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Are People with Mental Health Problems Violent?

The stigmatisation of mental health and mental illness is nothing new and can be traced back through the centuries and across cultures.

Despite much improvement in the treatment of mental illness and an increasingly open dialogue about the effects of mental illness from sufferers and professionals, the evidence shows that paradoxically increasing numbers of the general public fear violence from those who are mentally ill.

What is mental illness?

Whilst the term mental illness is ubiquitous, it is a ‘catch all’ term which fails to differentiate between people struggling with their general mental health, people who struggle to regulate their emotions and the tiny minority who have an actual illness as defined in psychiatric terms.

In its most extreme form, mental illness is an inability to ‘hold’ onto reality and is a terrifying experience for the sufferer – this would be the definition of psychosis. However, as terrifying as this is, there is simply no correlation between violence and mental illness.

Where does this fear come from?

The fear of mental illness seems to be profoundly primal. Human beings pride themselves on the rationality and intellect and to be exposed to someone who has ‘lost their mind’ triggers fear – if it can happen to them, can it happen to me? Losing ones mind can feel like losing the connection with what makes us human.

Periodically these fears are brought back to the surface, often as a direct result of some unfathomable act such as the recent school shooting in Texas where 19 children and two adults were murdered by an 18 year old gunman. How can something like this happen? Who would do such a thing?

Human beings seek to ‘fit in’. We all to a greater or lesser extent abide by the rules and laws laid down by our culture and society. Where we abide by the rules and perform well, society tends to reward us. The rewards are multiple, but are generally related to social standing and financial payment which propels us to continue to do well: fitting into culture affords us self esteem.

Many people who suffer from mental health problems have experienced trauma during their lives – it can be argued all of them. We now know, in no small part thanks for the 1998 ACE study (Adverse Childhood Experiences) conducted by the CDC-Kaiser Permanente, that the more adverse childhood experiences a child is exposed to, the higher the likelihood that they will suffer from mental illness.

However, whilst striking, it was not only their mental health that was likely to be affected, the higher the number of ACE’s, the higher the risk of emotional and cognitive impairment, physical disease, poverty, criminality, social problems and substance abuse problems, all culminating in a higher likelihood of an early death. Trauma therefore impacts on a person in every facet of their future life. Trauma is not caused by poor mental health – poor mental health comes about through trauma, accompanied with the long list of symptoms above.

All human beings harbour thoughts and feelings that we consider to be in conflict to how we see ourselves and how we wish to be seen. Psychoanalysis was the first discipline to start to talk about how we all have sadistic drives, harbour murderous thoughts and take glee in the suffering of others. Psychotherapy seeks, amongst other things, to help people know themselves and to integrate these parts of their character.

However, where this integration has not happened people can ‘split’ these parts of themselves off – as if it simply is not a part of themselves – and ‘project’ them into others: I am ‘good’, you are ‘bad’, or in this case, I am ‘sane’ you are ‘mad’.

I would therefore suggest that much of what drives the stigma around mental illness and the association between the latter and violence is driven by fear leading to the psychological defence called projection. ‘Mental illness’ or ‘mental health’ is a convenient scapegoat for the parts of ourselves that we disavoy.

What can be done to challenge the misconceptions around mental health and violence?

In order to challenge the misconception that people with mental health problems are violent, we need to be able to have a mature and complex conversation about society, trauma and how we are all collectively responsible for ‘othering’: scapegoating and ostracising certain groups of people who are vulnerable. There is correlation between childhood trauma and violence, but violence is not caused by mental illness.

Alongside this we need to use factual statistic to show that simply having a psychiatric diagnosis or ‘suffering from depression’ makes a person no more likely to be violent or to commit a crime than anyone else. What does significantly increase the possibility is childhood trauma, contributing to feelings of low self esteem, a lack of belonging in society, poverty and feelings of disempowerment.

The effects of stigmatising those with mental health problems

Through engaging in an open and honest debate around mental health and mental illness, we can not only support those who are suffering to talk about their experiences and seek help, but also acknowledge to ourselves that we are all in no small part likely to be affected by a mental health issue at some point in our lives. This makes it ‘our’ problem rather than ‘theirs’.

Where people with mental health problems are stigmatised it further alienates them from mainstream society and the opportunity to ‘contribute’ to that society and feel a sense of belonging, purpose all leading to greater
self-esteem.

Stigma and scapegoating leads to shame and shame makes it even harder for people to access help. People with mental health issues need support, compassion (not sympathy) and a pathway to belonging in society. It is no more helpful to pretend that they have no problems than it is to demonise them.

Mental illness is a social problem

As discussed earlier, trauma – particularly childhood developmental trauma – impacts on every aspect of a persons ability to lead a fulfilling, healthy life. And trauma begets trauma, meaning that it is passed from generation to generation. Therefore, rather that scapegoating those with mental health problems, perhaps we need to collectively pause, reflect and look in the mirror to see what sort society we are all contributing to.

 

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

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

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Using empathy to re-build connection with children and young people

This last year of global pandemic has been a time of massive disruption to almost everyone. With it has come disconnection in various forms and the challenge of reconnecting at points when restrictions have lifted. Children and young people have faced their own particular challenges with school closures preventing contact with peers and friends, in addition to the stress of uncertainty about exams and other limitations related to online learning. At a time when many teens would normally be exploring social freedoms to the full, those who have kept to the rules have made do with scraps of interaction and often relied heavily on digital forums. Sadly, a considerable number have struggled to hold onto what fragile self-esteem and social confidence they formally knew. Even some of those used to thriving have found their resilience quashed and required additional support to pull through.

