining more self-confidence to take more risks or becoming more aware of one’s personal desires and wishes, rather than following the path that was expected by others.

I see this as a maturing process, a way of becoming more in touch with oneself and making choices that are more in line with who one is rather than being restricted by self-limiting beliefs. To live according to our beliefs and values is a great thing to do, if we know what they are in the first place.

To find out more about leadership coaching or psychotherapy get in touch with us.

 

Sam Jahara is a UKCP Registered Psychotherapist, Superviser and Tavistock Certified Executive Coach.

 

Further reading by Sam Jahara –

Antidotes to coercive, controlling and narcissistic behaviour

An in-depth approach to leadership coaching

Demystifying mental health

Women and Anger

Why all therapists and mental health professionals need therapy now more than ever

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An In-Depth Approach to Leadership Coaching

Coaching in organisations has become increasingly popular over the past 20 years as workplaces become less hierarchical and organisations seek a more sophisticated approach to leadership.  The more recent shift linked to the pandemic has sped-up changes already on the horizon. 

Leaders are feeling an increasing sense of pressure and responsibility, alongside a collective shift towards a more balanced life. The two positions are difficult to reconcile leading to more pressure on the leadership as employees demand more empathy and flexibility, alongside added pressures on organisations linked to global uncertainty, supply chain issues and political instability.

We are living in times where things are constantly shifting and adapting quickly is a must. We want better relationships and a better work-life balance. Technology is connecting and isolating us at the same time – online meetings demonstrates this paradox well. Those in positions of leadership require an ever more empathic and sophisticated approach to their role, alongside being one-step ahead in an already fast-moving world. 

The Role of Leadership Coaching 

The role of Leadership Coaching is to be alongside leaders through these challenging times. An exploration of the challenges and opportunities within a person’s role requires more than a behavioural and goal-oriented approach. A more psychological approach to leadership coaching requires a coach who can think ‘outside the box’ and work with what lies beneath the surface. This entails understanding what motivates and drives the client, the demands of the organisation, the story behind the client’s career choices or trajectory, their resources and pitfalls.

An exploration of the story behind an individual’s career choice and understanding of their relationships at work speaks volumes. This exercise can be very interesting for both coach and coachee and lead further understanding some of the issues at hand. Given that success is linked to relationships – to self, others and the organisation – exploring these is an essential aspect of leadership coaching.  

Finally, it is vital for leaders to have a place to discuss their anxieties, worries, and fears. Leaders must learn to know their vulnerabilities, and not deny or bury them. Facing and understanding these emotions is what leads to change. It is also through exploration that these anxieties and fears begin to lessen, and the client can start to focus their energies on more creative pursuits rather than constantly firefighting.

With space for reflection, a better understanding of one own emotions and relationships, and energies freed up for more important tasks and creativity, work starts to become more enjoyable. With better self-awareness leaders can enjoy their role and stand in uncertainty with more confidence. 

 

Sam Jahara is a UKCP Registered Psychotherapist and Tavistock Certified Coach. She coaches individuals and groups in organisations as well as those who are self-employed or run their own business.

 

Further reading by Sam Jahara

Demystifying mental health

Women and Anger

Why all therapists and mental health professionals need therapy now more than ever

Fear and hope in the time of Covid – part 2

The Pandemic and the Emerging Mental Health Epidemic

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Executive Coaching, Psychotherapy, or both?

Executive or Leadership coaching is nowadays widely offered in organisations. Employers know the benefits of investing in developing their leaders and employing a coach is one of the best ways of doing this. 

What Makes a Good Leader?

Good leaders need to be self-aware, emotionally intelligent and have excellent interpersonal skills. The leaders who develop such qualities fair far better than those who have risen to the top due to high performance in their respective fields, but do not have the qualities needed to lead a team. Leaders of people need to know how to do relationships. This includes setting boundaries, being assertive and knowing how to communicate well with their peers and staff.

