Brighton and Hove Psychotherapy

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Does the sex of my counsellor or psychotherapist matter?

A question I have often either been asked or has come up up is whether the gender of the clinician matters (or should matter) to the client?

The answer, as with most questions relating to the intricacies of psychotherapy is not categorically ‘yes’ or ‘no’.  However, the question opens up other questions which may themselves be more interesting such as, what are your beliefs about psychotherapy and why should the sex matter?

To start with, there are clearly cases and instances where it is entirely appropriate for a patient or client to want or need to work with a therapist of a particular gender.  Aside from the fact that this may simply be the wish of the client (and therefore to be respected) valid reasons may include a history of sexual abuse by one gender leading to the client feeling safe with the other gender (often their own).

However, if we drop beneath the obvious, the question takes on more of a philosophical slant and how it is answered gives much insight into what a clinician believes about psychotherapy – let me explain.

There are many ‘schools’ of psychotherapy and many methods, however most of these have more in common than they don’t and secondly, most clinicians are to a greater or lesser extent ‘integrative’ in that they use different models in their clinical work.  The greatest distinction, or divide, perhaps lies in whether or not a method, and thus a practitioner, believe in unconscious process or not (and spoiler alert – I do profoundly).

As a psychoanalytically informed psychotherapist, I work with the unconscious which means to say that I take very little on face value and work with my clients to understand why they think, behave and act in the way they do; in other words, how is their past experience influencing their perception of the present without their knowledge.  Through therapy the past can be uncovered, worked through, grieved and its hold on the present reduced.  This frees clients up to make informed and thought through choices based on their reality as it really is now rather than where they were previously stuck.

Those who don’t believe in the unconscious (namely behaviourists or person-centred therapists to name a couple) take things on face value.  They do not believe in unconscious process and work very much in the ‘here and now’.

How does the unconscious link to the sex of the therapist?

Those of us who work with the unconscious will, to a greater or lesser extent, work with transference – that is, work with whom we represent to the client in the room.  And whom we represent will invariably be one of the client’s caregivers, usually a parent.

Transference is very similar to projection, which is something we all do at times – we ascribe values to a person based on prior assumptions rather than on the reality of who they are.  The difference with transference is that the clinician, if trained well enough, will receive the client’s projections and be thinking about who they are (represent) for the client.

Freud believed (and rightly so) that transference occurs irrespective of gender/sex.  We will therefore ‘transfer’ our unfinished business relating to either or both parents onto the therapist.  This too is my experience as I work in the transference and so recognise that how the client relates to me tells me something important about how they learnt to relate as a child and I can represent their mother just as easily as their father in the transference.

Therefore, whilst in some cases the sex of the therapist may matter, in most, it does not.  And I believe that has also been my clients’ experience over the years whereby they may have had a preference in working with a female, have ‘ended up with me’ and we have done excellent work.

 

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

 

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

 

Further reading by Mark Vahrmeyer

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Parental Alienation and the impact on children

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

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Do Psychotherapists Need to Love Their Clients?

Freud is an extraordinary and greatly misunderstood individual (and mental health practitioner).  Many believe we have ‘evolved’ beyond his ‘outdated’ theories and indeed, there are views and  theories of his that are no longer literally relevant. However, to dismiss him on this basis is myopic and superficial in that Freud’s writing has taken us to where we are today in the world of  psychotherapy; and so many of his theories are increasingly becoming ‘evidenced’ through technology and our understanding of brain plasticity and the need for relationship to grow a mind.  So, with this in mind, I shall now start my piece with a Freud quote: 

‘Psychoanalysis is in essence a cure through love’ Freud, S. (1906) correspondence with  Jung. 

What is love? 

The first question that must be considered in Freud’s statement is the question of what love is? 

Clearly Freud is not talking about Eros, or erotic love; he is referring to Agape, love towards fellow human beings. However, I believe Freud is saying something significantly more profound and more important: By using the terminology ‘love’ Freud is drawing a comparison to the role of the analyst (or psychotherapist) in the transference – the role of the parent who has let the child in the client down. 