We are still in the early days of reconnecting with the world and all the structures of human engagement that we once took for granted and, with time, we will no doubt start to see the fuller picture of how people’s lives have been impacted by COVID and all that has come in its wake. For some, reconnecting is proving to be a battle. There are those for whom the protection of a smaller, quieter world felt safer and some are simply feeling rusty about conversing and interfacing with real live people.

Hardships faced by those whose lives COVID has touched in very tangible ways, have brought forth numerous stories of lived empathy in response to people encountering terrible pain and the loss of health and loved ones, empathy perhaps evoked by the realisation that these losses could become reality for any of us. Likewise, there has been widespread, heartfelt support for the thousands of frontline workers who have sacrificed their own safety for the wellbeing of others and for those who have lost jobs, income and businesses. Many have felt for children deprived of opportunities to learn and play as they usually would and this continues to be a time when the younger generation needs us to recognise and engage with what they are going through.

Children and young people with social and emotional difficulties always require our empathy as part of recovery and perhaps even more so in these times. Empathy is what helps them feel understood, paving the way for self-acceptance, which in turn makes it more possible to seek support from others. Daniel A. Hughes (pioneer of Dyadic Developmental Psychotherapy) places Empathy at the core of the PACE approach, along with Acceptance and Curiosity (see my other blogs on these two subjects). In his book, co-written with John Baylin (The Neurobiology of Attachment-Focused Therapy: Enhancing Connection and Trust) he talks about embracing “the child’s defensiveness, putting connection before correction” and offering “radical acceptance” of the child’s mistrust.

In this context, Hughes and Baylin were referring to the particular struggles faced by traumatised children with attachment difficulties but we could apply the same principle to supporting children and young people who are emotionally and socially adjusting to each “new normal” they are faced with, whether or not they have experienced additional childhood trauma pre-COVID.

Hughes and Baylin recognise that this is no easy task, likening it to “hugging a porcupine”. Social and emotional defences, by their nature, are often difficult to permeate and can repel. A child or young person who repeatedly gives off a vibe of wanting to be left alone can leave the person reaching out feeling confused, rejected, useless and resentful and can lead, understandably, to withdrawal. This makes it even harder for the child or young person to reconnect, risking further disconnection, isolation and all the ill-effects that these states can bring.

If we can catch ourselves withdrawing and find empathy within ourselves for how the child or young person may be feeling in that very moment when they are unable to allow us in, we provide a bridge back into connection. This is so powerful as it communicates that we have not given up and that we see the child or young person as worth sticking with – we still see that part of them which has the potential to be in relationship with others and the world.
Brene Brown, in a Youtube clip based on part of her Tedtalk on Empathy, beautifully describes how “empathy fuels connection”. She refers to Teresa Wiseman’s 4 qualities of empathy: recognising another person’s perspective is their truth, staying out of judgement, recognising emotion in others and then communicating this. This is about “feeling with people” she says. Being with others is so much more effective than trying to fix the situation by saying the right thing: “Rarely can a response make something better, what makes something better is connection.”

In taking an empathic stance, we make an active choice to suspend our own anxiety and impatience about the pace at which a child or young person is re-engaging with life post-lockdown. We accept where things are at and we take time to understand as best we can. We then make what Brene Brown calls a “vulnerable choice”, that is choosing to connect with something in ourselves which knows the feeling we have encountered in another. This vulnerable choice is a risk well worth taking if we are serious about wanting to mitigate against the secondary effects of COVID on the mental health and wellbeing of children and young people today.

 

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

 

References – 

See more from Brene Brown at: https://www.youtube.com/watch?v=jz1g1SpD9Zo

Read more from Baylin and Hughes.

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Executive Function Skills (part 1) – What They Are And Why Some Children Struggle With Them.

Executive functions are the cognitive skills we use to control and regulate our thoughts, emotions and actions to achieve goals. These three main areas of executive function work together:

  • Self-control/ inhibition – the ability to resist doing something distracting/ tempting in order to do what’s needed to complete a given task, helping us to pay attention, act less impulsively and stay focused.
  • Working memory – the ability to hold information in mind and use it to make connections between ideas, make mental calculations and prioritize action.
  • Cognitive flexibility – the ability to think creatively, switch gears and be flexible to changing requests and situations, allowing us to use imagination and creativity to solve problems.

For example, all three areas are needed in social pretend play:

  • Child needs to hold their own role and those of others in mind (working memory)
  • Child needs to inhibit acting out of character (employ self-control), and
  • Child needs to flexibly adjust to twists and turns in the evolving plot (cognitive flexibility)

The joint forces of our executive function skills can be thought about as . . .

  • the conductor of an orchestra, organising multiple instruments to make one unified sound or
  • an air-traffic controller managing safe take-off and landing for hundreds of air-craft

Executive functions are controlled by the frontal lobes of the brain which are connected with and control the activities in many other regions of the brain.

Hot and Cool Executive Functions
Hot executive functions are the self-management skills we use in the heat of the moment when emotions run high – they require concerted conscious effort and help us give up short term gain for the sake of a more important goal. Examples include: resisting temptation; focusing on a boring task; breaking an old habit; and biting our lip when angry. Cool executive functions are the skills we use when emotions aren’t really a factor. Examples include: remembering a list of numbers and repeating them back in reverse order and following a simple recipe.

Executive function skills are a vital part of learning. They help children to be in the right place at the right time with the right equipment, listen to the teacher, wait for a turn and not call out. They are also pivotal in managing frustration, getting started on a task, staying focused, accepting constructive criticism and asking for appropriate help. They enable children to notice and correct mistakes, prioritise, persevere and complete challenging activities, resist the urge to retaliate and feel more confident about managing in school.