Psychotherapy is all about relationships – to self, others and the world. In psychotherapy, we learn to understand ourselves on a deeper level. This translates into knowing how we impact and are impacted by others. The aim of self-knowledge is to become more perceptive about patterns we repeat that are unhelpful or even harmful to ourselves and those around us. This extends to relationships at work, where the leader has a responsibility to shape the culture of an organisation and create an environment where people have the best chance to perform well. 

The leader and their staff‘s performance directly impacts the success of an organisation, which brings us back to the importance of good interpersonal relationships, communication and self-knowledge, especially when what is required is seeing and working with what lies beneath the surface.

What is the Difference Between Psychotherapy and Coaching?

Psychotherapy and leadership coaching are two distinct professions, each with a with their own set of skills and training. However, coaches with psychotherapy training under their belt are in a good position to coach executives due to their in-depth training in psychological theories and processes. Psychotherapists are trained on what makes people think, feel and behave the way they do. This knowledge can be directly applied to organisational and team dynamics. 

However, this does not in itself make any psychotherapist into a skilled leadership coach. Coaching leaders in the context in which they are working requires training, knowledge and experience in the field of business and as well as psychology. It also requires an ongoing interest in both, and the drive to constantly learn.   

Psychotherapists who work as coaches also need to know how the two differ and where they overlap. No one wants to engage in coaching and end up receiving psychotherapy instead, or vice-versa. Executive coaching is work focused, usually time-limited and takes place less frequently than psychotherapy. People engage in coaching usually to work through challenges they are experiencing at work, to develop themselves in their role or to explore changes in their career. Finally, psychotherapy and coaching can take place alongside one another, with two different professionals who will support the client in distinct but possibly overlapping areas of the person’s life. 

 

Sam Jahara is a UKCP registered Psychotherapist and Tavistock trained Executive Coach. She has a special interest on the impact of unconscious dynamics at work. She was born in Brazil and lived in Germany, The Netherlands and Australia. Sam currently lives and works in the UK and sees clients from her Lewes and Hove offices as well as online. You can get in touch with Sam directly via her profile.

 

Further reading by Sam Jahara

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When Home and Work Merge

The onset of national lockdowns in early 2020 (and subsequent restrictions) have made working from home the ‘new normal’. What was once seen as an ideal for many, free from commuting and office politics, suddenly became an enforced reality for all of us.

Our homes, which were previously separate, became our place of work, schoolroom or therapy room. The initial sense that being at home was an exciting new way of living and working, gave way, for many, to a sense that home and work were one and the same.

When home and work take place in the same space does it make us think about what function the workplace has? The workplace allows us to leave a lot of work-related stress there when we go home. Ad hoc chats with colleagues are part of how we manage some of the anxiety and challenges of working life. In short, the places that we work at and the people that we work with, hold a lot of our emotions.

This sense of something being held by a place and the people in it chimes with what Bion (1962) referred to as ‘containment’. Bion’s theory was based on the idea that it’s a person, invariably an early caregiver, who the infant looks to, to help them to process unbearable feelings. The infant cries and expels their feelings and the caregiver, through touch, facial expressions and sound makes these feelings more tolerable and, this in turn, calms the infant.

Bion felt that this cycle of learning what it is like to have feelings contained by another was part of how an individual learns to cope with their own feelings in later life. Once we learn this we can contain our own feelings and we can also trust others to contain them.

How does this translate to the impact on our lives of working and living in the same space? Bion spoke about the impact of the caring parent on a child. Might this sense of something being contained by another also relate to the place in which we work? This place forms it’s own sense of containment that may be lost with home working. It is somewhere that we engage with unconsciously as a space where we leave the challenging feelings that are evoked by the tasks carried out there. This place holds our feelings and leaves us free to go home and leave them behind.

Home working challenges us to find a way to manage this lack of separation and hold a boundary between what is work and what is not – and the anxiety that comes with that. How we do this is as individual as we are.

