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Analytic Therapy for Addictions

Freud stated that his aim in psychoanalysis was to help patients transform ‘hysterical misery into common unhappiness’. Similarly in Buddhism, the concept ‘Dukkha’ is commonly translated to suffering, unhappiness, pain or stress and refers to the habitual experience of mundane life.

Why Do We Get Addicted to Things?

Addiction has been around for thousands of years and always reveals a certain pattern in which we are motivated by our brain’s reward system. This system organises our behaviours, provides tools to take the desired action and then rewards us with pleasure, aka dopamine.

Dopamine is a chemical that is released in the brain that makes you feel good. When we do things that we enjoy, dopamine is released. When we experience big surges of dopamine, like when taking drugs, the craving for that same surge is what causes addiction.

Addictions are now enabled more than ever before by the use of mobile phones and the internet. Gambling, shopping, and pornography are facilitated by the device in your pocket. Addictions can also be hidden in seemingly healthy habits such as healthy eating, work and exercising. However, being addicted to anything, no matter how ‘healthy’ can cause strain on your mental well-being.

How We Treat Addiction

There are two main approaches to therapy when it comes to treating addictions and their underlying causes. One includes a good advice model and the other includes a more exploratory approach.

CBT

The first approach involves CBT and specialist interventions which may lead to the source of the addictions. Advice may include keeping diaries or replacing destructive habits with healthier ones. This approach is more advice-led and may help a client get their addiction under control, but it may not dig down to find the root of the issue and one addiction may actually be replaced by another.

This is where analytical or exploratory therapy comes in.

Analytic Therapy

Analytic therapy recognises that people are more than their problems. It helps the patient to find their own ways of helping themselves by setting manageable goals that bring about change. It is a form of talk therapy that allows patients to understand their difficulties and develop new methods to keep the issue at bay.

Analytic therapy encourages patients to dig deep to find the route of the problem which is often found when discussing relationships with family members, early experiences of loss, ways they deal with negative feelings and common thoughts throughout the day.

When the history has been delved into, the therapist and client can agree on behaviours and things that must change in their life for their plan to control addiction to become easier. Some need to control their reactions to triggers, and others may simply need to understand their triggers.

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

  1. Feelings of helplessness or powerlessness are produced by specific situations whose meanings interact with prior traumas. In this area, the addictive act, or the decision to undertake an addictive act can help the client take back control. Through exploration of the issues leading to addiction, we can discover feelings that lead to the urges.
  2. Feelings of powerlessness are often related to past traumas which have led to these internal feelings and corresponding feelings of anger towards those feelings.
  3. These feelings are then displaced into addictions. However, through therapy, the feelings that were once unbearable and overwhelming can, over time, being to be understood.

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

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How Psychotherapy Taught me to Live Life

This piece is written by a ‘fictional’ client who is a composite of three real-life clients who have shared their experience of psychotherapy with me.  Some details have been changed to ensure confidentiality, however, the thoughts feeling and experiences expressed are those of three very real clients:

When I came to psychotherapy I did not even really know what it was.  I knew I needed something because I knew I was struggling but whether that something was counselling, psychotherapy or what I simply had no idea.

As well as not having much of an idea about what to expect from my psychotherapy, I also had no idea about how long it would take.  And I was impatient!  It is therefore with a surprise that I look back upon my two-year journey of weekly one-to-one psychotherapy with some degree of awe with regards to how little I really understood what I needed and for how long; from my initial impatience, a sense of appreciation and security developed from knowing that on Tuesdays, at 5pm, I would be seeing my psychotherapist.

Where I say that psychotherapy taught me how to live life, I mean this in the sense of courageously living rather than existing.

Prior to psychotherapy I approached life and relationships from a default fear position.  Not that I knew that at the time – the way I was all seemed perfectly normal to me.  Normal is, after all what we are familiar with.

However, part of me also know that I felt unfulfilled and lacking in purpose and meaning.  Meaning in terms of my own desires and meaning in terms of what relationships could offer me.

It has been through a slow process of learning to be in relationship with my psychotherapist that I have slowly learnt to have a healthy relationship with myself.  Through being held in mind, I have learnt to hold myself on mind.  And through trusting that the relationship with my psychotherapist was and is genuine, I have come to accept that just perhaps, relationships with others have something to offer me.

I am now two years into my ‘ongoing’ psychotherapy relationship.  It has been hard, frustrating, frightening, constructive, containing and life enhancing all in equal measure.  The only commitment: we both show up each week for the session.

How have I changed

Most of all I have let go of the past.  My experiences still happened, of course.  There is no magic to undo that.  However I have accepted that I can still have a life without having gotten what I needed as a child.  And through this have come to accept that I can treat myself differently to how I experienced my parents treating me.

My relationship with myself

‘Has psychotherapy made you happy?’, people I know sometimes ask me.  No.  But then happiness is not the purpose of life.  I do, however, at times feel content and even happy.  More importantly, I am able to feel the full range of human emotions without running away from them.  I can navigate my emotional world using my mind in a way I simply could not before psychotherapy and instead would use all sorts of distractions to avoid feeling.

My relationship to others

I have far deeper and more authentic relationships with others – something I now realise I avoided in the past for fear of them really seeing me and then rejecting me.

Relationships have become important to me and I am far more able to tolerate difference in those around me – to accept that they have different minds.

In summary

Put simply, my life now has substance.  I know more about who I am, who I have been and how I spent much of my life hiding from myself and others because of not feeling accepted; I now have compassion for this part of me.

Mark is an integrative psychotherapist primarily informed by attachment theory and object relations psychotherapy.  He works relationally and sees individuals and couples in Hove and Lewes.

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How body stability creates psychic stability

There is No Such Thing as a Baby

I frequently blog about the importance about including the body in the process of psychotherapy and how the unconscious resides in the body.  However, unlike many ‘body psychotherapists,’ I believe that the involvement of the body is more profound than identifying the presence of the body in the process. Let me explain using one of Donald Winnicott’s most famous quotes, “There is no such thing as a baby.”