Children with under-developed executive function skills may act without thinking, overreact to small problems, be upset by changes in plans, forget to hand in homework, delay starting effortful tasks, switch between tasks without finishing any, lose or misplace things, struggle to meet deadlines and set goals, and lack insight into their behaviour.

Factors which can make it harder to access our executive function include tiredness and sleep deprivation, dyslexia and more complex learning difficulties, neuro-developmental conditions like Autism and ADHD, environments which overwhelm our senses and create stress, one-off traumatic incidents and complex trauma as a result of Adverse Childhood Experiences.

Given their significance, difficulties with Executive Function can contribute to social, emotional and mental health difficulties if they are unsupported and children who are already vulnerable for any of the above reasons may experience a compounding of the challenges they face. It is therefore essential that we take time to understand what these issues look like for each individual and adjust parenting, schooling and community interventions accordingly.

Look out for my forthcoming blog –  Executive Function Skills (Part 2) for ideas on how to support children with these difficulties.

 

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

 

Additional resources –

  • UNDERSTOOD website: https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/executive-functioning-issues/what-is-executive-function
  • The book  Why Can’t I Do That? A Book About Switches by Fi and Gail Newood is designed to help children understand what Executive Function skills are and how they link to everyday challenges.

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Helping children to ride the waves of big emotions

Quite a few people this week have asked me about tips for supporting children at times of high emotional stress (e.g. anger, rage or anxiety). For this reason, I thought I would share with you some generic pointers for parents that I use in clinic, but which could apply to most children. These are predominantly drawn from the principles of Dialectical Behaviour Therapy (DBT) and Dyadic Developmental Psychotherapy (DDP), which you may have heard of.

1. When a child is calm, help them to understand that emotions (of any kind) are a bit like waves… they rise, they peak and they fall. They come and they go, but they DO eventually end.

2. When a child (or their parent) notices that they are starting to become distressed (or to ‘fall out of their window of optimum arousal’), they can be supported to try the TIPP approach:

T = TEMPERATURE
Helping a child to change their body temperature (e.g. by splashing the face with cold water or eating or drinking something cold) can help them calm, as the body naturally gets hotter when distressed or aroused.

I = INTENSE EXERCISE
Engaging in intense exercise to match the level of emotional arousal (e.g. star jumps or running) provides a healthy outlet for anxious tension. – Ideally this should be a rhythmic exercise as it is more likely to activate a child’s earliest neural pathways of feeling soothed from when they were rocked as babies.

P = PACED BREATHING
Slow breathing, concentrating on their breath and (importantly) breathing out for longer than they breathe in, helps children to regulate the bodies. This is because longer exhalation naturally slows their heart rate and activates the Parasympathetic Nervous System (PNS), which in turn helps the body to calm.

PAIRED MUSCLE RELAXATION
Supporting a child to tense and then relax parts of their body, supports muscles to release tension. Relaxed muscles require less oxygen, so heart rate and breathing naturally start to slow down.

3. Having a calm box – Supporting a child to develop a pre-prepared box of all their favourite textures, smells, photos, games, sensory toys, etc., can be a lovely way to start to talk about emotions with a child and help them to feel a sense of self-efficacy in managing their own emotions. As time goes on, a child might start to ask for their box before becoming overly distressed.

4. Parental matching of the affect – When a child’s brain is distressed, it regresses to a much earlier developmental form of itself, whereby it does not register language or logic in the same ways. For this reason, a parent needs to ‘match’ the emotional intensity of the child in their non-verbal behaviours (e.g. when a child is shouting: using a loud (but not angry) voice, using BIG physical gestures, maintaining intense eye contact, etc.). The very act of ‘mirroring’ a child to themselves helps them to feel held and contained. The parent can then gradually lower their voice and soften their gestures, which the child will match in turn. I think of this as ’emotional hand holding’.

5. Having a cuddle – Following an emotional outburst, close physical connection instigated by a safe adult, is one of the most soothing and regulatory activities to do with a child to bring them back into a state of optimum arousal. It also enables them to learn that no matter what they have done or said, they are still loved, which is so important for developing a secure and healthy attachment. Once they are physically and emotionally calm, you might then want to talk about the actual behaviour if this needs to be addressed, however, the key is…’Connection before Correction!’!

I hope that you find some of these tools helpful. It is of course important to note, however, that what causes (and maintains) emotional distress in children can vary hugely from child to child. It is also important to note that for some children, what causes and maintains their distress can be very hard to determine. In such cases, parents should feel empowered to seek professional advice regarding a targeted assessment of their children’s specific needs.

Happy surfing everyone…!

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

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Helping Children With Loss Through Story Books

Children, like all of us, encounter loss in their lives, temporary and permanent. They may lose a treasured possession, a loved one who dies, a parent who leaves or is imprisoned, a friend who moves away, or a valued teacher in the transition between year groups or schools. Some are unlucky enough to lose their health or abilities they once took for granted. Others lose their home or their country and there are those who lose their innocence through exploitation and with it perhaps their sense of self and any respect and trust they had for the world.

With loss comes associated feelings, held in the conscious or unconscious mind or both. Support in processing losses may or may not be available and the degree to which children show lasting difficulties will vary accordingly. Stories are just one tool which can help children connect with and work through internal emotional conflicts associated with experience of loss.

Like art, stories help us to take new perspectives and understand ourselves, others and the world differently. They can offer comfort or challenge, enliven or unsettle us. By engaging the imagination, not only can stories transport us to another time and place but they can also open up a rich emotional landscape which might otherwise be off limits to the defended conscious mind.