 

To enquire about psychotherapy sessions with David Work, please contact him here, or to view our full clinical team, please click here.
David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove and Lewes.

 

Reference:

Bion, W. (1962). Learning From Experience. London: Karnac Books.

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Making Changes

As well as working privately, I work within an NHS IAPT Service providing psychological therapy for depression and anxiety disorders and when a client comes into therapy, one of the first things we discuss is goals for treatment.

What is it the client is hoping to change by the end of treatment? Is there anything that the client is not able do now, because of their difficulties, that they would like to be doing in the next couple of months?

Goals help to focus the therapy. It’s quite common that the client will say they would like to increase their confidence or to improve their self esteem, to be less anxious or to be happy. These are very broad goals, would be difficult to measure and don’t tell us what the client would actually be doing differently if they were to be confident, have better self esteem, be less anxious or be happier. So we work together to work out what this might look like.

One way to help determine goals for change is to think of our values. When considering values we need to think about what is really important to us, what gives our life meaning and purpose. Values are what we care about and are different for everybody. They can change over time depending on where we are in our life. Meaningful activity is value driven. Values are fluid and don’t have an end point, they are how we want to live our lives, they help us to be the person we want to be.

We hold values in different areas of our life: intimate relationships / marriage / being a couple; family relations; friendships & social relationships; parenting; career / employment; physical wellbeing / healthy living; connecting with the community; spirituality; education / training / personal growth; mental wellbeing.

It can be useful to consider what values you hold in each of these areas and rate how important each domain is to you and where you are in achieving that domain. For example what kind of values do you hold in physical wellbeing? How do you want to look after yourself physically? Is it to take regular exercise, eat healthily, get enough sleep and rest? Are you achieving this as much as you would like to be? What sort of friend do you want to be and how would you like to act towards your friends? For example, loyal, trustworthy, to spend time with friends, to share, to listen, to have fun together. What kind of values might you want to model as a parent? For example, to be curios, have courage, be adventurous, have determination, gratitude kindness and have fun (to name but a few). Values can be described as compass directions in which we live our life.

If you feel that you are not where you would like to be within a particular domain, how can you bring this value further into your life? This is where goal setting comes in. Values are a direction we want to progress in. Goals can be set to help us achieve that direction. For example, if we place value upon exercise and physical health we might have the goal of going for a swim twice a week or we might have a goal of completing a qualification, which sits within the value of education and personal growth. Goals can be achieved and have an end point. You maybe familiar with the acronym SMART goals. This means goals are specific, measurable, achievable, realistic and time limited. So if we wanted to make the goal of ‘going for a swim twice a week’ into a really SMART goal we could add a set time period, i.e. ‘going for a swim twice a week for half an hour’. By setting SMART goals we break down the areas of change into manageable chunks.

Change is difficult and if we are feeling low or stressed and anxious we can often feel overwhelmed. It is likely that areas of our life that are important to us have become affected and we don’t know where to start to change this.

Setting ourselves small goals for change in line with our values is a useful starting place. It’s important to remember that there is no such thing as a failed goal. If we don’t achieve our goal it still give us useful information. Perhaps we set ourselves an unrealistic goal, in which case we might consider how we can break this down further into smaller, more manageable chunks. We can explore the process along the way whilst trying to achieve our goals and moving towards our values. In this way change takes place and has a positive impact on our mental wellbeing.

 

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

 

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 –

Social Connections

Back to ‘Bace’ics

Interpersonal Therapy (IPT) explained

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Communication, communication, communication

Of all the problems presented by clients when they first attend therapy as a couple, communication difficulties are often to be found as the most pressing. However, our difficulties with communication is not just an issue within a relationship: it touches every aspect of our lives – which makes the effort of finding out how we communicate well worth the effort.

Our style of communication is based on how we learned to communicate in our families, culture, society, and with our peers.  It is important to understand that communication is a learned skill:  when we are born, we will be neither good nor bad communicators. However, since it is a learned skill, it means we can unlearn things that make communication a problem, and we can learn new ways to be more effective in the way we relate our ideas, opinions, thoughts and feelings.