Parents should love their children and most do. However, loving a child is complex as it means to allow and encourage that child to have their own experience – emotional and psychological – separate to the parent. It is about being able to encourage and tolerate difference and then celebrate it in own’s child. 

Children who have been let down – neglected, abused or abandoned – have learnt that their survival depends on ‘keeping their parent happy’ – they sacrifice their own separateness and own experience in order to hold on to a parent. This is not a child who is ‘loved’. But a child who is owned. 

Love therefore in Freud’s sense of the word is about true empathy – to be able to understand and accept another’s experience without becoming threatened by it, without collapsing and without colluding with it. And without sacrificing our own experience. 

Does loving a client mean accepting their behaviour? 

Behaviour, when driven unconsciously by effect (emotion) is termed ‘acting out’ and ‘acting out’ is mindless. Furthermore it is an attack on the therapy and an attack on the therapist. 

Much like a good parent will have empathy for a child’s fear of the dentist, or a child’s desire for sweets placed next to the till, this does not mean that the child gets what they want – the avoidance of the dental appointment or the indulgence of sweets. A ‘good enough’ parent is able to empathise with the child’s feelings but withstand their demands. In short, a parent’s job is to hold their child in mind and advocate for their best interests rather than the child’s self interests (or their  own self interests). 

Is Psychoanalysis in essence the same as a Person-Centred Approach? 

Now we have established what Freud probably means by love, we can consider whether the analytical approach is in essence the same as a person-centred approach – one of unconditional positive regard. Is this not love? 

To a point it is, however, in my view (and that of analytically minded clinicians) the person-centred approach leaves the whole idea of ‘the unconscious’ just there – in the unconscious: in other words it does not exist. What you see is what you get.

Without working with the unconscious and in the transference, a clinician cannot really ‘love’ their client as they are oblivious to the drives and projections that are paying out in the room – the meaning behind the strength of emotion from the client. And they remain oblivious to whom they represent for the client and thus where the loss or trauma resides relationally. 

An analytical clinician will work to understand whom the client is projecting onto them – the transference – and will work within the context of that to provide the client with a different experience of relationship 

Evicting the bad parent 

We all ‘internalise’ our parents – working models of how we experienced them. If this process of internalisation goes ‘well enough’ then we can draw on a solid sense of sense that is supportive of us taking up space in the world and in other relationships: we can bear our inner world However, if it goes awry somehow, then that working model can be punitive, critical and unsupportive and we avoid contact with our inner world at all costs. The process of analytical therapy is to ‘evict’ the bad  parent and offer the client an alternative object (person) to introject through the consistent therapeutic relationship. 

How to ‘love’ our clients 

Loving our clients is a hard thing to do not because they are unlikable or unlovable, but because it  means consistently offering the client a different experience of relationship that they will be unconsciously trying to sabotage in subtle ways. Freud also spoke of our fear of change and suggested that in order to mitigate against change, going forward we always seek to replicate the past. Abused and neglected children feel unconsciously ‘safe’ in abusive and neglectful relationships as then the ‘world makes sense’ and they can simply use their old defensive  mechanisms to carry on surviving. They also don’t need to feel vulnerable. 

Loving a client means holding appropriate boundaries, offering them support and understanding whilst resisting either being seduced or offended by attacks. And as with real life evictions, the internal parents will protest and fight back to stay put. 

Ultimately loving our clients means to hold them in mind in ways they never were – their best interest rather than self interests. 

 

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

 

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 –

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Online Relationship Counselling

There are many reasons why people seek out online relationship counselling and psychotherapy, from ongoing conflicts and communication challenges to infidelity, bereavement and grief, or family-related issues that are causing a rift. By working with a trained counsellor remotely from your own home, you’ll benefit from a confidential and safe space to discuss any issues, past or present, to help you improve your relationship.

What is Online Relationship Counselling and Psychotherapy?