Winnicott famously made this statement in 1947. On face value, it may seem somewhat absurd. After all, we have all seen babies and know they exist. However, the reality is far more complicated, because every baby that any one of us has ever seen is only visible because it is in a relationship with its primary carer (which for simplicity, I shall refer to as its mother).

A baby cannot exist alone but is essentially part of a relationship.  Babies exist in an absolute state of dependence, such that the infant (the word is taken from the Latin – ‘infans’ – not able to speak) has no knowledge of maternal care, as this would require the knowledge of ‘an other’ providing the care.  The baby therefore is essentially indivisible from its mother and thus cannot exist in its own right.  The infant’s experience relies on the mother’s ability to merge with, and adapt to, her baby.  Therefore, whenever we see a baby, we actually see a baby, its mother, the relationship between the two and also the wider social context within which that baby lives and has come to be.

There is No Such Thing as a Body

The same principle can be applied to a body.  There is no such thing as a body in its own right.  A body is created, shaped, moulded and exists within the relationship that the mother of the owner of the body has had with it.  In other words, the body and how it is experienced by the person in the body is contingent on the relationship that the baby has with the mother and the wider environment. This then dictates the relationship that the owner of said body, has with him or herself (if any.)

Why Does the Body Matter?

Psychotherapy is about many things, but one of the primary tenets is that it is a relationship within which the client/patient can, through relating to the therapist, establish a relationship with themselves. Having a relationship with ourselves includes having a relationship with our body. However, I believe that too many psychotherapists assume that such a relationship is necessarily experienced as helpful by the client at the outset of therapy, or even possible.

The Body as an Enemy

If we come to inhabit, or embody, our bodies through the relationship with our mothers and the wider social context, and our mothers were abusive to us, then the experience of our body can be one of ambivalence (‘I don’t really care about my body”) through to experiencing the body as dangerous, attacking or not our own.

Examples of where internalised abuse/hatred is expressed towards the body include cutting and burning the skin through to anorexia and bulimia, to name a few.

Risk of Trauma

Assuming a pre-existing, or even conceptually possible positive relationship between a client and their body on the part of the psychotherapist is naive. At worst, it risks re-traumatising the client.

If, for the client, all that is bad resides in their body, then they need to slowly find a way to ‘meet’ their body in a different context and to tentatively form a different relationship with their body – to reclaim it from the ‘bad’ parent. The therapeutic process involves creating a different relationship with ourselves, one in which we are able to leave the echoes of past formative relationships behind. At the very least, we need to learn to think about ourselves as players in those stories in a different way. In the same way, we need to learn to relate to our body as our own and as our friend, guide and an integral part of us.

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

Further reading

Body psychotherapy

What is attachment and why does it matter?

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What is Psychotherapy?

In this age of jettisoning the past and continually embracing the new, the answer to the question of how psychotherapy works has remained largely unchanged since the days of Freud.  Modern enquiry and comprehension brings the capacity to understand what happens in the brain as a result of effective analysis, psychotherapy, or indeed, good enough parenting.

To use an analogy, Freud worked out how to bake the cake of psychoanalysis and with it, what ingredients to use.  Modern science has the capacity to empirically prove how those ingredients work through neuroscience research.  In this piece, I shall concern myself solely with the main ingredients of what is needed for effective psychotherapy.  Although they are but two, how they are applied marks the difference between an amateur cook and a master chef.

In 1968, Michael Balint, a psychoanalyst in Britain, wrote the following ‘recipe’ for effective analysis which holds true for counselling and psychotherapy to this day:

“Although, as a rule, it is not stated quite so implicitly, we are compelled to recognise that the two most important factors in psychoanalytic therapy are interpretations and object relationship. It should be borne in mind, however, that with the latter we are on comparatively unsafe grounds because psychoanalytic theory knows much less about it.” (p159, The Basic Fault – Therapeutic Aspects of Regression)

Balint is making two important points in this brief paragraph. Firstly, he gives us the key ingredients of what makes psychotherapy work. Secondly, he tells us that while object relationship is an essential ingredient, in 1968, psychoanalysis lacked an understanding of why that is.

A basic cake ingredient remains the same through the generations. No doubt, there are scientific reasons to explain why the chemical constituents of flour and egg make a good cake. This is also true of Balint’s main ingredients; interpretations and object relationship, or, put more simply, understanding ourselves and the importance of the therapeutic relationship.

Understanding, or, Knowing Thyself

Insight and understanding is a key tool in making changes.  If clients can form a compassionate – and that word is key – understanding of how their past relationships (object relationships) and experiences have shaped them, they can develop the capacity to change.  However, this possibility of change is entirely contingent on the therapeutic relationship they form with their therapist.  Insight alone cannot lead to change. This is the fundamental answer as to why the many shelves of self-help books comprising an ever-increasing proportion of high street booksellers, never really lead to any change in their hopeful authors. Change requires a relationship in which loss can be worked through and trust built in a new way of relating; trust that the other person in the relationship (the psychotherapist) will not let the client down. At least not catastrophically.

Object Relationships

Why can change only take place in the capacity of a relationship?  In the past, I have written blogs about the therapeutic relationship and its importance, as well as on the principles of attachment.  However, to recap, psychotherapy is about re-parenting.  On a fundamental level, it is about helping the client to experience a good enough relationship where they are listened to, cared about and held in mind.  Through this, the client can start to develop their own mind, and over time, hold themselves in mind in ways they have not been able to do in the past.

If the therapeutic relationship is so important, why is it not enough?  It can be argued that affective attunement is about offering interpretation, if interpretation is about helping a client to understand why they feel, think or behave in a certain way. Is this not, after all, what a good enough mothering relationship provides, minute by minute, hour by hour and day by day?