What is your style of communication?

Read through a brief description of the four main types of communication and think through which style would be a best fit for you.

  1. Passive Communication       

Passive communicators fail to communicate to others what they think, want or need.  Sometimes they don’t even admit it to themselves. Passive communicators might believe that they are protecting others from their feelings, but in fact more often they are protecting themselves from potential conflict and/or rejection.

Example:

Your partner or friend asks you to do something you do not really want to do. You may feel you are under time pressure, already have too much to do, or already had something else planned for that time.

Passive response:

Agree to do what the partner/ friend asks (what feelings are involved here?)

Say, “Okay”

Pretend not to hear request

Passive communication includes:

  • Avoiding situations which might be uncomfortable
  • Avoiding conflict
  • Avoiding situations that feel emotionally risky
  • Not expressing feelings, thoughts or needs
  • Ignoring our own rights in a situation
  • Lying or making excuses in uncomfortable situations
  • Being apologetic or putting down self
  • Letting others make decisions for us

Feelings might include:

  • Relief (avoided conflict)
  • Resentment (of others for making decisions, having power)
  • Annoyed with self (didn’t say what felt/needed)

2. Aggressive Communication                

Aggressive communicators say what they think without taking into account the other person’s feelings, thoughts or needs.  Aggressive communication includes shouting, intimidating body language, sarcasm and violence. This form of communication aims to hurt, and is often a projection of the hurt and anger the person is feeling.

Example:

Your partner or friend asks you to do something you would rather not do.

Aggressive response:

Laughs at person and storms out of room. (note the ‘acting out’)

“Of course I can’t/ won’t do it!  What an idiotic suggestion.  Why would I want to do that now?  It’s stupid.”

“Yeah, right”

“You always do this.  Don’t you ever do things yourself?  Why me?  You never do things yourself: it is always left to someone else.”

“Why the xxxx did you ever become my partner/ friend?”

Aggressive communication includes:

  • Expression of feelings, needs and ideas at expense of others
  • Violating others’ feelings or rights
  • Dominating and belittling behaviour
  • Having a sense of power or control in the situation
  • Saying what you think without thinking about the outcome
  • Sarcastic remarks

Feelings might include:

  • Sense of power
  • Justified in what you have said
  • Pleased to get your way in the situation
  • May feel isolated (aggressive communication can distance people)
  • Frustration
  • Bitterness

3. Passive Aggressive Communication

People who use a passive aggressive communication style, indirectly say what they think or mean.  It often leaves the person receiving the remark feeling confused, as they have not been clear about what they really think or feel. Although the person speaking might believe they are being polite in communicating this way, both they and the recipient can often be left with unresolved feelings that linger.

Example:

Your partner/friend asks you to do something that is inconvenient for you.

Passive-aggressive response:

“Sure, no problem”…Then seeks out confidante and says, “I just talked to X, who asked me to do this. Can you believe it? He never does things himself, he’s so lazy… How did I get into a relationship with him.”

“I guess I can do that.  I am a bit busy, but I’ll probably be able to do it.  I missed something important the last time, but obviously you need me to do this so I will.”

“Whatever”

“I suppose that is one way to organise your life – getting others to do the work for you. Sure, I’ll do it.

Passive aggressive communication includes:

  • Being indirectly aggressive
  • Trying to control the situation while being ‘nice’
  • Manipulative behaviour
  • Being unclear about how you are truly feeling
  • Denying your feelings about a situation, when you are clearly aware of them
  • Making others feel guilty
  • Avoiding rejection and hurt
  • Getting what you want without facing conflict

Feelings might include:

  • Low self-esteem
  • Isolated because of distancing and confusing communication
  • Angry at self
  • Relief because person has made their point whilst avoiding conflict.

