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The dynamic maturation model: a new way of understanding how to cope with mental distress and create happier relationships

Psychotherapy was revolutionised in the second half of the last century by the development of attachment theory, the science of human bonding and needs. I wrote about this in my BHP blog ‘Why we need a secure base’. It describes how infants who do not have their primary needs met – for comfort, warmth and love – as they grow up often face emotional discomfort and turmoil when they become adults.

Those in a stable, loving and caring framework as children can enjoy life and deal with its many challenges with equanimity and resilience. The development of attachment science was a huge leap forward in the understanding of human psychology.

Over the past thirty years, Dr Pat Crittenden, a US child psychologist, has added a new and very important dimension to this core framework. It is called the dynamic maturation model (DMM). It shows how our behaviour in adult life is shaped through adaptive responses to early experiences. If the care we are given is deficient by being avoidant of emotions, or conversely, is based on exaggerated emotional responses, then in adult life we have difficulty in coping with perceived danger and stress.

Understanding the DMM can play an important role in creating self-awareness, personal growth, and emotional wellbeing. It is a fruitful way of explaining how we can best process information, manage our emotions and form relationships.

The DMM divides our survival strategies into three broad categories:

  • Type B: balanced/secure. Those who have experienced ‘good enough’ parenting – thus establishing a secure base – are able to integrate emotional and cognitive information in a balanced way. They experience the full array of emotions but can self-regulate and offer empathy to others. As a result, they form stable, caring relationships, and respond flexibly to stress.
  • Type A (avoidant/cognitively biased): As a result of their upbringing, these individuals learn to inhibit the expression of their emotions and place a disproportionate weight on logic to manage their environment. This strategy usually develops in response to caregivers who discourage emotional expression, leading to self-reliance and emotional suppression. They often come across as cold and unfeeling, even though their coping strategy is based on vulnerability.
  • Type C (preoccupied/emotionally exaggerated): These individuals are dominated by their emotions and persistently exaggerate their sense of fear, anger, sadness or disgust (the four primary emotions) to gain attention and reassurance. This makes them appear volatile, difficult to deal with, and unboundaried. Their strategy develops through childhood experiences where caregivers were inconsistent or unpredictable, triggering heightened emotional responses.

By identifying our own dominant strategy, we can begin to understand why we react to stress, relationships and challenges in particular ways.

Understanding relationships through the DMM

The attachment strategies outlined above play a crucial role in how we form and maintain relationships. The DMM explains why some individuals struggle with intimacy, trust, or conflict resolution:

  • Avoidant individuals (type A) may struggle with vulnerability and prefer independence over deep emotional connection.
  • Individuals who are preoccupied and express exaggerated emotional responses (type C) experience anxiety in relationships, fearing abandonment or rejection. This is because the volatility generated by a frequent resort to anger causes heightened friction.
  • Balanced individuals (type B) are more likely to navigate relationships with confidence and adaptability.

By understanding these patterns, individuals can make conscious choices to improve their interpersonal interactions, foster healthier relationships, and address attachment-related insecurities.

The DMM and personal growth

An empowering aspect of the DMM is that it views attachment strategies as dynamic and plastic rather than fixed. Unlike traditional attachment models, which often label people as permanently secure or insecure, the DMM acknowledges that strategies evolve based on life experiences and the exercise of personal agency. This means that personal growth is always possible. For example:

Individuals who recognise their avoidant tendencies (type A) can work on embracing emotions and allowing themselves to be vulnerable. Those with preoccupied/emotionally exaggerated strategies (type B) can practice balancing emotions with logical thinking, reducing emotional tension. Anyone can develop greater flexibility in responding to stress, thereby improving their emotional resilience.

Therapeutic approaches based on the DMM can help individuals adapt their strategies to become more balanced and effective in navigating relationships and challenges.

The DMM in everyday life

Understanding one’s attachment strategy through the DMM has practical benefits in daily life. It can improve:

  • Communication: Recognising one’s own biases in processing information leads to clearer and more effective communication.
  • Emotional regulation: Developing awareness of how emotions influence behaviour facilitates better self-control and stress management.
  • Decision-making: By balancing emotional and logical processing, individuals can make more rational and informed decisions.
  • Conflict resolution: Recognising attachment-driven reactions in conflicts helps people respond rather than react, leading to healthier outcomes.