To contradict myself, it is also too simplistic to simply suggest that the object relationship with a psychotherapist is akin to re-parenting. It is far more disappointing and frustrating than that. It is, for the client, a coming to terms with the stark reality that they cannot and will not ever have the mothering they needed for the child they once were. It is the working through of this and then, ultimately, the abandoning of infantile objects – unconscious childhood trauma driven states of mind – for adult objects – conscious adult states of mind that can tolerate the limitations of adult life and adult relationships; a tolerance of pain and abandonment of pleasure.

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

Further reading on this subject:

How does counselling or psychotherapy work?

What is transference?

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What is Intimacy?

From ‘the family’ to ‘the couple’

There has been a historical shift from ‘the family’ to ‘the couple’ as the central organising unit in contemporary life, with an emphasis on intimate connection. The ‘ideal’ couple of today are both friends and lovers immersed in a disclosing intimacy of mind and body. For previous generations, the modern discourse on intimacy would be an anathema. Where once we may have ploughed the land together, bound by a common task to a shared end, today we talk. Rather than being a by-product of a long-term relationship, intimacy is now a prerequisite for one. Today, we expect much more of our intimate relationships, including personal happiness and sexual fulfilment, yet we lack the role models for the new intimacy we seek. No longer bound together simply by survival needs, and with sex separated from reproduction, our closest relationships become conduits for ‘higher’ intimacy ideals.

Our early experiences of intimacy

Our understanding of intimacy and intimate connection is grounded in our social, biological and psychological histories. In the evolutionary account, ‘attachment’ is a biological imperative rooted in an infant’s need to maintain physical proximity to its caregiver to ensure survival.  Our early emotional attachments, though, are not simply about protection from present danger. They are also about the emotional and psychological human need for a secure base. Our physiological and mental development always takes place in a relational context. Our emotional responses are organised and regulated through our formative relational experiences of the presence and absence, sounds, smells, gaze and touch received from our caregivers. Herein our attachment styles are forged, informing our later capacities and appetites for intimacy.

We receive our initial cues about how the social world works in our families, and here too, we learn the rules of intimacy. We learn whether we are supposed to be strong, competitive, angry, sad or tender. We treat as truth the things we learn about love, trust and life. We make decisions about the world and ourselves on the basis of these truths. Many of these decisions (made out of conscious awareness) will have great bearing on our adult emotional lives. When our attachment experience is secure, we are less likely to struggle with psychological issues of self-worth. When it is not, for myriad reasons, such as traumatic experience, loss, separation and fundamental failures of attunement, we are more likely to develop core beliefs about ourselves as not being ‘lovable’, ‘enough’ or any number of injunctions against being important, being visible or belonging. These will inevitably play out in our intimate adult relationships. The developing infant is continuously learning about the boundaries between self and other at the same time being schooled in the power dynamics of intimacy. We all bring the legacy of intimate childhood relationships to our adult pairings, activating our original relational templates to confirm old and new beliefs about our value and worth. We navigate a perilous path between ‘too much’ and ‘not enough’ proximity and distance, me, you and we.

How couples therapy can help

Our need for meaningful connection remains throughout our lifespan. In its absence, symptoms from physical illness and depression to addiction may develop. Therapy can support couples in tracing the lineage and source of their beliefs and assumptions about intimacy and in an exploration of their disappointments and discontents, as they are experienced in the here and now context of their relationships. The couple willing to risk the emotional vulnerability of open-ended conversations about the tensions, conflicts and failures in their relationship be they sexual or domestic are indeed brave. True intimacy requires the recognition and will to balance the dual imperatives of individuality and interdependence, amongst other things.

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor who is available at our Hove practice.

Further reading on this and related subjects:

How does attachment influence parenting?

Aims and goals of couples’ therapy

Love, commitment and desire in the age of choice

Relational therapy – a view

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Grief – how to grieve?

Grief is often referred to in the context of intense feelings experienced with the loss of a loved one. The loss we experience is often caused through death. Grief is, therefore, synonymous with bereavement.

This, however, is nowhere near the whole story. In order to know how to grieve, we need to understand grief.

When we are told that someone is grieving, we may assume they are feeling intensely sad. Although this is often true, grief is comprised of a multitude of emotions, and sadness is only one. One of the early pioneers of grief work (yes, there is such a thing), was Elizabeth Kübler-Ross. She suggested grieving was an active process that required a “working through of emotions” broken down into five core groups: denial, anger, bargaining, depression and acceptance. Sadness would fall into the ‘depression’ group in this model.

Since Kübler-Ross, plenty of other models have been proposed. All of these have added something to the field. I will not directly elaborate on these in this blog, but further information can be found on the Internet.

Grief is, therefore, an umbrella term for a whole host of emotions, and it is a verb.  It is something that we must allow ourselves to experience and actively engage with.

 Why should I grieve?

Emotions exist within us, whether we consciously acknowledge them or not.  Where we are unable to feel them (through repression, which is always unconscious) these emotions will often express themselves as a conversion reaction. They will be expressed through the body such as in aches and pains. They may be expressed through even more obscure symptoms, such as a loss of physical movement.

Where we are aware that we are feeling grief, but actively suppress the feeling, emotions are likely to manifest as anxiety or depressive symptoms, which can persist for years.

Thus, there is no escaping it, grief must be felt and ridden out, like a storm. To complicate things further, it is not a linear process. We might have felt anger (perhaps with our loved one for leaving us) and moved onto bargaining (“If only I had done more for them…”) However, this does not mean that we will not return to anger again. And again…

We must grieve because we need to acknowledge what we feel.  If we do not (because we can’t or won’t) things get complicated.

How do I grieve?

Grieving (in the context of bereavement) used to be a socially prescribed activity which was both acknowledged by the wider community and defined as a process. Those who were bereaved would often wear symbols of their grief – black clothes or a black armband. Within their community, it was acknowledged that they would be grieving for a set period of time, often a year. This practice has largely been lost in northern Europe. However, in southern Europe, it remains common in more traditional communities to see widows wearing black for the remainder of their lives.