4. Assertive Communication    

People who communicate assertively, are clear and say what they mean. They accept their feelings, thoughts and ideas without judgement and express these in such a way that they don’t put the other person down.  When being assertive, they take into consideration timing, situation, feelings and thoughts.

Example:

A partner/ friend asks you to do something at short notice, when you have deadlines of your own.

Assertive response:

“I am unable to do this as I need to finish x by y.”

“I am unable to do this now, but I could do it by x.’

“I cannot do this now, but I would like to help. How about we meet at x and we can do it together?”

Assertive communication includes:

  • Expressing your feelings, needs and ideas, while maintaining respect for the other person
  • Knowing what you feel so that you can express it clearly
  • Standing up for your rights: saying “yes” or “no” when you mean it
  • Being honest with yourself and others
  • Saying what you mean (with persistence—sometimes you have to repeat yourself when being assertive)
  • Making own choices
  • Taking risks in communication
  • Facing potential conflict

Feelings might include:

  • Feeling good about self
  • Increased confidence
  • Increased self-esteem
  • Relief

Communicating assertively can make us feel anxious, but it often leaves us feeling empowered. It takes practice, but it can become habit. Think about your needs and feelings – and then consider the best way of articulating them.

It is also odd to think that to make ourselves assertive, we need to make ourselves vulnerable (by being honest and open about how we feel). If we fail to do this, and continue to communicate without the connection with feeling, we are likely to continue to ‘act out’ various defensive communication styles learned in our early family units.

How can Therapy Help?

Therapy will help you to understand your feelings better, which in turn will lead to a better understanding of your needs and the needs of those around you. You can then begin to make choices about how you wish to communicate those feelings and needs with clarity.

 

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

Face to Face and Online Therapy Help Available Now

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Cultural Identity and Integration – Feeling at Home in your own skin

I feel lucky to live and work in a place where I am in contact with people of diverse cultural backgrounds. Many seek me out as a therapist to talk about their personal struggles with cultural identity and belonging. Difference is something which is deeply felt in one’s skin and bones and living in a different culture to one’s own can feel like being a fish out of water – permanently. Everyone goes through their own unique set of issues depending on circumstances linked to upbringing, race, gender, immigration status, class, age, sexuality, and disability.

Sense of Belonging

Cultural and psychological integration go hand in hand, given culture is an intrinsic part of one’s identity which is linked to a sense of belonging, safety, and mirroring. All of these are associated to early childhood experiences; for instance, hearing our parents or carers speak in a certain language or with a particular accent, and sensory experiences – smell, taste, sound, and touch. Most of us can recognise the familiarity which transports us ‘home’ through hearing a piece of music, eating certain foods, or hearing our language. Other familiar experiences can include literature and art, nature and wildlife, and weather.

The True Meaning of ‘Cultural Integration’

Migration, whether through choice or not, can result in the loss of everything that has once felt familiar. These losses need to be felt and mourned, so we can better accept and embrace the new culture we are living in. I have come across individuals from other cultures who had on the surface integrated very well in the UK, but on the other hand carried a deep melancholia about their cultural past, preventing them from ever fully ‘arriving’ here. Leaving one’s country and culture for another means reinventing oneself to a certain degree. Whilst this may sound appealing to some, the other side of it is that it can feel that you must constantly explain yourself. The lack of familiar cultural references, working harder to understand and be understood, and the constant feeling of being different are aspects of a migrant’s daily experience which remains invisible to others. We understand cultural integration more superficially as whether one can speak the language fluently, settle and adapt to a new environment. This is only the beginning.

The Role of Psychotherapy

We can think of Psychotherapy as integration of the different parts of the self which conflict with one another. This usually involves mourning losses, accepting reality, and learning to live with (or even embrace) paradox and uncertainty.  This is not about leaving your culture behind – quite the opposite. The more we process and integrate experiences, the more we learn to accept who we truly are. As you can imagine, this will not happen in just a few sessions. Preferably seek a culturally aware psychotherapist who has been through this process themselves or is at least far enough along the journey to take you through it.