Most children speak and understand the language of play and they live stories, in their everyday playful interactions with food, sounds, textures, objects, animals and people. And, of course most are introduced to and love books, from a young age. Well-told children’s stories tap into a child’s thirst for make-believe, for adventure and for powerful emotive themes such as love and hate, despair and hope, failure and redemption.

For this blog, I have selected 6 story picture books which I will briefly summarise:

Amos And Boris by William Steig (1971)
This beautifully written tale of enduring friendship focuses on the unlikely alliance of a mouse (Amos) and a whale (Boris), who become acquainted when Amos falls off the boat he has made (which is sadly lost forever) and Boris rescues him. The two travel together, learn about their differences, survive a falling-out, share ideas and develop “a deep admiration for one another”, becoming “the closest possible friends”. Coming one from land, one from sea, the time comes for them to separate: “. . . we can’t be together . . . I’ll never forget you though.” Years later, Boris is beached by a hurricane and Amos, aided by elephants, is then able to save his life. The wrench of what may be
their final parting is sad and tender yet secure in the knowledge that each will continue to be remembered in the other’s heart and mind.

Badgers Parting Gifts by Susan Varley (1984)
This story opens with the inevitability of the ageing Badger’s death and his awareness of the loss his friends will feel after he’s gone. When he dies, Badger is sorely missed by all the animals but especially Mole, who feels “lost, alone and desperately unhappy.” The friends’ sadness is intensified by Badger’s absence, as it was he who had always been there for them in times of trouble. And in missing him, they start to come together and share memories. This, in turn, highlights to them the gifts which Badger has left behind, skills he taught each of them when he was alive which they can now remember him by and use to support each other. Gradually, sadness gives way to a comforting and emboldening remembrance and gratitude.

The Red Tree by Shaun Tan (2001)
This story tells of a girl who loses her sense of purpose and place in the world, and with it any sense of hope. Through unique, extraordinary, incredibly crafted images, and condensed, graphic text, we travel into the girl’s mind, inhabited by surreal, exaggerated and often frightening forms and scenes which overwhelm her. She is not seen, heard or understood and oscillates between these worlds of chaos and a relentless nothingness. A happy, colourful life is out of reach and all seems doomed and irresolvable. She has lost everything and become lost herself. And then, suddenly, life returns (thankfully!) and with it hope and joy. This speaks to the immense value there is in sitting alongside and fully taking in the realities of another person’s bleak experience. As the reader, we witness the
girl’s pain, perhaps helping her to mourn her losses and then re-discover herself.

The Day The Sea Went Out And Never Came Back by Margot Sunderland (2006)
Eric the sand dragon lives on a beach and adores the beautiful sea beyond, which in its daily rhythm comes and goes predictably, with the tides. One day the sea goes out and does not return. This is devastating for Eric who waits and longs for the sea to come back and is then overwhelmed with the pain of his loss. He becomes trapped and isolated inside himself. Eventually, attracted to the vulnerability of a dying wild flower, which he then saves, Eric is drawn back into life himself. He saves more flowers and a rock pool garden is created. Eric starts to feel safe enough to fully mourn his loss and in so doing discovers that remembering his beloved sea builds a treasure store in his mind which
he can keep forever.

The Lonely Tree by Nicholas Halliday (2006)
Set in the New Forest, this original book uses the seasons to chart the forest life-cycle through the friendship between an old, story-telling oak tree and a young, curious evergreen. As the oaks sleep for the winter, the evergreen becomes acutely lonely and, when spring finally comes, all hope is cruelly crushed when his oak-tree friend fails to wake up, his long life ended. The evergreen cannot comprehend what has happened but holds onto his cherished memories, through the sadness. Hope returns as a fallen acorn germinates and a new oak is born, destined to form a new friendship with the evergreen. Stories of the forest are retold and, as they are, the trees’ roots go “deeper and
deeper into the ground”, reminding us that with companionship we can endure and process the pain of loss and live a more enriched life.

The Heart And The Bottle by Oliver Jeffries (2010)
Beautiful illustrations alongside a concise narrative makes for great dramatic effect, telling the story of a delightfully curious and creative little girl who experiences the apparently abrupt and unexplained loss of an adored grandparent, with whom she had discovered and shared many wonders. She puts her heart into a bottle for safe keeping but as she grows up becomes limited and encumbered by its seclusion, which she finds she is unable to reverse. It is only through connecting with her own daughter’s zest for life that she allows her heart to be freed and re-discovers treasured memories of her beloved grandparent who she can now enjoy remembering. Her inner-child, in league with her actual child become the unwitting healers.

These books, like many others, model that feelings are okay, they are a normal response to loss and are to be expected. This is an important message to our children, particularly given that many of us are still filtering cultural and familial influences in our own lives which would have us discount feelings in order not to rock the boat or blow other people’s stiff-upper-lip cover. Children are expert at tuning into our sensitive pressure points and while they may push our anger buttons quite readily, they may avoid talking about sadness if they sense we may be uncomfortable and find it hard to hear and hold them. In turn, to avoid burdening others or being alone with pain, their own natural defences against connecting with sadness can become strengthened and entrenched.

A story book can serve as a helpful third party, a neutral but enriching messenger, able to venture into forbidden territory within the safety of metaphor. Connection with characters breeds understanding and empathy for one’s own pain. We can read the story exactly as it is or go off piste, filling in blanks with a child, co-creating a personalised narrative, re-writing the ending and reflecting all the while. Repetition can work wonders, enabling a child to use pictures as prompts and retell the story from memory. Each retelling can add meaning and a layer of digestion for the child, outside of his/her awareness, whether or not any overt life parallels are drawn.