While it may seem in the moment that your relationship is at breaking point, a trained psychotherapist can help you talk through your problems to help you find a solution and to see each other’s point of view. Many couples imagine that relationship counselling means sitting in a therapy room with a clinician, however, there is also the option to talk with a trained professional in the comfort of your own home with online sessions.

Our psychotherapists are trained to provide a supportive and non-judgemental environment to help you face any difficulty in your relationship. Though practically identical to face-to-face therapy, online therapy offers the option of receiving counselling or psychotherapy remotely through a secure platform for greater accessibility, convenience and approachability.

How Can Relationship Counselling or Psychotherapy Help My Relationship?

For some couples, just a few sessions of counselling can help them resolve their problems while for others, it’s the beginning of a long process of discovery in order to make a breakthrough. Your clinician will be able to help you in setting out expectations. Whether you’ve been struggling with the same argument for years or it’s a new issue that has arisen, a couple’s psychotherapist can help you work through the problem in a healthy way.

Communication is such a vital component of any relationship and finding new ways to talk through issues can help you move past rough patches and restore your relationship or amicably go your separate ways – an essential consideration where children are involved. Couple’s counselling or psychotherapy can be an incredibly rewarding experience that can make a marked di?erence to your partnership. Through choosing to work online, you can access to our highly skilled team from anywhere in the country.

Contact us today if you want to talk to an expert about your relationship or if you need any advice.

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


Online Therapy for Depression

Depression is like a whole-body illness that affects not just your mood and thoughts but also your physical self, such as your appetite and sleep patterns, and how you view yourself, your capabilities and your emotions.

The symptoms of this condition vary from person to person, as well as in severity, but they can range from a feeling of helplessness and sadness to anxiety, insomnia, a loss of appetite, irritability and even suicidal thoughts.

How Can Psychotherapy Help?

There are several types of treatment available for depression, but the most effective is talking therapy in the shape of counselling or psychotherapy. Depression can be thought of as a ‘stickiness’ related to unexpressed emotion. A clinician trained in working with depression will listen to you without judgement, in a confidential and safe space to offer you the support you need to work through the problems that are troubling you. They can offer suggestions of strategies to deal with your depression and techniques to help you during the darker times.

Online depression counselling and psychotherapy makes it easier to speak with a trained professional, with sessions held remotely to make them more convenient and accessible. Depression can often make tasks feel insurmountable, so being able to speak to someone from your own home can also make therapy more approachable for many people.

Self-acceptance is fundamental in overcoming the destructive thoughts and beliefs one holds about themselves when they are depressed. Psychotherapy can help you recover trust in yourself and develop a better relationship with yourself through being in a relationship with your therapist.

Seeing a counsellor or psychotherapist work through depression enables you to learn a new approach in expressing your thoughts and feelings in the presence of another. Our clinical team are skilled in helping people deal with negative thoughts and feelings, as well as in providing objective advice and guidance to help you overcome the challenges related to this condition.

If you’re feeling depressed or want to talk to someone about how you’re feeling, get in touch with our team today and talk to someone.

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


Online Anxiety Therapy

There are various symptoms of anxiety, including an overwhelming feeling of fear, panic or worry, as well as physical signs such as sweaty palms, dizziness and palpitations. For those struggling with an anxiety disorder, these feelings can occur on a frequent basis and are isolating and distressing.

Anxiety is a problem that can be exacerbated if stressors are allowed to build. It’s important to get help and support if you’re finding yourself struggling with anxious thoughts on a regular basis. By speaking to someone about what you’re dealing with, you can understand what’s causing the negative reactions to your thoughts to be better equipped to tackle them.

How Can Online Psychotherapy Help?

Anxiety can be debilitating for many people but having specialist support in the form of psychotherapy can be effective in helping relieve the worry associated with this condition and encourage recovery. Our trained therapists can help you develop effective coping strategies and resolve the issues that are causing anxiety in your life, as well as help you identify the triggers for your anxiety.