 

Sam Jahara is a UKCP Registered Psychotherapist with a special interest in working with issues linked to cultural identity and a sense of belonging. She works with individuals and couples in Hove and Lewes.

 

Blogs by Sam Jahara

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Leaving the Family

Psychotherapy and the climate crisis

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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

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Anxiety, Fear states, Trauma

Why do we get anxious and fearful?

The anxiety /fear response is the brain’s way of trying to keep us safe and healthy. Anxiety serves as a faithful reminder of things which the brain assesses need to be avoided, based on past experience. Most of this experience is past or learned experience. This is important in understanding the role of anxiety and fear states.

Firstly anxiety and fear are natural emotions which are built into our biochemistry in order to ensure survival. The fright flight fight response takes place in the lower ‘old brain’ and is vital to promote survival. This is the area of the brain which we probably all have had some experience of in recent days and weeks with the Corona virus pandemic. This response is what we are seeing with a frightened population stockpiling food and resources and even fighting over supplies.

Secondly alongside the biochemical response of the old brain, we each have individual mental and emotional responses which are very variable

Understanding that the brain is a pattern seeking machine is really helpful here in understanding these variable responses. The brain simply reproduces a response based on past similar experience.

In order to treat anxiety we need to look at these patterns.

Different schools of therapy  have different approaches.

Behavioural  therapy looks at how thinking influences feelings and how to interrupt that pattern.

Psychodynamic therapy seeks to understand and connect past experience (which may be outside of our awareness) with the current response. A therapist can help the client to decontaminate, to understand, and process those experiences which may be outside of our awareness.

Creative psychotherapies such as Dramatherapy, Art Therapy and Music Therapy specialise in helping the client to access, process and release, out of awareness experience in very safe non directive ways. These therapies are especially indicated where there is trauma, neglect and attachment issues which are causing or contributing to anxiety and fear states.

Mindfulness therapy is very beneficial for anxiety,  fear states and panic attacks. It works by showing the client how to learn to place awareness in the body, the feelings, sensations- to  notice the thinking and then to return to body awareness. It becomes possible to observe thoughts passing as if watching a video, and then to return to the calm still space within the body.

Over time in mindfulness therapy, a new awareness begins to develop which interrupts the fear response. The mind develops an ability to dis -identify with the thinking, the feelings and the sensations which create and support the anxiety fear response. The ability to return to the still quiet space within is a skill that can be developed with practice both within and outside of sessions.

 

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. Online therapy is available.

 

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Paying attention to stress

We are evolutionarily wired for stress.  For our early ancestors, inhabiting a natural world beset with predatory dangers the flight/fight response was crucial to survival.  The same alarm system exists today for the same survival purpose evolution originally intended. 

What is different is that today the more likely sources of threat (at least for those of us living in the industrialised world) are emotional.  Our biology, psychology and physiology are interlinked in subtle and complex ways, all with implications for our health and well being.

A stress response is activated when an event, physical or emotional is perceived as threatening.  As human beings we make multiple assessments via our central nervous system to interpret a stimulus and prepare ourselves to respond. Our response will be a combination of physiological and behavioural adjustments commensurate with the perceived degree of threat.  What is “commensurate” varies from person to person.  Each stress event is experienced in the moment but may have resonance from the past.  Our personal histories as well as our dispositions influence our response to a stressful event.

Acute v chronic stress

Whilst on the one hand stress can be understood as a physiological event vital to survival, on the other it is increasingly understood to have a corrosive effect that impacts negatively on our long term health.  Here it is important to distinguish between acute and chronic stress.

Acute stress triggers immediate discharges in the nervous, hormonal and immune systems, activating flight or fight reactions that help us survive imminent danger.  These are highly adaptive and highly effective responses.  In the case of chronic stress, the same systems are activated(over and over) but without resolution.  The effect is elevated cortisol and adrenaline levels which can damage tissue, raise blood pressure and undermine the integrity of our immune functioning.