Religion

Love it or hate it, the one thing religion gave (or gives) us is a powerful story of what happens after we die.  From the Vikings with Valhalla to the Christians and Heaven, the concept of an afterlife can bring great solace to loved ones who are left behind.  The loss of socially prescribed ways of mourning, combined with a loss of religious beliefs, has made grieving more difficult.

Meaning making

A universal task in coming to terms with grief is to find some sense of meaning within it, and to weave this together into a narrative. We are no longer provided with cultural narratives in the way that we once were. This then becomes something that we need to do ourselves.

Why is grief hard for some people?

When I embarked on my own professional psychotherapy career, working directly with dying patients and their relatives, I imagined that the loss of the deceased would be felt most acutely where relationships had been close, connected and happy. However, the inverse was true. Where relationships had been difficult, strained, or even devoid of contact for long periods of time, the bereaved would often struggle to process the loss far more. This occurred particularly where the relationship was between a parent and their (adult) child.

The reason for this lies in attachment and in how we learn, through attachment, to feel.  For those of us lucky enough to grow up in homes where there is no abuse or neglect, and no unexpected losses, we find it relatively easy to move in and out of relationship – to say ‘hello’ and ‘goodbye’. With the security of the relationship comes an ability to feel emotions and make sense of what is being felt. Thus, the process of grieving, whilst hard, is something that can be actively undertaken.

In some parent/child relationships, the child has been significantly disappointed by the parent in the past. Parental neglect and/or abuse can lead to an accumulation of unacknowledged earlier losses in the relationship. In these cases, the final physical loss of the parent can make it very hard to come to terms with the enormity of all the losses that person represents. The loss is not only of the relationship and person, but also of hope. If the relationship between parent and child was strained or difficult, it is likely the bereaved will be poor at navigating his or her emotional states. This makes grieving terrifying, at best, or unthinkable, at worst.

Grieving is normal

As a clinician, I get a lot of fulfilment in helping clients to grieve. It is different from any other presenting issue they bring to me. Grief is the universal leveller. We will all experience it at some point in our lives. The way out and through grief is always the same – we have to feel the full range of emotions that our grief brings up.

Grief is not a mental health condition, and yet many people become stuck with their grief. When this happens, the secondary symptoms can mutate into more complex conditions such as anxiety, clinical depression and panic attacks.

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

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What is a personality?

We all use the word ‘personality’ in everyday language. We might use it to describe how we experience another person (“She has a nice personality.”) We use it to describe elements of how a person may behave, in the case of personality traits.  And sometimes we use it interchangeably with the word ‘character’ to describe somebody. But what actually is a personality, and why does it matter – particularly when it comes to psychotherapy?

As the word ‘personality’ refers to the mind of a person, and as no human has ever seen a mind, in essence, the term is an abstraction. It’s an idea, a way of understanding how we tick, not a concrete object.

The dictionary suggests that a personality is a collection of characteristics that make up somebody’s character.  What, then, is character?  According to the dictionary, it is the mental and moral qualities distinctive to a particular individual.  And character is apparently synonymous with personality!  Confused yet?

OK, so this is how we mental health professionals generally understand personality. Personality is made up of two distinct categories – temperament and character (there’s that word again).

Temperament

Temperament is considered to be the traits that we inherit from our parents – either genetically, or through other biological means.  A person’s temperament may be a higher predisposition to anxiety, a genetic predisposition to addiction, or to being quick to anger. We are either born with our temperament. or it is developed in utero or shortly thereafter.

Character

Character, in contrast to temperament, is something that emerges at a slower rate as we grow, explore our world, relate to our caregiver and mature.  For example, we learn how to relate to others (particularly in close relationships) through our own attachment story with our primary carer. This way of relating takes place over a significant period of time.

Nature vs Nurture

We can substitute ‘temperament’ for the word ‘nature’ and ‘character’ for the word ‘nurture’ to keep things simple.  While most forward-thinking counsellors or psychotherapists will acknowledge that nature and nurture both play a significant role in defining our character, the jury remains out as to exactly where the boundary lies between the two. In fact, there may be no boundary at all!  For example, it is now increasingly accepted that what matters is not so much a genetic predisposition, but epigenetics – how our genes interact with our environment.  Therefore, just because someone has a genetic predisposition towards alcoholism, if they are raised in a loving home where they can develop a strong, solid sense of identity, it is unlikely they will become a full-blown alcoholic.

Why it matters

Therefore, personality matters as it is a word that encapsulates a large part of our identity and mind.  And in mental health, it is particularly important, as when clinicians treat clients or patients, the work will be significantly different depending on whether the presenting issue is an isolated issue, such as anxiety, or whether the problem relates more to the structure of a person’s personality. Just to confuse matters further, if a client presents with anxiety and has traits or a diagnosed personality disorder, the work will be lengthy and complex.

In Lay Terms

If who we are – how we experience ourselves and relate to others – is dysfunctional, damaging or harmful, then deep psychotherapy is required to restructure the personality. As personalities have taken a long time to form, it takes time for them to change. And because personalities are made up of temperament and character – nature and nurture – how much change is possible is something the therapy will uncover. The goal of depth psychotherapy is, of course, to change the level of the personality. However, it is also about developing kindness and compassion for one’s personal limitations and accepting these so we may lead a calmer, more fulfilled life.

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

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What is transference?

I am sometimes asked, “What is transference?” Some clients are strongly negative towards the idea (of how they understand) the concept. A blog seems like a good opportunity to de-mystify this term and emphasise its importance to psychotherapy and to psychodynamic and psychoanalytic counselling.

Freud Again!

The notion of transference dates back to Freud. He used the term to describe how patients (clients) will project, or quite literally, transfer their feelings from a significant childhood relationship onto their psychotherapist.