There can be various reasons why your anxiety has developed, from stressful work or school environments to difficult relationships, your health or social interactions. By talking through your issues and the causes for your anxiety, you can increase your self-awareness to manage your feelings and thoughts more effectively. Removing yourself from the situations that cause anxiety isn’t always possible but having an arsenal of techniques makes dealing with it easier, which can be a great comfort. And in a supportive and therapeutic relationship, you will no longer face your anxiety alone.

Online anxiety psychotherapy is just one form of treatment but talking to a trained professional can help you in many ways, from understanding your condition and what may be causing it, to learning techniques to deal with the symptoms. Online psychotherapy enables you to benefit from the advantages of face-to-face sessions but from the comfort of your home for a more convenient and accessible solution. It also ensures you have access to our highly skilled team from anywhere in the country.

If you want to discuss online anxiety counselling with us, contact us today or take a look at our practitioners.

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


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Why does the difference between counselling and psychotherapy matter?

What a difference a year makes. For all of us the world is an inconceivably different place to a year ago. Not only are we all living with greater uncertainty, we have all had to enormously adapt to living, socialising, relating working, and not least, having therapy in a different way.

Almost exactly a year ago I wrote a blog on entitled ‘The Difference Between Counselling and Psychotherapy’, which has received some traction. More recently, the age old question pertaining to the difference between these to related disciplines has come bursting forth through a collaborative project SCoPEd project which seeks to set out training requirements and practice standards for counselling and psychotherapy. This project is receiving a lot of attention
(accompanied by fierce criticism) by many in the ‘talking therapies’ field. I have no wish to get drawn into the intricacies and politics of the actual project but do firmly believe that from a client’s perspective, standardisation of training requirements and robust practice standards that differ between counsellors and psychotherapists can only be a good thing. More so, I believe that they are essential.

Many of my clients come to be after trying some form of ‘talk therapy’ which may or may not have been helpful. Many come because they are unclear about why they don’t feel better and have ‘stumbled’ across me and my practice via a search engine. Few really understand that there is a difference between counselling and psychotherapy and few understand what they may need and why that may be a psychotherapist.

The fact few understand this has nothing to do with the fact that there is a fundamental difference and put simply, the more I have trained and the more years of experience I have, the more cognisant I have become not only of the differences, but also of how to assess what someone needs and whether they are in fact suitable for therapy.

I have written extensively about the differences between psychotherapy and counselling in my blog a year ago and if you are interested, you can read them here. My blogs are aimed predominantly at lay people who may be considering entering into therapy, rather than at the counselling and psychotherapy community.

Why do clients need to understand the difference between counsellors and psychotherapists?           

At present the distinction (in the minds of many) is blurry. Many counsellors believe the two terms to be interchangeable and are thus aggrieved by any proposed framework that should distinguish between the two disciplines: most counsellors think they are psychotherapist; few psychotherapists consider themselves counsellors.
The distinction matters from a duty of care perspective. Deeper work with clients dealing with complex trauma, personality disturbance and psychiatric disorders requires an in-depth understanding of how to identify these issues and an assessment of our ability to work with such clients and the client’s ability to ‘make use’ of the therapy, their robustness.

Turning clients away

My practice is generally full as my work is long-term, however, when considering taking on a new client I undertake a clinical assessment of their suitability for therapy. I aim to answer the question: ‘can I help this person?’ It may seem counter-intuitive, however, I am far more likely to turn down clients pre- or post-assessment now than when I first started out as a counsellor.

Why? Because I now know what I do not know and where my limitations lie.

A GP will not undertake surgery as they have been trained in general practice. They can, however, recognise that a patient needs to see a specialist who can offer an expert opinion and in-depth complex treatment. A GP is invaluable precisely because they are aware of what they do and don’t know and work within their limitations.

This is the ethical responsibility that I believe all counsellors and psychotherapists would carry at the forefront of their minds, however, without training in formulating (our word for diagnosing) how can a clinician know what they don’t know? Herein lies the problem.

Do no harm

The Hippocratic Oath, subscribed to by medical professionals the world over applies to us too.  In trying to help (rescue, fix, therapise, relate to) a client, unless we are acutely aware of what we are dealing with, we can do more harm than good.

Is there a place for counselling?