For many people, functioning with chronically elevated cortisol and stress hormones is normal.  The circumstances of our early lives, including our attachments may have necessitated a state of hyper arousal and vigilance.  Without any conscious awareness our bodies stress responses can remain highly active.  Indeed it may be the absence of stress that creates unease in the individual habituated to its hormonal high but such a state of addiction to our own stress hormones may have serious implications for our long term immune functioning and health.

When we are unaware of what is happening in our bodies we are unable to act in self preserving ways.  The same is true of our emotional states.  If we are unable to identify what it is we feel, we will struggle to communicate it.  Our capacity to identify our emotional states will largely depend upon the messages that were conveyed to us early on by significant others.  A child may conclude that “I am not ok when I am angry” for instance, based on the blatant or subtle (verbal and non verbal) responses of a parent/ group of which they are a part.  In order to prevent the threat of rejection or shame the child will learn to shutdown or repress the unacceptable expression of anger.  This repression if it is to remain successful will require constant vigil and adaptation, such that overtime the legitimate expression of anger will be compromised and confused.

Self awareness

We need to develop a degree of emotional competence and fluency in order to protect against the hidden stresses that can pose such a (ticking time bomb) threat to our health.  This means being able to identify and express our emotions effectively, to assert our needs and maintain healthy (physical and emotional) boundaries.  It means being able to distinguish between past and present realities such that we cultivate awareness (and compassion) for unmet childhood needs.  Remaining disconnected with these aspects of our personal histories can contribute to hidden stress with potentially serious implications for our physical and emotional health and well being.

 

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

 

Further reading by Gerry Gilmartin –

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

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Managing Work Stress

Most of us have to work in order to live. For many, work can take up a large proportion of our waking lives with up to a third of our lives being spent at work.

While the primary reason for working is to make money, our work life can (and should) be much more than that. Working and having a career can become an intrinsic part of our identity and can indeed give us meaning and purpose in the world.

When we meet a new person, one of the first questions we often ask them is: “What do you do?” We can identify ourselves by our work and the position we hold within it, and our work can become one of the most important aspects of our life.

When our work life becomes stressful, our emotional response to it can become out of proportion to the actual situation. We can feel that our livelihood is jeopardized and at a deeper level it may feel like the very core of our being is threatened. Stressful situations at work can soon spiral out of control as we lose our clarity and our ability to stay objective in the face of these perceived threats.

What is stress?

 There is no clear medical definition of stress, but generally speaking we can say that stress is our body’s natural response to demands or threats that are put upon it. The stress response is usually the ‘fight or flight’ response that can help protect us in dangerous situations.

Under normal circumstances, stress is healthy and can help us stay alert, focussed and be more energetic. It can give us the motivation to get up in the morning and get on with our day.

However, if we have a demanding job or there are conflicts at work we can end up in a heightened stress state for a prolonged period of time. This can have a negative affect on both our physical and emotional health and we need to be mindful of the signs that we are becoming too stressed.

 What are the common symptoms of stress?

Cognitive symptoms: Inability to concentrate, constant worrying, racing thoughts, seeing only the negative in situations.

Physical Symptoms: Frequent colds of flu, aches and pains, nausea, dizziness, chest pains, rapid heart beat, loss of sex drive.

Behavioural Symptoms: Changes in sleep pattern, using alcohol or drugs to relax, changes in eating habits, withdrawing from other people.

Emotional symptoms: Depression, anxiety, mood swings, irritability and anger, feeling overwhelmed, loneliness and isolation.

What is causing your stress?

As well as noticing the signs and symptoms stress, we also need to identify the situation that is causing us stress. Some of the main work issues that can cause stress are: being overloaded, conflict with colleagues, management style of the organisation or our line manager, change and personal factors such as work/life balance. Some of these will be easier to address than others, but as a starting point, don’t carry the stress alone.

What can you do?