Overall, the DMM is a powerful tool for generating self-understanding and personal development. By explaining how attachment strategies shape behaviour, emotional processing, and relationships, it provides a framework for individuals to recognise their behavioural patterns and make conscious changes. Unlike traditional attachment theory, the DMM offers a growth-oriented perspective, emphasising that attachment behaviours are adaptive and can evolve over time. By applying the insights of the DMM, individuals can
develop healthier relationships, regulate emotions more effectively, and navigate life with greater resilience and self-awareness.

Further reading: The DMM is described in more detail on Dr Crittenden’s main website The Family Relations Institute 

 

David Keighley is a BACP Accredited counsellor/psychotherapist offering short and long term therapy to individuals and couples using a variety of techniques such as EMDR, CBT and Schema Therapy. He is also a trained clinical supervisor.  He is available at our Brighton & Hove Practice.

 

Further reading by David Keighley –

The empty chair in therapy

How therapy can help with anger issues

Do you have unrelenting standards?

Why we need a ‘secure base’

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Why is three the magic number? Third spaces, secure bases and creative living (part two)

 

In my last blog ‘What is the unconscious?’, I attempted a very brief explanation of what we might mean and understand when we refer to the unconscious and how exploring this unknown territory is an integral aspect of the therapeutic alliance. This alliance can be described as an intersubjective (between two people) process, in which Thomas Ogden identified a phenomenon which he named ‘the analytic third’ – ‘ the jointly created unconscious life of the analytic pair’ (2004).

The old adage tells us: two heads are better than one. When two systems, substances or minds meet, they can mingle, merge or meld and experience a transformative process, so that when they separate again, each is changed by the experience. I referred to the concept of neural synchronisation or coupling in my previous blog, which can show, using fMRI readings, the coordinated mapping of brain regions reflected across two subjects when they are engaged in joint storytelling. Perhaps what we can see in the images produced in these studies is ‘the jointly created unconscious life of the analytic pair’ made visible? This process of combination and creation is the third space or analytic third where new thoughts, forms and ways of being are created.

The theory of third space also emerges in a sociocultural tradition which describes the individual mind as a hybrid emerging from a triad of individual, community and cultural artefacts shared over generations similar to Jung’s theory of a collective unconscious. Physical locations can be contextualised as existing across a trio of spaces: the domestic (home and family), the civic or professional (schools, libraries, community hubs, workspaces) and the individual (bars, restaurants, night clubs, shopping centres, leisure centres).

How do we use these spaces, physically and psychologically?

I suppose I am asking which one of these or combinations gives us a sense of safety or security. Does our individual hybridisation of these spaces create a composite third or base that we depend on or live from? Perhaps the answer is a fluid, interchangeable one, sometimes the workspace is where we retreat to feel a sense of purpose that the unrecognised efforts involved in domestic or family life can sadly fail to provide. Or perhaps, home is where we feel completed, accepted and at ease in contrast to the sometimes unreasonable expectations of our professional environments. Can we most relax in a social environment where we ‘let our hair down’ and give over to behaviours that would be deemed unacceptable in our family home or workplace, or is this an anxiety producing space where comparisons of our social standing are accentuated? Or do we enjoy the anonymity of a public library, sports or shopping centre where we can exist alongside but unconnected to other members of the public similarly engaged in commonplace everyday individual pursuits?

A safe space of our own…

I quoted Winnicott in my last blog, his hope that his work would enable, “the patient [to] find his or her own self, and will be able to exist and feel real. Feeling real is more than existing, it is finding a way to exist as oneself, and to have a self into which to retreat for relaxation. Winnicott (1971).

Attachment theorists speak of a ‘secure base’ from which the infant can explore their worlds, the physical and psychological. They conceive of this as a primary relationship, an attachment to a caring individual who helps the infant develop that sense of self:

The sense of self comes on the basis of an unintegrated state which, however, by definition, is not observed and remembered by the individual, and which is lost unless observed and mirrored back by someone who is trusted and who justifies the trust and meets the dependence. Winnicott (1971).

