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February 21, 2022 by BHP Leave a Comment

Pornography and the Online Safety bill

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

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

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

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

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

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

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

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

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

 

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

 

Further reading by Mark Vahrmeyer

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

 

Filed Under: Mark Vahrmeyer, Relationships, Sexuality, Society Tagged With: addiction, Depression, Self-esteem

September 6, 2021 by BHP 2 Comments

I Never Thought My Son Would Watch Pornography

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

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

Pornography and the Adolescent Brain

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

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

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

Boys and not girls

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

Meanwhile, in the real world

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

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

Disadvantaged Parents

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

As youngsters become men

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

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

What can parents do?

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

 

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

 

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

 

Further reading by Kevin Collins –

Why is it hard to make decisions?

Communication, communication, communication

Filed Under: Brighton and Hove Psychotherapy, Kevin Collins, Relationships, Sexuality Tagged With: addiction, Relationships, sexuality

January 25, 2021 by BHP Leave a Comment

What’s wrong with good advice?

Often, the people who engage in therapy with me will ask for advice, tips on managing anxiety, what to do about a relationship situation, how to manage a tricky situation at work. Sometimes someone might ask for general ‘life advice’. Of course, mostly what they want is some sort of reassurance and although its not true that therapists never give advice I tend not to offer reassurance. Why not?

Well to start with, the problem is rarely not knowing what the right thing to do is. If someone wants ‘tips’ on sleep or anxiety strategies, I might advise them to look on the internet, there’s plenty of it out there and its free and of course generally sound. Eat your greens, go to bed at a regular time, do some exercise, especially yoga and don’t take too many or too much, mind altering substances.

This reminds me of a joke, –

‘Doctor, If I stop drinking alcohol altogether, eat my greens and give up sex, will I live longer?

Dr – Well I can’t tell you with any certainty whether you’ll live any longer, but one thing I do know, it will certainly seem much longer!’

Of course, what people struggle with is not, not knowing, what the healthy thing to do is, it’s doing it and the reason for this is that they/we are conflicted.

Many clients may come saying they want to stop, whatever it is, that is causing them problems. So I ask why don’t they then? and they say I don’t know. Well the answer is simple, another part of them doesn’t want to stop, whatever it is there doing, is serving some purpose, even if the consequences of continuing to do it are grave. Of course, in many cases this can indeed be tragic, people find themselves compulsively doing things that they know hurt themselves or others, damage, destroy or put important, sometimes essential relationships at risk.

Therefore, advice on stopping the behaviour rarely works as the addiction or compulsion is a solution to another, sometimes, -unconscious problem., as Depache Mode noted, they’re, “looking for love in all the wrong places”.

– “in the woods of anguish, it’s easy to lose your way”. (George Nash 7.9.2020)

The difficulty in a way is in beginning therapy, as the client and therapist needs to come to a together about what the problem is and what the contract of work is.

I have had many clients come with problems and basically say, well, I’ve told you the problem, now over to you to give me the right advice to fix it. Needless to say, these client’s often leave before the work starts. For instance, someone I saw with a destructive addiction was clearly harbouring a long festering repressed grief about an abandonment by his father, however this wound was so repressed that any interpretation of mine that it might be important to look at this just didn’t work and we were immediately at a stalemate.

Of course, my job is to be as tactful as possible, to not push the client beyond where they are ready to go and to be as patient as possible, BUT, destructive behaviour is always the result of past hurts and unless we do find a way together to think about these, a stalemate or premature ending will be the result.

 

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

 

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 –

Psychiatry, Psychology and Psychodynamic Psychotherapy 

Analytic Therapy for Addictions

Loss

Post Natal Depression in Mothers & Fathers

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Filed Under: Mental Health, Paul Salvage, Relationships Tagged With: addiction, anxiety, Psychotherapy

June 22, 2020 by Brighton and Hove Psychotherapy Leave a Comment

Analytic Therapy for Addictions

In this blog I want to briefly explore the analytic approach to addictions.  Freud stated that his aim in Psychoanalysis was to help the patient transform ‘hysterical misery into common unhappiness’. In Buddhism, a central concept is that of Dukkha, commonly translated as ‘suffering’, ‘unhappiness’, ‘pain’, or ‘stress‘. It refers to the fundamental painfulness of mundane life.

Henry David Thoreau (1854) declared that most men lead a life of quiet desperation.

As depressing as these concepts seem, the intention is actually to relieve suffering, that it is the excess of suffering that we visit upon ourselves by an excess of demand, the demand to be excessively happy, to criticize and shame ourselves for not being ‘good enough’, the sadistic internal voices that berate us for the shortcomings of what is often an unachievable internal ideal that creates an unbearable pressure.