If possible, speak to colleagues and your line manager, and to your HR department if you have one. Letting others know that you are stressed will enable them to step in and help if they can.

Additionally, think about your work/life balance. Are you spending too much time at work with not enough down time? It’s easy to fall into the trap of needing to work more because you are stressed, which means you have less downtime and hence more stress. Re-addressing priorities in an important part of dealing with stress – make some time for yourself. If you able, do some physical exercise to help you unwind the physical tension. Start a mindfulness practice to allow your mind some ‘time off’. Speak to your GP if you are experiencing the physical symptoms mentioned above. And finally, if it becomes overwhelming, consider speaking to a counsellor or psychotherapist to help you process the emotions than can arise from feeling stressed.

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.

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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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On Brexit and the Psychological Defence of Splitting

On Friday, everybody in the UK awoke to a new world. The dust has yet to settle and the repercussions of the vote to be enacted; we live in interesting times.

Whilst I have a view on whether we should or should not leave the EU, this blog is not about that. It is about how as a population we have literally been split down the middle and how this process – splitting – can be seen as a psychic defence process of the same namesake. If it does, what does it say about all of us?

Splitting is the technical term for ‘black and white’ or ‘all or nothing’ thinking. We can all be guilty of this at certain times – particularly when put under pressure and feeling fear (more about this shortly.)

Splitting is therefore an inability of a person to mentally hold the positive and negative qualities of self and others: it a failure to mentalise – to hold an integrated self and other in mind. It is described as a primitive defence (primitive referring to a defence we learn early in life) and stems (or so the theory goes) from the infant’s inability to see both the satisfying aspects and frustrating aspects of their caregiver’s attention to them as being from one and the same person. The infant therefore ‘splits’ the parent (or object) into a ‘good Mummy’ and a ‘bad Mummy’.

How does splitting work in relationship? Well with relationship to others, it creates enormous instability, as the other is experienced as either good or bad, loving or hating, black or white, British or foreign. And this split is experienced in the relationship to self too, so that undesirable, unthinkable or unacceptable aspects of the self are ‘split off’ and projected onto others, further fuelling the relational instability. Interestingly, splitting is one of the defences most associated with Borderline Personality Disorder.

The campaign for the EU or for the UK – as it was presented to us – has left the population with little ability to hold their splits by virtue of it culminating in base choice of ‘Remain’ or ‘Leave’. Add to the mix the fear and hate-based rhetoric by politicians and the media, and it becomes a challenge for any one of us to not become aroused (impassioned) about our positions by denigrating the views of the other camp.

I would suggest that the reality for all of us is that how we feel about the EU and Britain’s identity and role in Europe – and therefore by extension our own role and identity – is conflicted. Again, whilst remaining unbiased in my views, factual evidence would suggest that being a member of the EU has brought benefits and challenges and idea of leaving promised, at least in phantasy, much the same (again, phantasy as much of what was promised stirred unconscious desires of identity and safety without us as yet having an evidence that this will be the outcome).

So now, in the aftermath of the vote, where the political establishment is in turmoil and the media in overdrive, how do we reflect and hold our splits? Perhaps we can recognise that in every Remain voter, there is a part that would vote Leave, and that in every Leave voter, a part that would vote Remain. To accept this means accepting that ‘the other’ is not inherently evil, stupid, or self-centred, but has felt obliged to split off their conflict and ambivalence.

Being honest with ourselves about our own splits and how fear, stress and the political system forced a split is the first step, the second is perhaps in noticing that nothing has as yet changed. We are all feeling stress and worry, which raises our arousal levels and drives us to seek a sense of knowing and security – this is human nature. But pausing, breathing, switching off the constant manic newsfeeds and slowing down will create significantly more of a felt sense of safety and security than continuing to allow the chaos to create psychic splits in us that cause us to react rather than act.

For some tips and guidance on developing a daily practice that can help bring about a felt sense of stability and calm, please see our blog on mindfulness.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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