We can think of the analytic third as an unconscious space in the therapeutic alliance, co-created, that can provide a psychological secure base to develop and live from creatively. Perhaps the room where the analytic pair meet, virtual or real could also be considered a third space? One that combines the experiences of the domestic, individual, professional and civic lives. And if we explore this space with curiosity we can, perhaps, use the opportunities it provides to approach a sense of being that is mediated through the unconscious alliance of two individuals, putting their minds together to create a potential space for the individual’s most creative expression of themselves.

I have tried to draw attention to the importance … of a third area, that of play, which expands into creative living and into the whole cultural life of man … [this] intermediate area of experiencing is an area that exists as a resting place for the individual engaged in the perpetual human task of keeping inner and outer reality separate yet interrelated … it can be looked upon as sacred to the individual in that it is here that the individual experiences creative living. Winnicott (1971)

The magic ingredient

In ‘A General Theory of Love’ authors Lewis et al describe how our human emotions, relationships and psychotherapy work: ‘Loving is mutuality; loving is synchronous attunement and modulation. As such, adult love depends critically upon knowing the other … Loving derives from intimacy, the prolonged and detailed surveillance of a foreign soul.’

It might be useful to think about the work done in a therapeutic alliance in these terms, as Freud said, ‘Psychoanalysis is in essence a cure through love’.

 

Shiraz El Showk is a Training Member of the Association for Group and Individual Psychotherapy (AGIP) and a registered Training member of the UKCP, She is experienced in Psychodynamic counselling and Psychoanalytic Psychotherapy work with individuals, on both long and short term basis. She is available at our Brighton & Hove Practice, Lewes Practice and Online.

 

Further reading by Shiaz –

What is the unconscious? (part one)

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How do I become more assertive?

Ask any psychotherapist what the goal of therapy is and you will likely get a slightly different answer. However, I would suggest that assertiveness is a core aspect of the work – allow me to explain.

Assertiveness is relational in context. We can and need courage to go forth in life but assertiveness is only needed in the context of relationships; when we are on our own we may need courage and bravery, but not assertiveness.

Healthy relationships between two (or more) adults are based on the premise that each can remain psychologically and emotionally separate to the other, each be aware of their boundaries and where both parties can put their wants and needs into the mix and negotiate to get these met.

Assertiveness is the ability to be aware of where you physically, psychologically and emotionally begin and end and importantly to be able to name those limits and protect them if necessary.

The two types of relationships

I see the world of relationships split across two realms – the one-person and two-person world.

In a one person world, even though it may look like there are two people interacting or having a relationship, in reality there is only one. If one party feels unable to ‘stand up’ to the other – to put their needs into the mix – then the relationship essentially revolves around the wants and whims of one person. This would be what we think of in the context of having a relationship with someone with a narcissistic personality: narcissistic people want the world to reflect back to them their wants and needs and they are unable to take anyone else into consideration.

There is a second scenario where one person relationships or interactions can manifest even if neither party has a narcissistic structure and that is where one of the individuals is unable to bring themselves, their wants, needs and appetite, into the relationship and this is where they are unable to be assertive.

For such people, when they encounter resistance from another, it brings on huge anxiety and their default position is to ‘placate’ or go along with the other for fear of upsetting them, hurting their feelings or encountering conflict – they are overly and pathologically agreeable.

This is behaviour that has been learnt at a very young age in their family of origin and most likely came about as a result of being in relationship with a parent who had a narcissistic structure.

For young children, their primary objective is to preserve the relationship with their caregiver(s). This is primal and essential as a child with no parent will not survive (either literally or psychologically).

The attachment style link

Now if a child is what we called securely attached, they learn from a young age that they are allowed (encouraged) to bring their thoughts feelings and needs into the relationship with their caregivers. This does not mean that they get everything that they want, but what it does mean is that that child can express anger, frustration, sadness and joy, without being shut-down by the parent. This is the perfect environment for a child to learn to become assertive.

If on the other hand a child has grown up to be insecurely attached, then in this context they have picked up overt or covert messages from their caregiver that they are not allowed to simply express themselves – that they are either too much, or too little. The child, in a bid to preserve the precarious attachment with their parent modifies their behaviour to become what they believe their parent wants them to be. And this become an entrenched way of relating that they then take forward into all encounters in their life.