All 5 of these books also convey a sense of hope, always integrated into the experience of loss. Again, this is a powerful lesson in a world which all too often splits artificially the good from the bad. We might not long for loss or wish it upon anyone else, but when it comes we, alongside our children, can do what we can to to feel it, to know it, to share it and to find new life somewhere within it.

 

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

 

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The Benefits of Yoga Breathing for Children with a History of Trauma

When children feel helpless, angry, or scared for long periods of time, it can be remembered in their bodies. This is particularly so in the case of trauma, whereby specific (trauma-implicated) body parts may start to feel somewhat disconnected to the rest of the body (e.g. headaches, neck pain, stomach aches, back spasms, etc.). Body tension is also common in children who were very young at the time of their trauma and, therefore, may have no conscious or verbal memory of it. This phenomenon can be hard for parents (and professionals!) to make sense of and can often lead to them seeking assessment and treatment for many things before considering the long-lasting impact of historical stress or trauma on child. An important task of a psychologist, therefore, is to help chronically stressed or traumatized children to tolerate physical sensations without being afraid of then. This includes teaching them how to regulate their own internal arousal.

The brain-body system that we target in this kind of work is known as the Autonomic Nervous System (ANS) – also known as our ‘survival system’. At its most basic level, the ANS is comprised of two discrete branches called the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). The SNS is associated with the release of chemicals such as adrenaline, which spur the brain and body into action. The PNS on the other hand, is associated with the release of chemicals such as acetylcholine, which enables us to be calm and to regulate important bodily systems such as our digestion and sleep. In a healthy child, the SNS and PNS work closely together to enable a child to have an optimum awareness of both themselves and their environment, so that they can respond to each appropriately. For some children, however, historical stress and trauma can cause the SNS too become too powerful, leaving the child vulnerable to quickly dysregulating in response to misunderstood internal sensations or external stressors.

One biological marker that has been identified as a strong indicator of how well the ANS is working is ‘heart rate variability’ (HRV). In healthy children, the very act of breathing leads to steady, rhythmical fluctuations in their heart rate, which in turn is a measure of their wellbeing. This is because inhalation activates the SNS (and therefore raises their heart rate), whereas exhalation activates the PNS (and therefore slows heart rate down). Good HRV – and therefore, good balance between the SNS and PNS, enables children to execute a reasonable degree of self-regulation, including being able to calmly appraise upsetting situations without dysregulating, such as disappointment or peer rejection. Poor modulation between the two systems, however, negatively affects how their body and brain responds to stress. Research indicates that people with posttraumatic stress disorder (PTSD) often have poor HRV (Hopper, et al., 2006).

One way to improve HRV, has been shown to be through focused breathing techniques. Indeed, simply changing the way one breathes, has been associated with a wide range of positive physical and psychological outcomes, including marked improvement in mood disorders, asthma, and back pain (e.g. Pilkington, et al., 2005; Sherman, et al., 2005; Streeter, et al., 2010). Focused breathing techniques for children can be found in many forms, but one particularly successful form has been shown to be via Yoga. This may be because Yoga supports children to pay attention to what is happening within their bodies rather than just outside of it – teaching them that all sensations peak and fall, with a beginning, middle and end (Van der Kolk, 2014). This can be of particular benefit to children who rely on either sensory numbing or over-stimulation, or who may need additional support to feel ‘safe’ in their bodies.

In my clinical experience, I regularly find that children, even without a history of trauma, can still benefit hugely from mindfulness-based breathing exercises. For this reason, I am very grateful to Dr Emma Stevens (Clinical Psychologist), for recommending a lovely book of breathing for young children based on the principles of Yoga – “Frog’s Breathtaking Speech” (Chissock and Peacock). My children have loved reading this story and learning the techniques. I hope yours will too!

 

References:

Chissock, M. & Peacock, S. (2020). Frog’s Breathtaking Speech How children (and frogs) can use Yoga breathing to deal with anxiety, anger and tension.

Hopper, J., et al. (2006). Preliminary evidence of parasympathetic influence on basal heart rate in posttraumatic stress disorder. Journal of Psychosomatic Research, 60 (1), pp. 83-90.

Pilkington, K., et al. (2005). Yoga for Depression: The Research Evidence. Journal of Affective Disorders, 89, pp.269-85.

Sherman, K., et al., (2005). Comparing Yoga, exercise and a self-care book for chronic low back pain. Pain, 115, pp. 107-17.

Streeter, C., et al. (2010). Effects of Yoga versus walking on mood, anxiety and brain GABA levels: A randomized controlled MRS study. Journal of Alternative and Complementary Medicine, 16, pp. 1143-52.

 

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

 

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Why behavioural approaches do not work for all children

One of the most frequently asked questions put to me in clinic, is why some children do not respond to traditional reward/punishment based behavioural strategies. The answer is simple – because, contrary to popular opinion, these strategies do not work for all children in all situations.

This is because the ability to make a mental link between a behaviour and a punishment, and to then be to be subsequently less motivated to use that behaviour again, actually involves quite sophisticated cognitive processes. It also requires specific parts of the brain to be functioning well. Difficulties with this may apply to children with learning disabilities or neurological conditions. It may also apply to children who are anxious, fearful or traumatised. This is because anxious or fearful children are often operating from a very primitive part of their brain that physically impedes their ability to access more developed parts of their brains. This in turn makes it harder for them to make cause and effect links, to generalise, to suppress their impulses, to make rational decisions, to maintain empathy for others and, in some cases, even to trust in the motivations of others. Punishing these children without supporting them to understand what is happening for them, therefore, is actually more likely to increase their fearful behaviours and further undermine their trust in those around them. For some children, it can also exacerbate feelings of shame.