Unequivocally yes. Counselling is enormously beneficial and most psychotherapists started their careers as counsellors in some capacity. Counselling is often all a client needs and it can bring about enormous change for many. However, it is not appropriate for more complex or serious relational or personality disturbances.

In turning clients way it is not solely or even frequently because their requirements lie beyond my abilities; I often suggest to prospective clients that counselling may be more appropriate for them, especially if they have no prior experience of ‘talking therapy’ and are wanting to work through a time-limited issue.

And beyond psychotherapy?

The clients I do turn away as their requirements lie either beyond my knowledge base or holding capacity, I do so from a position of ‘doing no harm’ and making an often tough ethical decision. It may be that that person requires psychiatric support but it may also be that their level of disturbance is best treated by a multi-disciplinary team. And then there is, of course, psychoanalysis.

Inaccessible for many – sadly as Freud saw Analysis as being something that should be accessible for the general population – provides something that psychotherapy cannot: the ability and framework within which to work at depth with powerful regression.

To summarise, the difference simply must be acknowledged and accepted between the professions for the safety and well-being of clients and patients. To do otherwise is plain hubris.

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

 

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

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Why psychotherapy sessions should end on time

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Psychiatry, Psychology and Psychodynamic Psychotherapy

I am aware that these terms often get confused, so will use this blog to offer some very brief definitions and distinctions. Full disclosure – I’m biased, the psychodynamic model is ‘my bag’, however it’s also really important to point out that, the research suggests a pretty equal efficacy between therapeutic approaches and that the working relationship with the therapist is more important than the particular model of therapy they practice. 

Psychiatry: – which isn’t a therapy but the branch of medicine that seeks to treat ‘mental disorders”. As its part of medicine, it seeks to take a scientific, biological view of the disorders and its main source of treatment is ‘medicine’ or psychiatric drugs, such as anti-depressants or anti-psychotics. These ‘disorders’ are seen primarily through the prism of chemical imbalances and this is what is known as biological Psychiatry.  However, within Psychiatry there are differences, for instance, – Social Psychiatry. Social psychiatry, challenges the traditional psychiatric view that mental illness is caused by abnormal thoughts and actions relating to biological imbalances and stresses the importance of social factors, such as relationships, and the wider contexts of a person’s life. 

Counselling Psychology:-A counselling psychologist will have first completed a degree in Psychology and then an additional counselling training. In theory their approach, or at least the ‘psychology part’,  will be based on theories resting on experiments and scientific deductions, for instance the British Psychological society states that “As a science psychology functions as both a thriving academic discipline and a vital professional practice, one dedicated to the study of human behaviour – and the thoughts, feelings, and motivations behind it – through observation, measurement, and testing, in order to form conclusions that are based on sound scientific methodology.”.

A critique of this would be around the critique of scientific methods, for instance A few years back, scientists at the biotechnology company Amgen set out to replicate 53 landmark studies that went on to be widely accepted as fact. They were able to replicate the findings of the original research only 11 percent of the time. This proves a general critique of science, which is that is inherently flawed as it is undertaken by humans and therefore always, although often subtly and perhaps unconsciously, driven by unconscious subjective and paradigmatic factors. 

 

Psychodynamic Psychotherapy

Johnathan Shedler, working in America, contrasts the psychiatric and psychodynamic approach, arguing that, “a psychiatric diagnosis alone is a poor and limiting way of understanding a person” as it, “fosters the fiction that we can treat emotional pain as encapsulated illness separate from the person having the pain.” 

In my experience many patients have adopted this split way of viewing themselves, it’s very seductive, the idea we are in control and can pick and choose between our emotions rather than having to surf whatever waves they may throw up,  this can appear comforting, however its isn’t because it’s a fallacy. A recent humorous Instagram, post suggests: – “1. Avoid emotional burnout by never experiencing emotions in the first place.” 