In such contexts, the clinical work is through the relationship between t erapist and patient to start to slowly dismantle this relational style. The patient must mourn what they did not get as a child and then uncouple how they survived as a child from daily interactions in the present. In other words, they must start to become assertive and survive their unconscious fears of abandonment.

 

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

 

Further reading by Mark Vahrmeyer –

Why do we expect Women to Smile and not Men?

Why do some of us feel a constant sense of dread?

Is there a good way to break up with someone?

Can self care become an identity?

Can psychotherapy help narcissists?

 

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What is belonging and why does it matter?

I was recently invited onto the Podcast ‘Conversations with Annalisa Barbieri’ to talk about the topic of ‘Belonging’.

The discussion centred around our mutual experience of growing up in cultures that were not of our families of origin. Annalisa is technically a ‘second culture kid’, and I am a ‘third culture kid’ – the latter meaning I spent my formative years in a country other that that of my parents or where I was born.

The focus of our conversation was on belonging and whilst a rich discussion, we were limited by time and the need to keep the discussion relevant to a broad audience.

In this blog I am going to (briefly) explain why I believe how ‘belonging’ is absolutely essential to not only our emotional and psychological health, but beyond that, critical to our very existence. And how it is under threat.

I have in previous blogs written about primary belonging which we refer to as attachment, and so I am now primarily approaching the topic from a more anthropological perspective.

My premise is that if we do not have a strong sense of belonging then there is an inverse correlation with the amount of (death) anxiety we are exposed to. At the extreme, this anxiety is unbearable and is the primary source of neurosis (and psychosis).

What is belonging?

Our first sense of belonging is derived from our family of origin. Belonging and attachment are inextricably linked for children and the main role of belonging in our family is, beyond immediate safety, as a means of deriving self-esteem.

As children we want to please our parents. We learn ‘right’ from ‘wrong’ and bit-by-bit form an understanding of the culture of the family – the rules and ways of being in that family. Through satisfying those rules, we derive self-esteem. So what is self-esteem?

Self-esteem is a combination of feelings whereby we feel valued and appreciated alongside feeling a sense of belonging. It is linked to meaning in that if we are embedded in a culture (a family) and are able to fulfil the expectations of that family – the cultural expectations – then we derive a sense of meaning from the process.

However, self esteem does not only come from ‘fitting in’. Healthy and psychologically robust children grow up in environments where the culture both supports them to derive self esteem from meeting expectations but also from forging their own path – expressing who they are.

As humans we are all somehow trying to find our personal balance between ‘standing out’ and ‘fitting in’, whether that be in the culture of our family of origin or later, in society.

What is Culture?

When I use the term Culture, I am referring to it on a macro level – in the context of society. If society is made up of the people with whom we share commonality, then culture is an expression of the values of that society.

Culture has two functions – it enables people to find mechanisms for generating self esteem (work, social groups, interests etc.) and secondly, and this part is entirely unconscious, it has an enormous symbolic function in assuaging death anxiety. Every culture on the planet provides its constituents with answers to cosmological questions, the four primary being:

Where do we come from (the story of our origin);
How to behave whilst we are alive (and derive self esteem);
What happens when we die (funeral rites etc.);
A myth of some sort of afterlife.

Culture is therefore in essence religious, and so are all human beings. However, as powerful as culture is, it remains symbolic and therefore cannot compete with the realities of death and so there remains residual death anxiety that we contend with. This in part gets expressed by an intolerance towards others who have a different culture as when we encounter difference it unconsciously increases our own anxiety as our cultural values are undermined and thus death anxiety encroaches upon us.

A currently example of the above is the war in Ukraine. The West thinks it can win on firepower – which it can technically – but what they fail to realise is that Putin is fighting a religious war – a war to restore the ‘myth’ – the culture – of Russia. Ergo, the war is unwinnable.

The role of myth

When we hear the word ‘myth’ many of us think of stories of old, perhaps extending back to the Ancient Greeks who had many a myth to tell. The truth, however, is that all cultures are comprised of myths. The answers to the aforementioned cosmological questions that each and every culture answers for its constituents are in essence myths. They are myths because they are stories rather than empirically provable.