A second concern with an overly heavy reliance on behaviourist principles when applied to children, is the theoretical and research origins upon which these principles are based. Behaviourism was largely developed in the 1950s and 1960s in laboratories with small mammals such as dogs, cats and rats – animals with significantly less developed brains than our own. Whilst these experiments can teach us a lot about how to shape behaviour in its purist sense therefore (i.e. classical and operant conditioning), they offer nothing in terms of how we build children’s self-esteem, build their intrinsic motivation, or even how to protect their attachment relationships. For instance, classically conditioning young babies to sleep by ignoring their attachment-seeking behaviours, can have detrimental effects on a child’s subsequent relational security and internal regulation skills. Similarly, a heavy reliance on operantly conditioning ‘good behaviour’ in young children with external motivators (e.g. star charts) has been shown to undermine a child’s natural desire to problem solve, be creative and to keep building on their successes when these external motivators are later removed.

Whilst some behavioural principles within a parenting repertoire can undoubtedly be helpful, therefore, when used to excess, and particularly when used in the absence of a broader context of sensitive, loving and developmentally appropriate care, they can quickly become damaging. This is because human children have brains that require so much more from the parent-carer relationship than simple behavioural conditioning.

Part of my role as a Clinical Psychologist, therefore, is to help parents, carers and professionals, to find new and more effective ways of supporting children to reach their full potential.

 

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Tips for talking to young children about their behaviour

When talking to young children, most people know that ‘open’ as opposed to ‘closed’ questions are helpful. That is, questions that cannot easily be answered with a simple “yes” or “no” answer and invite the child to give more information. These questions typically start with “who..?”, “where…?”, “what…?” and “how…?”. What many people don’t realise, however, is that the most frequently used open-question starter – “why…?”, can be hugely counterproductive to conversations with young children.

This is because young children can easily experience the word “why” as threatening. A “why” question implies that the child should have (and the adult expects them to have) a level of insight about their behaviour that they genuinely might not have at this stage. For some children it can cause them to close down by becoming silent or simply saying “I don’t know”, which can feel infuriating to parents. Other children may feel the pressure to just give an answer – any answer – which might not even make sense (e.g. “I did it because my tummy was hurting”). This is because they just feel the pressure to say SOMETHING, which can also feel upsetting to parents. (Incidentally, when a child says that their tummy is hurting, that actually can be a sign of anxiety).

Much better, is to side-step the “why” question altogether with young children (e.g. “what made you do that?” or “when you did that, what did you think might happen?”) These kinds of questions keep the dialogue flowing and importantly, help the child to start to understand for themselves what their thoughts, feelings and motivations were when they used a particular behaviour.

This is an important foundation step towards impulse control and emotional regulation.

 

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What is the difference between fate and destiny?

Many people will use the terms ‘fate’ and ‘ interchangeably and it can often not only be difficult to differentiate between the two, but also to understand what is actually meant by them. Both terms essentially refer to predetermined events that lie outside of our control and thus imply some sort of ‘higher power’ rendering them essentially religious in meaning.   But what is the real difference and are they useful words?

I believe that the word ‘destiny’ implies a degree of positivity as well as agency that one may have over their future; fate feels particularly hopeless to me in terms of the capacity for a person to have any sort of influence over the outcome.  Hollywood would have us believe that we are destined for good things, and fated to bad, however this negates free will and assumes pre-determined destiny.  As a clinician who believes in free choice as a basic tenet of the psychotherapeutic process, I have a resistance to both terms, instead preferring to consider how a person makes meaning in a world limited by circumstance – personal and existential.

Accepting reality

Much of the work of psychotherapy is around coming to terms with reality – past and present.  This means accepting what was in terms of our experience of childhood or past traumas and working through the complex emotions around them.  It often means grieving both what we had and what we didn’t.  Seeing something as fate or destiny can be protective in the short-term but can massively hinder how we approach life.  I consider it to be a degree of ‘magical thinking’ whereby there is a belief in a force, entity or deity who overseas our lives – the magical thinking is in psychological terms the belief in an all-mighty parent.

Accepting reality in the present also means accepting uncomfortable limitations which we may now not be able to change.  For example, it may mean coming to terms with the end of a relationship and accepting our role in its demise; or it may mean coming to terms with a biological loss – such as an inability to have a child – and accepting that this is not fate, but painfully, it is random and unfair.  And life is unfair and random.

Protection in a higher meaning

There is an illusion of protection in imagining that ‘things happen for a reason’ when this is simply not how the world operates.  This does not negate personal responsibility and scientific cause and effect, however, to make sense of the world through ascribing meaning to events that lie outside of our control is childlike and an avoidance of reality – the reality being that we are not in control.

Perhaps this is ultimately where we can draw a clinical distinction between fate and destiny: once we have come to terms with reality and accepted the experiences of the past and the limitations of the present, then where we take responsibility for our life, we are shaping our destiny.  In this context I believe this word can be used whilst being firmly rooted in reality and it conveys an acceptance of our past and our limitations and that we are willing and able to shape our future to the best of our abilities.

In this sense destiny is self-prescribed based on authentic living and choosing a life of substance.  It means identifying and then choosing to engage with that which brings our life meaning.  It means making decisions whilst accepting the ramifications of those decisions and the losses that accompany them.

Decisions – all decisions – are expensive, in that once taken, alternatives are precluded.  Bearing reality and accepting loss are therefore build into making any decision, even one as simple as choosing the pasta dish over the salad in a restaurant – the loss of choosing pasta is the salad, but also the idea of what the pasta would be like – we allow the fantasy of the pasta to become a reality and accept it, or at least bear it.  It may exceed our expectations; it may disappoint, but whatever happens, it will be different to how we imagined.