Modern life is designed to sell us things. One the most successful early pioneers of advertising, Edward Bernays was a nephew of Freuds and advertising has very successfully realized that we are driven to buys things that we imagine will make us feel better about ourselves, that within the object brought is an identity of ourselves as, better, more desirable, happier etc, in short to offer us promises of less painful or even pain free lives.

Zizek notes that the unconscious ideology of today is the demand to ‘enjoy’.

In terms of addictions, especially the addictions, now facilitated by the internet, and even more so by the internet in the pocket, the phone; gambling, pornography and shopping, these promises are ever ready. Its is also worth noting that addictions can be hidden in seemingly healthy pursuits; healthy eating, work, exercising, that can also be used as an avoidance of emotional pain through compulsive stimulation.

There are broadly speaking two approaches to therapy and to treating addictions and their underlying causes, the conscious strategies and good advice model and the more exploratory underlying approaches. Both have their place and it may be necessary to utilize both to really address issues.

The first model; involves CBT and specialist structured interventions; – managing access to the source of addictions, keeping diaries, replacing destructive habits with healthier ones and these will be more advice led. Sometimes it may necessary to utilize these approaches to try and get something under control. However, what these models may not do is to really dig down and get underneath the causes of the problems. The addictions are often the symptoms of underlying traumas and difficulties, sometimes these are not conscious and this is where the analytic or exploratory approach focuses its beam. The problem with not doing this, is that in true wac-a-mole style, the underlying causes tend to resurface and one addiction will merely be replaced with another.

Lance Dodes (2019) an analyst specializing in addictions highlights three pertinent areas of exploration:-

  1. Feelings of helplessness or powerlessness, produced by specific situations whose meanings interact with prior traumas. In this situation the additive act or even just the decision to undertake an addictive act can help the person regain a sense of control. The exploration of the issues leading to these feelings can unpick the unconscious feelings leading to the urges and ‘allow anticipation of future addictive urges, with the possibility of mastering the behaviour.’
  2. These feelings of powerlessness are often related to past traumas and difficult experiences often in relation to the clients attachment history, which has led to internal feelings of powerlessness and corresponding feelings of rage against these feelings.
  3. These feelings are displaced into addictions, through therapy these feelings that were once felt to be overwhelming and unbearable can over time and within a strong therapeutic relationship begin to be able to be felt to be understood and able to be experienced, often through the experience of the therapist being able to face and contain the feelings with and alongside the sufferer.

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 –

Loss

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconscious

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Filed Under: Brighton and Hove Psychotherapy, Mental Health, Paul Salvage Tagged With: addiction, attachment, mind and body

December 9, 2019 by Brighton & Hove Psychotherapy Leave a Comment

The dangers of over medicalising

Earlier this month (October 2019) the government announced a new service for gaming addicts aged 13-25 at the Centre for Internet and Gaming Disorders.  According to the World Health Authority Gaming Disorder is a pattern of persistent or recurrent gaming behaviour so severe that it “takes precedence over other life interests”.  This description could equally be applied to any addiction be it an addiction to gaming, alcohol, dieting, exercise, drugs or sex to name a few.

New addictions and other mental health categories are being ‘discovered’ almost weekly.  The current version of The Diagnostic and Statistical Manual of Mental Disorders – DSM-5 published in 2013 contains 541 categories of mental disorders. This version replaced DSM-IV published in 1994 containing 383 disorders.  That’s an increase of 158 categories in 19 years – just over 8 new categories per year, a little more than 1 every couple of months.

GPs, psychiatrists and other mental health clinicians use the DSM to diagnose their patients.  Each category has a list of symptoms and as long as the patient presents with a required number of symptoms within the category a diagnosis is given.  Alongside a diagnosis there is a choice of treatment or treatments which will typically be a combination of medication and/or some form of psychotherapy to treat the symptoms.

So far so good, however with new diagnostic categories based on surface symptoms springing up so regularly the structural causes that lie beneath these symptoms are given less and less attention.  Two people may present with the same surface behaviour, for example, a pattern of persistent or recurrent gaming behaviour.  In both cases the person might describe significant impairment in important areas of functioning like work, relationships, their social life, education or occupation and so the label gaming addiction may be applied.  Dialogue however may show that for one the symptom is linked to how they wish to escape from feelings of anxiety and depression whereas for the other it is a consequence of the delusional belief that the gaming world they enter is in fact the real world and one in which they have a real place.  Similarly we might consider two people who are persistently restricting what they eat leading to weight loss or a failure to gain.  Again a discussion may show that for one person the reason they are dieting is because they imagine that the thinner they are, the more lovable they will be whilst another person may be refusing food because they believe it to be poisoned.