Shedler describes the difference between having therapy and having meaningful therapy; – If someone has had meaningful therapy, they will be able to describe the relationship with their therapist, what it was like and what they learnt about themselves, some patients can have had lots of therapy but not be able to describe these aspects as they and the therapist have seen therapy, as a “provider of techniques. “

A critique of Psychodynamic Psychotherapy is that it is often unfocused, that it has no clearly defined goals and no clear direction, which is a fair point but one that is an inherent part of a truly analytic approach. Barnaby Barratt, author of ‘Beyond Psychotherapy-Radical Psychoanalysis’,  defines Psychodynamics as relating to, “an understanding of the human condition that is non-manipulatively interested in the meaning of life’s events for the participant and one that is holistically interested in ‘mind, body and spirit’”, I.e. is interested in the dynamic interplay of these aspects of being human without taking sides, but simply in allowing the conflicts inherent in being human to be explored and brought to consciousness so that whatever uneasy peace may be possible, can be facilitated, and that folks in relation to being human in my opinion  is as good as it gets. 

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

Analytic Therapy for Addictions

Loss

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconscious

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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A Primary Task

This is second of eight short blogs exploring the elements of therapeutic change as proposed by Dr Sebastian Kramer.  Click here to read the first one – ‘A Desire to Change‘.

2.  A primary task, a goal . . .

When a client enters therapy they give us permission, to help them with an initial task or goal.  This goal may change throughout the therapy so it can be discussed and the ‘therapeutic sat nav’ can be reset. 

It is important that both of therapist and client understand and agree with what is being worked towards. 

We call it a ‘therapeutic contract’. It helps to keep our talking on subject and the last thing a therapist wants is for a client to walk out of the room thinking that the session had not been useful, that the conversation may have drifted around too many subjects or they had not been asked the questions they were hoping to be asked.  

In systemic psychotherapy it is not unusual for us to ask for feedback from our clients a little way into the session to help us understand if the session feels on track and useful so we can change direction to recalibrate the conversation.

When I was training I thought it was the therapist’s job to solve all of the client’s problems and dilemmas – this was an overwhelming and crippling thought.

I now understand that therapy can exist in chapters, in segments and in episodes.  You can move in and out of therapy with different goals.   

Therapy is an on-going dialogue with the therapist’s job being facilitate, encourage, cajole, challenge, question, celebrate and witness the reflection, insights and successes that our clients experience.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

A Desire to Change (part 1)

Covid 19 – Talking with children in uncertain times

Family Therapy for Beginners

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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A desire to change

One of my favourite papers is by Dr Sebastian Kraemer, called ‘Something Happens: Elements of Therapeutic Change’.  This blog helps break down what therapists and clients set out to do, as they sit together in a therapy room both hoping that change can be immobilised from a stuck situation.

This is first of eight short blogs exploring the eight elements of change identified as:

1. A desire to change

2. A primary task

3. A theory of mind and a method of treatment

4. Courage and honesty

5. A specific narrative

6. Neutrality and reflectiveness

7. A tradition

8. Something happens

A desire to change: As the client and therapist sit face to face in their first session progress has already begun  – the desire to change has been acknowledged and acted on.  The request for help to a therapist has been made and the therapist has accepted this. 

However long a therapist has been practicing – having collected skills, theories and techniques along the way – each new client brings a unique story and request for help.  They bring their stories of strength, courage and endurance alongside their stories of distress, confusion and pain.  Just turning up to the appointment is an act of bravery, it is our role as therapists to acknowledge and respect the clients vulnerability; walking alongside them as they take action to change.

On first meeting, many clients report that they have noticed shifts in their thinking, changes in behaviour and an increased sense of hopefulness that things can be different – this is before the first session.  This could possibly be a placebo effect or could be understood further in the context of the research around models of change.

In the early 1980’s Proschaska and DiClemete set out five stages of change. Upon arriving at their first session clients are already in transit between Stage Three and Stage Four 3 of this theory – monumental shifts in awareness and readiness have already taken place:

Stage One. Pre-contemplation – the ‘I’m not ready’ stage

I am unaware or under-aware of a problem and have not got plan to change – leave me alone.