Opportunity cost

Economists often talk of opportunity costs – the cost paid in making one choice and therefore forfeiting the other possible choices.

Opportunity cost applies just as much in the field of psychology.  If we make certain choices in life, we will not be able to choose other life paths.  Despite what Instagram and Facebook promise – none of us can have it all!

One can argue that the terms of fate and destiny are simply that – words to describe something.  However, when our experience of the world is shaped and understood through words, they become exceptionally powerful and potentially limiting.  Therefore, whilst not as esoteric and catchy, I prefer the terms ‘loss and responsibility’ as replacements for ‘fate and destiny’.  At least we can come to terms with loss and then exercise a conscious sense of responsibility in shaping our lives going forward.

 

Mark Vahrmeyer is a UKCP registered integrative psychotherapist who draws strongly on existential thoughts and theory to help clients make sense on an increasingly senseless world.  He sees clients in Hove and Lewes.

Further reading by Mark Vahrmeyer –

How do I choose a Psychotherapist?

Is growing up in a different culture always a good thing?

What causes insomnia?

Why does psychotherapy matter in the modern world?

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When praise becomes harmful to children

Contrary to its intention, praise does not always make a child feel good.

Whilst we might typically think of praise as a gift, it is technically an evaluative judgement on the other person (e.g. “you’re a good girl” or “you’re a brilliant artist”), which for some children can be experienced as threatening or even dysregulating (Stephen Porges Polyvagal Theory).

This risk is particularly pronounced in children whose earliest relationships have not enabled them to trust in the safety of relationships and/or have caused them to develop negative core beliefs about themselves as inherently bad or unlovable. For these children, being told that they are “good” or “fantastic” at something, is so far removed from their own sense of themselves that they cannot make use of it. More likely, they will be put on high alert for when the other person will no longer see them as “good” and will see their true self. It also creates inevitable comparison – and therefore, competition, with other children. For very traumatised children, therefore, ‘global praise’ (or generalised, non-specific praise), can actually act to undermine their trust in the safety of their relationship with the person giving it to them (Hughes, Golding & Hudson, 2019).

Whilst not all children have experienced developmental trauma, however, it is still true that global praise is not helpful to children. This is because it contains too little information about what the giver is enjoying about the child, or what they are doing well, for them to make use of it. Indeed, a natural tendency (for any of us!) when offered global praise, is to immediately deny it (e.g. “I don’t always have gorgeous hair! You didn’t see me yesterday!”), to assume that the giver is lying or does not know what they are talking about (“As if I always sound intelligent!”), to focus on our weaknesses (e.g. “Clever! You should see me doing my times tables!”), to make us anxious (e.g. “I’ll never be able to hit the ball again now you’ve said I’m a good shot!”) or to assume that we are being manipulated (e.g. “What’s she after?”; Faber & Mazlish, 2001).

A healthier alternative to global praise is ‘descriptive praise’. That is, the act of actively looking for specific things that you appreciate, value or enjoy about your child (e.g. “You two have just sat there colouring for 20 minutes with no squabbling”, or “You picked up all your toys, thank you!”) In offering descriptive praise, parents and professionals should attend as much, if not more so, to the effort that a child is making as their achievements (e.g. “I can see you are putting so much hard work into revising your spellings”). They should also ‘own’ their opinions (e.g. “I really like what you’ve drawn there. I like the stripes on your zebra. I think that’s a great drawing!” rather than “you’re a brilliant artist!”).

Unlike global praise, descriptive praise helps to build children’s self-esteem. This is because it supports children to start to recognise the positives in themselves. This happens because having someone else point out specific things that they like or value about them, in a way that they actually can hear and accept it, enables children to give themselves the praise they deserve (e.g. “Yeah, I did draw that chimney well”). Descriptive praise can also be a wonderful way of building enjoyment, joy, trust and security in attachment relationships, for instance, building in a period of descriptive praise for the child before they go to sleep each night. Further, descriptive praise can help to build a child’s resilience, as parents can support their child to start to recognise all their strengths in the face of adversity (e.g. “I know you’re sad that you didn’t make the football team, but I was so impressed with how you went and congratulated the other players. I thought that was really kind”).

For descriptive praise to be effective, however, it should always be within the context of GENUINE heartfelt appreciation and gratitude for the child or their behaviour, as our non-verbal communication is always stronger than our verbal.

References:

Faber, A. & Mazlish, E. (2001). How to talk so kids will listen and listen so kids will talk. Piccadilly Press

Hughes, D., Golding, K. & Hudson, J. (2019). Healing Relational Trauma with Attachment-Focused Interventions: Dyadic developmental psychotherapy with children and families. W. W. Norton & Company.

Porges, S. (2019). Home of Dr. Stephen Porges. www.stephenporges.com; Accessed: 2019.06.07

 

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

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What is ‘Blocked Care’ as it applies to parenting?

The phenomenon of parental ‘blocked care’ is a term coined by Clinical Psychologists Dan Hughes and Jonathon Baylin and Psychiatrist Dan Siegal. It represents a central feature of the Dyadic Developmental Psychotherapy (DDP) approach to treating children and young people with a history of developmental trauma and attachment disruption.

Research into the areas of attachment, trauma and neurobiological development, are teaching us that children’s brains are shaped on a neurological level by their earliest caregiving experiences. 

We now even know that an infant’s brain is primed, even in utero, to adapt to the type of care that it anticipates receiving from its primary caregivers in order to maximise its chances of survival. 