In this way the same symptom covers two very different causes and psychological structure.  In order for the symptoms to be reduced the underlying cause needs to be explored.  This is the work of long term psychotherapy where the person is treated as a whole and is encouraged to speak about themselves and their relationships both as they are now and also as they were in the past.  Personal history and family dynamics are thought about so that the meaning behind the symptoms can slowly emerge.

 

Please follow the links to find out more about about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

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Filed Under: Brighton and Hove Psychotherapy Tagged With: addiction, anxiety, Depression

May 30, 2016 by Brighton & Hove Psychotherapy 1 Comment

Does psychotherapy cure addiction?

Does psychotherapy cure addiction?addiction

The answer to this question depends very much on whether addiction is seen as a disease in the medical sense of the word, and secondly, on whether it is indeed the goal of therapy to cure.

In response to these questions, I would suggest that rather than being a disease (as the 12-Step programmes are so fond of framing it) addiction is in fact a maladaptive way of managing uncomfortable feelings in lieu of more functional methods. Good affect regulation – the art of navigating our constantly changing emotional states – depends on our ability to use our mind to self-soothe and seek out other humans who will be available to witness and validate our experience. For some, reaching out to others is simply too frightening, and it becomes safer to use a substance or behaviour as a pseudo-other.

I would further suggest that the role of good psychotherapy is to help clients to build their minds so that they can use their minds to regulate their emotional state (see my previous blog on affect regulation.) It is not to cure. That does not mean that psychotherapy is not useful or an effective treatment, but it is a treatment to build the capacity to both process unprocessed experience and to help regulate affect.

What is addiction?

Addiction is a fascinating arena and one in which research is continuing, with conflicting ideas, views and theories competing for attention. However, some things have been established.

Addiction is a repeated behaviour that is used as a way of changing our experience and as a result changes our brain; the more we engage with the behaviour to change our experience, the more it changes our brain, making it more likely we then resort to the behaviour again. For many, it is a painful loop – especially where their addiction is socially unacceptable – drug addiction vs. being a workaholic – and has a higher cost of their relationship to self and others.

All addiction is chemical

Some researchers continue to try and draw a fundamental distinction between substance and behavioural addiction.  All addiction, I would argue, contains elements of both.  For example, someone who has an addiction to the most socially acceptable drug – alcohol – may find that their body goes through alcohol withdrawal when they stop drinking.  However, the success of their sobriety also involves letting go of significant behavioural aspects to their addiction such as socialising with certain friends; frequenting certain establishments; and even letting go of the pleasure of the ritual of pouring that 20-year old whisky from the decanter into a crystal tumbler at a specific time in the evening.  At the point of engaging in the ritual – moving to pour that drink – the addiction has taken over.

And behavioural addictions such as compulsive gambling; sex and pornography addiction and gaming addiction, to name a few, may on the surface seem to be simply behaviours without any substance influence, however, this is simply not the case.  Brain scans have shown that the brains of addicts light up in just the same way as those of substance abusers when that individual thinks about their addiction of choice.

Therefore ALL addictions change the brain and it can be argued that all addictions, irrespective of the substance or behaviour, are in reality an addiction to the chemicals and hormones released in the brain when engaging with that addiction – most notably, dopamine.

Addiction as an attachment disorder

Rather than viewing addiction as a weakness, disease or label for a person’s behaviour, it is far more helpful from both a compassion and treatment perspective to view the addiction as a way that that person regulates their emotional state, and to recognise that this has come about through a lack of emotional witnessing, validating and normalising behaviour (emotional neglect) on the part of their primary caregiver.  The behaviour and/or substance functions as a pseudo-relationship for the addict – one that feels far more consistent, safe and trustworthy than their experience of other close relationships has been.  This is also why despite loving their partners, families and children, some addicts simply cannot face letting go of their most important relationship – the addiction – and will forsake all others to protect it.

Who can heal the addict?

Psychotherapy is often critical in helping people with addictions to learn to adopt more functional ways of self-soothing and getting their needs met in relationship.  However all of this depends on being able to hold onto that thinking mind – the ability to mentalise – first and foremost and this can only happen through a prolonged and attuned therapeutic relationship.

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

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Filed Under: Mark Vahrmeyer, Psychotherapy Tagged With: addiction, Psychotherapy, self-care

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