Myths are stories that are held by the collective – by all, or at least most, constituents of a culture.

They may just be stories, but they are stories that hold great power in anchoring us to an identity and providing us with a sense of belonging.

Technology and the loss of myth

Joseph Campbell, the American writer and mythologist suggested that the world is changing too fast for us to cultivate and sustain myth. This matters significantly as, if myth forms the basis of culture, and culture functions as both a vehicle of deriving self esteem and in assuaging death anxiety, then the loss of myth renders us more anxious and less able to derive self esteem from our culture.

The deconstruction of Western Culture

We are living through a period of mass social change, much of which has been brought on my technology and some brought on by unexpected, but seismic events, such as The Pandemic.

In The West we are seeing long-standing cultural institutions and social structures being torn down at an alarming rate. The issue is not a moral one – some of these institutions and structures represent oppression and inequality and need to be challenged. However, we are at the stage of challenging virtually every construct that defines us right down to sex and gender. And yet have nothing collectively held to replace it with. There is nothing left to collectively believe in.

If all systemic meaning is removed and annihilated we will be left with nothing from which to derive our identity, sense of meaning and self-esteem. Perhaps this is already afoot as traditional ‘pillars’ of meaning collapse and people have little to replace them with, and certainly little of symbolic (religious) value, death anxiety comes rushing forward and manifests as both intolerance towards others (increasing culture wars), tribalism and ‘mental health problems’.

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

 

Further reading by Mark Vahrmeyer

Can chatbot companions relieve our loneliness?

What are feelings anyway?

Client or patient; patient or client – does it matter?

The psychological impact of the recession

Why do people watch horror movies?

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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.

Face to Face and Online Therapy Help Available Now

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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?

Face to Face and Online Therapy Help Available Now

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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 patients 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 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 is happening all the time in our lives, we simply are not aware of it. 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 somehow they remind us of a family member with whom we enjoyed a close relationship.

We constantly invent stories about others with whom we interact. Some of these stories may be accurate based on non-verbal cues, but others are examples of transference.

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

Counter-Transference

Counter-transference is the term used to describe what the therapist feels in relation to their patient. 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 psychoanalytical psychotherapy where the unconscious forms the basis of understanding a patient’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. And delivering freedom from the shackles of the past.

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’ is one that was brought to public consciousness by Jungian analyst Professor Joy Schaverian around a decade ago. Since then, it has gained significant traction as a model for explaining the often seen experiences and symptoms of adults who were sent away to boarding school as children. Specifically, it is a term used to explain and understand the experience of a child who loses the consistency of their primary attachment figures which constitutes a significant trauma that can shape this child’s life throughout adulthood.

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 applied.  Officially, this is not yet the case with BSS, although more and more analysts and psychotherapists (as well as journalists) are using the term. Irrespective of whether the term has been formalised as a distinct diagnostic category, what is clear is the trauma that is frequently caused to children as a result of being sent to boarding school and how this impacts on their ability to form attachments as adults – intimate and connected relationships.

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, irrespective of the underlying ‘approach’ to psychotherapy.

Schaverian (and others) suggest that BSS can be identified through disrupted relationship patterns, which with adults are generally found in romantic relationships. One of the characteristics of BSS is that what appears to be a strong sense of independence in the adult proves to be, in fact, a shell or mask, covering emotional vulnerability, depression, anger management problems and in more serious cases, 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 to adopt a ‘stiff-upper lip’ 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 significant 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 of the above would matter little, at least from the perspective of the individual in question, if they were to grow up comfortably inhabiting their own skin and needing a close relationships. Human beings are born into and shaped by relationship. We are relational to the core and this cannot be bypassed.

Boarding schools espouse entitlement, (pseudo)-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 irrespective of financial privilege. Whether a child is abandoned to the social care system as a result of an outwardly chaotic family life, or the abandonment is couched in the traditions of boarding school, the attachment disruption and damage 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 and readily acknowledged by society.

There is no doubt that emotional cruelty has an enormous 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, which is conversely what we see with adult survivors of boarding school.

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 patient. This enables them to start to make some tentative contact with his or her vulnerability.

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