The Five Care Systems in parents

What is perhaps less known however, is that parents’ brains are also neurologically influenced by their experience of caring for their child – that the relationship is symbiotic. When things are going well, we now understand that five main areas or ‘care systems’ in the parental brain are optimally functioning. These are:

  1. The Approach System: The system that enables us to fall in love with our children, to crave to be with them and to become completely absorbed in them. This system is associated with the release of oxytocin (colloquially known as the ‘love hormone’).
  2. The Reward System: The system that enables mutual delight and attunement when a parent interacts with their child. This system is associated with the release of dopamine (the ‘addictive hormone’).
  3. The Child Reading System: The system that enables parents to positively interpret our child’s behaviours and motivations and to remain interested in their unique qualities.
  4. The Meaning-Making System: The system that enables parents to think positively and meaningfully about their relationship with their child.
  5. The Executive System: The system that enables us to physically care for our children.

For some parent-child dyads however, things do not go so well and these care systems do not operate optimally. For example, some parents may face unmanageable levels of stress whilst caring for their infants, which may be exacerbated by their own poorly developed care and emotional-regulation systems. 

Others may be offering reparative foster parenting to children who, owing to previous experiences of abusive or neglectful parenting, now fear, mistrust and reject the care they are being offered, which can be extremely painful for their new carers to bear.

The real risk when things go wrong however, is that parents may enter (chronic or acute) periods of ‘blocked care’. When this happens, the first four systems listed above start to shut down. The parent no longer experiences joy or fulfilment of being with their child. They do not get the rushes of oxytocin and dopamine that other parents get, and they do not seek to be with their child.

These parents also become much more likely to interpret their child’s behaviours and motivations from a negative perspective (e.g. “he is manipulating me” or “she is a spiteful child”) as well as their own relationship with the child (e.g. “I am a rubbish parent”).

In psysiological terms a stressed out parent is operating in ‘survival mode’. They are no longer able to remain open and engaged to the child’s emotional and developmental needs and are simply coping. 

Without external support, the final care system – the executive system –  may also start to shut down. This is the point when we start to see abusive or neglectful parenting emerge where parents are physically unable to care for their child or children.

The growing evidence-base for blocked care highlights the crucial need for psycho-education, as well as early and non-judgmental support to parents and carers who are most vulnerable to it.

 References:

Hughes, D. & Baylin, J. (2012). Brain-Based Parenting: The Neuroscience of caregiving for healthy attachment. Norton

Hughes, D. & Baylin, J. (2016). The Neurobiology of Attachment-Focused Therapy: Enhancing Connection & Trust in the Treatment of Children & Adolescents. Norton

Siegal, D. & Hartzell, M. (2003). Parenting from the Inside Out. Tarcher/Penguin

 

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

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What doesn’t kill us makes us weaker: Developmental trauma and attachment styles

There is a lot of wisdom in sayings that have been part of our language and culture for as long as we can remember.  For example, being ‘on the back foot’, meaning to be at a disadvantage or on the defensive, is a perfect expression of how our relationship to our body influences how we relate to ourselves and the world around us.  Likewise, to have a ‘gut feeling’ about someone or something, is really very profound as our emotional system (our unconscious) resides in the body and expresses itself somatically through, amongst other parts of our body, the gut.

However, one expression I come across quite often that is not only incorrect but also harmful is ‘what doesn’t kill us, makes us stronger’.  It is an expression which is frequently accompanied by a disavowal of any felt emotion in relation to the event being described and suggests that somehow we grow stronger and more resilient through trauma.  The latter is particularly true of childhood developmental trauma where an individual has been regularly misattuned to, neglected or abused.  In the case of developmental trauma, what doesn’t kill us makes us weaker and less adaptable to the realities of life.

Developmental trauma, also known as complex trauma, arises ‘when caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief’ – Dr. Bessel van de Kolk (2014).  Developmental trauma directly impacts on cognitive, neurological, psychological and immunological development of infants and maps onto our attachment patterns in later life.  In other words, we grow our brains and minds from our early experiences with our primary caregivers which lays down a belief system about ourselves, about those around us and about the world in general.

A little about attachment

OK, so developmental trauma correlates to attachment patterns.  What are attachment patterns and why do they matter?  It is generally accepted that there are four types of attachment: secure; avoidant; anxious-ambivalent; insecure-disorganised.

If a parent has been available to their infant and able to attune to their child’s needs, the child learns that it is safe to turn to that parent in order to seek soothing and reassurance, and then safe to turn away and carry on exploring the world when they feel calm again.  This child is securely attached and will likely carry this attachment style into his or her adult relationships.

The other three attachment styles are all classed as insecure and arise from childhood developmental trauma.  Avoidant infants learn that they need to be self-reliant despite their anxiety; Anxious-ambivalent children seek out their caregiver but fail to be soothed through a lack of attunement – they pick up their mother’s anxiety; children with disorganised attachment feel enormous conflict in their main attachment relationship wanting to approach for security and feeling frightened of doing so.

Attachment patterns matter for a whole host of reasons, however, on the most fundamental level, attachment patterns dictate whether we are able to use relationships (with ourselves and others) to regulate our emotions, arousal and anxiety.  An inability to regulate our arousal state means it is more likely that we will suffer with higher levels of anxiety and be predisposed to emotional, mental and physical illness.

Thus, in the context of trauma, attachment and our relationship to self and other, what doesn’t kill us progressively makes us weaker.

The role of psychotherapy is to help individuals process trauma and through the therapeutic relationship start to challenge attachment styles and patterns.  It is possible to shift over time from an insecure- to secure attachment pattern.

 

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

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