The notion of transference is not limited to the therapy relationship. It’s something that affects many of our close relationships with others, particularly our partners. For instance, we may respond with anger or frustration if we ‘hear’ our partner use a tone of voice or phrase that a parent once used with us. Conversely, we may be drawn to someone because they remind us of a family member with whom we enjoyed a close relationship.

What’s Wrong With That?

The underlying principle of transference is that it is an unconscious process and therefore, we are unaware of it. While we are engaged in unconscious processes, the conscious part of us is always playing ‘catch-up’ by inventing reasons for why we behave in a certain way or for the way we feel about another person.

In the therapeutic relationship, the client starts to transfer ideas, fantasies, and feelings onto their therapist. This occurs because the client knows relatively little about the life of their therapist. What is transferred by the client onto the therapist becomes the basis of the collaboration in understanding the client’s relational patterns, childhood traumas and unresolved conflict.

Counter-Transference

Counter-transference is the term used to describe what the therapist feels in relation to their client. It is the therapist’s part of the entanglement of the relationship. It enables the therapist to become aware of what the patient may be feeling towards them or eliciting in them. Counter-transference shows why it is so essential for psychotherapists to be well trained and to have undergone their own rigorous analysis or psychotherapy. This enables therapists to distinguish which feelings come from their own unconscious process, and which are counter-transferential.

So transference matters?

Transference is the foundation of the work in any method of psychotherapy where the unconscious forms the basis of understanding a client’s struggles.

Is transference risky, or something to be scared of?

In a word, no, providing your psychotherapist is experienced enough to work in the transference and to be aware of unconscious processes. A psychotherapy process should never be dangerous, but nor should it be too safe. It is a daring adventure into the unconscious inner world that can be painful and difficult. Ultimately, however, it carries the goal of relieving suffering and trauma.

In other words

British analyst Harry Guntrip summarised the purpose and role of transference thus:

“Transference analysis is the slow and painful experience of clearing the ground of left-overs of past experience, both in transference and in counter-transference, so that the patient and therapist can meet “mentally face to face” and know that they know each other as two human beings. This is without doubt the most important kind of relationship of which human beings are capable and is not to be confused with erotic “falling in love”.

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

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Learning to be dependent in the pursuit of independence

When learning to be dependent is necessary

‘Dependence’ is a term that can carry negative connotations. To be ‘dependent’ might imply that we are unable to function alone and that we are unable to be the agent of our own life. It can also be interpreted as subscribing to outdated ideologies of male/female gender roles – the belief that women should be dependent, and men independent.

However, as is often the case in psychotherapy, learning to be dependent can be exactly what a person needs to do. As is always the case in psychotherapy, this dependence is with a view to enabling the client to become genuinely independent. In this sense, dependence is, therefore, a paradox.

Pseudo-independence and emotional neglect

I have previously written about the false sense of independence that some people have, which is born out of emotional neglect – a type of pseudo-independence. In a former blog, I referred to Boarding School Syndrome, in which the illusion of privilege masks emotional neglect and serious attachment disruption.

Pseudo-independence is an extreme reaction against dependence rather than true independence. If, as children, clients have been let down emotionally, or worse, neglected, they learn that nobody can be relied upon. It doesn’t matter whether this neglect came from an upbringing in the social care system or from within the gilded prestige of a boarding school education. These individuals might seem very capable and strong. However, this apparent strength is a mask to protect them from connection, relationships and dependence in the ordinary sense of the word.

Beneath the highly developed outer mask (in the case of neglect couched as privilege) lies a fragile interior. These clients crave connection. They want to be seen and validated for who they are and how they feel. But they find this terrifying. So, instead, they will often throw themselves into high-powered jobs, extreme hobbies or anaesthetise their inner voice with fine wine or expensive drugs.

In the case of someone who has experienced a more outwardly evident neglectful childhood (such as being raised in the social care system) the exterior shell of pseudo-independence is generally less polished and socially acceptable. Instead, their pseudo-independence may be shown through a turning away from society in the form of criminality and a “don’t mess with me” exterior.

How does learning to be dependent lead to healthy independence?

Well, psychotherapy is about learning to have a relationship with both our therapist and with ourselves. It is a process of giving voice to parts of ourselves that we have had to repress, split off or even kill off to survive. It is a relationship in which, week after week, the client learns to be seen and heard, to be accepted and validated. Little by little, if the client allows themselves to really feel seen and heard, and believes it, then it must mean that the other person in the room matters to them. Thus, it is through the psychotherapist mattering to the client that they can finally learn to rely on another emotionally.  Then, a collaboration can begin, with the psychotherapist coming alongside the client to help them make sense of their world.

In every psychotherapeutic relationship, the end is always in sight. It may be a very distant sense of an ending on the horizon, which may be many years away. Nonetheless, it is there. Therefore, the willingness of the client to allow the psychotherapist to matter to them, though this relationship will, one day, come to an end, is courageous. The process of becoming dependent and then becoming independent marks a shift in the relational quality of the client. If they can do this with a psychotherapist, maybe they can allow someone else to matter to them in an ordinary way.

Through learning ordinary dependence, which they never learned in the first place, clients can learn to navigate the ordinary ebb and flow of relationships. They will then discover that dependence on another is not terrifying, after all.  Even when we eventually have to say goodbye.

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

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Boarding School Syndrome

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

Like all mental health conditions, with the exception of a tiny minority, such as schizophrenia, boarding school syndrome (BSS) refers to a cluster of symptoms. When enough people present with similar clusters of experiences, behaviours or traits, and there is a clear correlation in their experiences, then a diagnostic category can be born.  Officially, this is not yet the case with BSS, although more and more analysts and psychotherapists (as well as journalists) are using the term.

What is Boarding School Syndrome and why does it matter?

Psychotherapy is about helping people to grow a mind and better relate to themselves and those around them.  In order to do this, the clinician will often work with the client’s past experiences, either directly through dialogue, or in the relationship between the client and themselves.  The latter certainly constitutes the ‘relational approach’ which has been evidenced to be highly effective, and one that we apply at Brighton and Hove Psychotherapy.

Schaverian (and others) suggest that BSS can be identified through disrupted relationship patterns, often romantic. In BSS, what appears to be a strong sense of independence proves to be, in fact, a shell or mask covering emotional vulnerability, depression, anger management problems and substance misuse or abuse problems.

BSS affects both genders. However, as statistically, boys are sent away to boarding schools in higher numbers than girls, boys and thus men are disproportionately affected.  Add the social expectations on male middle-class and upper-middle class former boarders, and the problems they face can become further entrenched and emphasised.

In my experience, former boarders will only present for psychotherapy once they hit a wall. This generally happens when addictive behaviours get out of control or when relationships fail.  Once the veneer of privilege and entitlement has been stripped away, the presentation of symptoms is akin to children who have been taken into care and raised institutionally. This results in a catastrophic attachment trauma that makes any form of genuine, close, intimate relationship extremely difficult.

All this would matter little, at least from the perspective of the individual in question, if they grow up comfortably inhabiting their own skin and genuinely do not need a close relationship. Sadly, this is rarely, if ever, the outcome. These institutions espouse entitlement, independence and academic rigour. Once a child has been abandoned by his or her parents to this system, the best they can expect to develop is a more or less robust shell that reflects back to the world the message that they are perfectly fine.  Deep down, they simply are not.

Neglect breeds a false sense of independence. Whether a child is abandoned to the social care system as a result of an outwardly chaotic family life, or if the abandonment is couched in privilege, the attachment disruption remains the same. The result is a false self-reliance with a deep wariness of their own vulnerability and a fear of relationships.  At least children who survived social care have a place to locate their problems – the neglect and abandonment is clearly visible.

There is no doubt that emotional cruelty has the greatest impact on the developing mind.  And a mind is what we use to understand ourselves – our emotional world and our vulnerability. We also use it to understand the mind of others. Without a developed mind, we may be left adrift in a flood of emotion, which is more often seen with children who have come through the social care system. Alternatively, we become rigid and emotionally stunted, incapable of connection.

How to treat Boarding School Syndrome

As I have already suggested, the defence from emotional neglect is the development of a false and rigid sense of independence. This is established by having no attachment figure to soothe them and help them make sense of their inner and outer emotional world. The vulnerable child is still there, but many former boarders will deny its existence, mirroring the attitude of their caregivers. Alternatively, they may treat their vulnerability with disdain, saying things like, “I just need to pull myself together”, “All this wallowing is a waste of time”, and “I am sure you have more deserving patients to see, I really am fine.”

The work of the therapist, like any we do, is in establishing a close, supportive relationship with the client. This enables them to start to make some tentative contact with his or her vulnerability.

Helping these clients imagine that they experienced neglect (and at times, abuse) can be an enormous piece of the work. For the client, it is hard to do, as it relies on a complete dismantling of a belief system – in their parents, their privilege, the institution, and lastly, their false self.

Despite what former boarders have been taught, finding their way out of their suffering is not something they can do alone or with the help of a book. It relies on the very thing they find hardest; establishing a secure attachment with their psychotherapist.

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

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What is psychotherapy?

Freud once described psychotherapy as the “impossible profession.” To those who have not experienced it, psychotherapy can sound like a curious, mysterious, complex or even frightening endeavour.

Using brief and simplistic explanations such as “talking to someone about your problems” to describe psychotherapy does not do it justice. At its best, psychotherapy is a process of looking at all aspects of an individual’s life in its depth and entirety.

What makes a person who they are?

Good psychotherapists are curious about what makes a person who they are, which begins with child development and the formation of personality structures and an individual’s past history of attachment to significant others and transgenerational influences. Additionally, psychotherapists take into account the historical, cultural, social and political influences in an individual’s life. These can include, for example, gender, age, disability, sexuality, cultural norms, their present situation and resources. All of these elements have an impact on how someone both views and processes the issues they bring to therapy.

Finally, much of what is communicated in the therapy room is communicated non-verbally, through facial expressions, body language and tone of voice. This isn’t to say that we, as therapists, scrutinise every detail of how someone presents. It is more about being genuinely curious about who the individual sitting in front of us is, and how they interact with those around them, so that they themselves begin sharing in this curiosity.

How does this lead to change?

Profound change in psychotherapy happens at different levels. At one level, it’s vital that we begin talking about what is troubling us with a curious and understanding other. This reduces isolation and helps us feel heard and validated. It is common for some of the symptoms to begin subsiding at this stage, and to experience a sense of relief. Another common response is for thoughts and feelings to surface more frequently, and this can lead to discomfort in the short term.

At this point, it is important to begin making sense of what we are experiencing. While it feels good to be heard, it is also necessary to skilfully sort through the chaos and uncertainty that can be generated by unprocessed feelings.

Alongside this, we will assess how past and present experiences are linked. For instance, does this situation bring up familiar feelings from the past? In dealing with this situation, what resources are available to you and what beliefs and values are hindering you? Where do these unhelpful influences come from? Throughout psychotherapy, we look at both conscious and unconscious influences in a person’s life. Some of the ways to explore those are through dialogue, associations, insight and dreams.

Next, we explore how to separate internalised unhelpful beliefs from current reality. Here, we draw on your internal resources, exploring the patterns repeat themselves in your life, and how to create a different way of being in the world. This process sounds more simplistic than it actually is, as some of our ways of being in the world are deeply ingrained and take time to shift. Plus, some are survival strategies which we have developed very early on and served us in getting through life, for better or worse.

Psychotherapy is a long-term endeavour because human beings are rich with complexity. This complexity can take time to unravel and transform. For long-term, sustainable change, there are no short cuts and quick fixes.

This just a taste of what psychotherapy can be. However, therapy is always led by what the individual (or group, family or couple) presents, and what they want to achieve. Getting there is a joint piece of work grounded in a solid working alliance between client and therapist.

If you are curious to find out more about how psychotherapy can be helpful to you, please get in touch with us at Brighton and Hove Psychotherapy.

Sam Jahara is a UKCP Registered Psychotherapist and Certified Transactional Analyst with a special interest in cross-cultural and intergenerational influences.

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What is narcissism?

Narcissism is a Freudian term that has become perhaps more ubiquitous in the social lexicon than any other derived from psychoanalysis.

It is a term that seems to define a generation in the eyes of the media – the Millennials, and one that we use disparagingly to describe celebrities before following them via social media, emulating them or electing them to the highest public office.

Narcissism in psychotherapy

In psychotherapy, narcissism is on a continuum from healthy to pathological. For example, it is entirely possible for a client or patient to lack enough healthy narcissism, in which case, the work is to strengthen their ego accordingly.

The sort of folk who get labelled as ‘narcissists’ – those who crave celebrity status, fame and live up to legend in seeking their reflection in the mirror that is society – rarely presents themselves for therapy. After all, why would they? They don’t have a problem – the problem is everyone else!

When we psychotherapists talk about narcissism and narcissistic defences and structures, it is rarely these people we are referring to. So how can we better understand narcissism as it presents in psychotherapy treatment?

What causes unhealthy narcissism?

Unhealthy narcissism is a defence.  Generally, it comes about through the young infant learning through relational patterns with his or her caregivers that he or she cannot rely on them, leading to a ‘turning away’. This turning away marks the beginning of a defensive structure built around self-sufficiency. However, this is not a self-sufficiency born out of healthy confidence, but one born out of emotional neglect.

Narcissistic structures are often well hidden in clients and patients and difficult to treat. Narcissistic patients and clients tend to treat all relationships, the therapeutic one included, as things that are there to be used and thus discarded when no longer of use. Relationships (in the truest sense of the word) are threatening at a core level to people who rely on narcissistic defences, as any true relating will open them up to a whole host of unbearable feelings and mental pain. The latter lies at the crux of the function of the narcissistic defence; the inability to cope with, endure and make sense of mental pain.

Is working with clients and patients exhibiting narcissistic defences a lost cause? Not if they willingly enter the therapy room and not if they are able to think about their vulnerable side and how they needed to develop a disdain for this part of themselves in order to survive. Without a doubt though, it will be a lively journey, because as the charming, likeable and self-sufficient façade starts to crack, rage, envy and mental pain will emerge and present themselves in the therapeutic relationship. This is often where the therapy can end, as the therapist is unable or unwilling to engage with the enactments that invariably will play out. If, however, these can be worked through, then there is genuine hope.

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

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How to grow a mind?

The connected human brains - Humans as a social beings

Connected human brains – humans as relational social beings

The word ‘mind’ is one that most folks use quite regularly and comfortably. Us psychotherapists use it more often than most. However, to the best of my knowledge, nobody has actually seen a mind. So, what is a mind, and why should we grow one?

Those of you who follow us know that at Brighton and Hove Psychotherapy we believe in mind-body integration and espouse a range of approaches in order to facilitate this. Furthermore, our approach is also in keeping with the latest neuroscience findings on why therapy works So, back to the mind. While there are differing definitions, we believe that a mind is that part of a person that enables them to make sense of their world (inner and outer) and can navigate and mediate between feelings and intellect. If the brain is in the head (no disputing this fact) and emotions originate in the body as sensations, then the mind is what enables us to connect the two up (counter-intuitively, neuroscientists are now suggesting that rather than residing in the brain, the mind is in the body – just like the unconscious).

In psychotherapy, the mind is very different to intellect. We can all probably bring to mind folks who have academically brilliant intellects, but struggle to apply a rational, wise mind to how they relate to themselves and the world around them. It could be argued that some of these people even hold quite powerful positions in government and business, so sometimes having a limited mind does not hinder performance, at least in certain parts of our lives.

We grow our minds from the moment we are born, perhaps even in utero. A mind is grown from the mind of our parents (or caregivers) and thus, the quality of our mind is generally directly correlated to that of our parents. They are the ones who use their auxiliary mind to build ours, hour after hour, day after day, and throughout our young lives.

They begin by helping us make sense of the turmoil of the sensations we feel in our bodies as tiny infants and give shape and form to our emotions through naming them and normalising them. With time, they help us understand that we are not alone in the world, and so, while our own emotional experience really matters, so does that of those around us. Finally, they guide us in developing wisdom in using our minds to navigate a complex arbitrary world. That’s if it all goes to plan, anyway, and often it doesn’t.

If our parents’ minds are limited because their parents didn’t enable them to grow their minds, they won’t have so much input to give us. This is one example of inter-generational trauma. Or, if our mother was depressed after we were born, she won’t have the capacity to attune – to be fully present – to us. In fact, any form of abuse or neglect will have a detrimental impact on our minds.

To emphasise the difference between the intellect and the mind, consider the impact of boarding school, particularly where children are young. This is traditionally an environment where the development of the mind is forsaken in lieu of intellectual prowess.

Why does all this matter? Well, because psychotherapy is about helping clients grow and develop their minds where, for whatever reason, this did not fully happen when they were young. It is precisely why therapy cannot be rushed and needs to be consistent and regular. One cannot fast-track the growing of a mind.

Let’s move on to another word we use a lot and consider how this all fits together – trauma. Again, this is a word with many definitions, and it is very much the zeitgeist at present. Essentially, trauma in an emotional sense is shock that has not been processed. There are broadly two types of psychological trauma: single-incident trauma, known as PTSD, or Post-Traumatic Shock Syndrome, and complex trauma, also known as Childhood Developmental Trauma. They are fundamentally different and require different approaches. We can treat PTSD with a range of approaches including counselling, brief psychotherapy, Cognitive Analytic Therapy (CAT), EMDR and energy psychotherapy, to name a few. All of these can be very effective. None of them grow a mind.

Childhood developmental trauma, or, as I prefer to think about it in most cases, a lack of parental attunement, requires a slow consistent methodical relational approach to enable the development of the client’s mind. This is what depth psychotherapy offers and the research – back to neuroscience – evidences that the relational approach does this best.

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

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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.GBP-Brexit (1)

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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Addiction


Addictions are strongly related to the level of enjoyment, pleasure or relaxation someone is capable of experiencing through their associated activity. Serious cases of addiction are possible if someone has an intense desire to repeat an activity over and over again. On the other hand, many people engage in potentially addictive activities regularly, such as sex, gambling and alcohol, without a significant problem.

While you may begin to experience these activities with a measured amount of awareness and stability, many people are oblivious to the fact that they are addicted to a particular thing. In most cases, an addiction becomes much more apparent when it leads to uncontrollable behavioural problems that affect your home, work or school life.

You may start to rely on your addiction to get you through the day, or perhaps inherit an aggressive, uncharacteristic nature that fails to subside without your addiction taking hold. Persistent drug and alcohol takers may find that they start to experience severe withdrawal symptoms that get worse as the addiction starts to develop.

Withdrawal symptoms occur when someone is deprived of their addiction and they can cause anything from slight discomfort to intense cravings. They vary depending on the specific type of addiction and on factors that may have lead to addiction in the first place, such as relationship problems, unemployment, stress, mental health and financial concerns.

There are many different types of therapy that focus on relieving withdrawal symptoms and helping someone to overcome their addiction. Cognitive Behavioural Therapy (CBT) is an excellent method of treatment that has proven to be very effective in the past. Here at Brighton & Hove Psychotherapy we will help you overcome your addiction through helpful talking therapies and counselling services, including a treatment programme and plan for change.

You should never be afraid to tell someone you are concerned or afraid that you might have an addiction. Support is essential when looking to tackle an addiction and we offer our expertise alongside family and friends to help you believe that you have what it takes to change your life for the better.

You can read our blog on how psychotherapy can help with addiction.

To learn more about therapy for addiction including pornography, gambling or alcohol in Brighton or Lewes, contact us today. We look forward to hearing from you.

Frequently Asked Questions

What is an addiction?  Read more

    An addiction is defined as a engaging with a behaviour or taking a substance to the point that you are no longer in control of your choice and it is harmful.  With substance addictions it can often be easy to see the harm and consequences of addiction; this can be less so the case with behavioural addiction where the harm is often to oneself.  The latest thinking around addiction is that it is often a type of attachment disorder whereby the addicted person ‘soothes’ difficult or uncomfortable feelings through their addiction rather than through a relationship.

    How do I know if I am addicted to something?  Read moreIf your behaviour feels compulsive, out of control, is damaging to you either outwardly or inwardly, initially reduces stress but then leads to more, it is likely that you have an addiction. Addictions are frequently linked to anxiety and depression issues.

    What is the addiction-shame cycle?  Read moreThe addiction-shame cycle is one of the cornerstones of addiction.  It is a way of describing how a person feels activated by stress, ‘acts out’ (engages with their addiction of choice) in order to dispel the unpleasant feelings, initially feels better and then feels shame and remorse at their behaviour.  A commitment is made to ‘do better’ and then the cycle repeats.

    How can psychotherapy help with addiction?  Read moreAddiction is like a relationally closed loop.  The addicted client often feels alone and ashamed.  The goal of psychotherapy is to bring an awareness to the addicts process, identify triggers, engage in helpful behaviour to manage triggers, learn to regulate emotion better and last but certainly not least, to help the addicted client to find safety in a relationship and to use the therapeutic relationship as a foundation to learning to get something from other relationships in the world.

    What happens in a first session?  Read moreThe first session with one of our practitioners is an opportunity for you both to work out whether you feel able to work together. Your psychotherapist or psychologist will likely ask you various questions relating to what has brought you and explain the process of therapy to you. The first session is a two-way process where you have toe opportunity to ask questions and to decide whether you feel ‘safe enough’ working with your therapist.

    How do I find a psychotherapist of psychologist I want to work with?  Read moreAt Brighton and Hove Psychotherapy, we have two physical practices, one in Hove and one in Lewes, where we offer a full range of psychological therapies. On our website you can view each profile of our associates and contact them directly using the form on their profile page. You can also use our handy search function to find the right practitioner for your needs.

    How long will it take for me to see a psychologist or psychotherapist  Read more

    We aim to respond to all enquiries within 24 hours.  You may contact our practitioners directly via their profile page. If the practitioner you wish to see has space then an appointment can usually be arranged within a week and sometimes much sooner. If they do not have capacity to see you they can refer you to a colleague in our practice who does have availability.

    How can I get in touch with you?  Read moreYou can contact our practitioners directly via the contact forms on their profile pages. They will then reply to you directly.

    What age groups of clients do you work with?  Read moreWe have psychotherapists and psychologists trained to work with every age group from infants through to adults.

    Do you offer evening and/or weekend sessions?  Read moreWe offer sessions every day of the week including on Saturdays and sessions are available into the evening.

    What are your fees?  Read moreOur fees are set by each practitioner depending on the type of therapy.  For individual psychotherapy or clinical psychology our fees range from £60 – £100 per session. For couple therapy our fees range from £70 – £100 per session.

    Is there parking near your Hove and Lewes practices?  Read moreBoth our Hove and Lewes practices are centrally located close to train stations, bus routes and with on-street parking or car parks nearby.

    Contact us

    At Brighton and Hove Psychotherapy, we have two physical practices, one in Hove and one in Lewes, where we offer a full range of psychological therapies. On our website, you can view each profile of our associates and contact them directly using the form on their profile page. You can also use our handy search function to find the right practitioner for your needs.

    If you are considering online therapy, take a look at our online therapy services.

    All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.


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