Stage Two. Contemplation – the ‘I’m getting ready’ stage

I am aware I have a problem to address but do not have the motivation or commitment to change my behaviour as yet. – leave me alone but watch this space.

Stage Three. Preparation – the ‘I am ready’ stage  

I have researched and planned a way to change.and my initial goals are clear – no time to talk I’m busy!

Preparation is considered the most important stage of the model – relapse is considered to be 50 per more probable if the preparation stage is not undertaken

– ON YOUR FIRST SESSION YOU ARE HERE –

Stage Four. Action – the ‘I am implementing my plan’  

I am making changes to my behaviour, my environment and my choices. I have sought help in this process and am being encouraged to feel more hopeful about the future

Stage Five. Maintenance – ‘I have changed and I want to keep it that way’ stage.

Work and effort is still required to maintain positive changes and prevent relapse.

A desire for change is important to begin the work however sometimes it becomes clear change may bring difficulties and risks that had not been contemplated originally.  Resistance to the change may then come into play and the work takes a different turn as goals are reviewed.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

Covid 19 – Talking with children in uncertain times

Family Therapy for Beginners

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Why psychotherapy sessions should end on time

Boundaries are critical not only to a psychotherapeutic relationship, but, as many clients learn through therapy, are essential to healthy adult-to-adult relationships.

In a good psychotherapeutic relationship, there is a solid contract between client and therapist such that clients know what to expect and when.  And part of this knowing by the client is knowing what time the session ends; most psychotherapy sessions last for a ‘therapeutic hour’ or 50 minutes.

Door-stop moments

Every clinician has encountered what are known as ‘door-stop moments’ with clients – they happen in the moments leading up to the end of a session where a client suddenly blurts out something emotive and important that can throw the therapist and lead them to extend the session by some further minutes.

Unconsciously, door-stop moments have much significance and represent a relational process between the client and therapist.  Yes, the content may be important, however, why is it being brought into the room (and relationship) in the final moments?

The client may unconsciously want to control the session by ensuring their therapist has no time to explore the content in detail; they may wish to ‘leave’ something difficult with their therapist to hold for a week; and they may be testing whether the therapist will hold the boundaries.  Or all of the above and more.

On hiding an being found

Donald Winnicott, esteemed 20th Century British analyst famously said “it is a joy to be hidden, and a disaster not to be found”.  Winnicott was making reference to the children’s game of hide and seek, which, is only enjoyable if we imagine that someone is looking for us.  If the other game participants give up and leave, we are left hiding with nobody holding us in mind – a disaster.  In this quote, Winnicott is talking about many concepts, but amongst others he is making reference to boundaries and holding others in mind.

Even though in the game of hide and seek the winner triumphs by not being found, they paradoxically only win if the other(s) are still searching for them – the game therefore is profoundly relational and based on an agreed set of rules.

Psychotherapy is also relational at its core and based on a set of rules (boundaries).  One of these is that sessions end on time.  Clients will find all sorts of ways to ‘hide’ from their psychotherapist, however, this is only ‘joyful’ if they believe that they will be found (seen and contained).

When a client presents a door-stop moment to us, it cannot be allowed to derail the boundaries of the relationship or the rules of the game.  Otherwise the client gets what they think they want (more time) but feels omnipotent and thus unsafe with their psychotherapist – in other words, the client has hidden so well the psychotherapist has forgotten about them.

It is never about the client even though it seems it is

Extending a session due to a door-stop moment is never about the client’s needs and always about the psychotherapist’s.  The client relies on their psychotherapist to ‘hold them in mind’ and thus hold their best interests in mind.  It is the latter that gets lost when a session is extended.

How can it be in the psychotherapists interests to extend a session?

Unconsciously the psychotherapist has also ‘got lost’ and is unable to remain separate from the client’s needs.  They thus extend the session to try and ‘please’, or appease the client, which fundamentally is about avoiding the client’s anger’ rage and disappointment.  And the job of a psychotherapist is precisely to survive these feelings in their client and what it makes them feel.

Don’t become a psychotherapist if you want your clients to like you

Psychotherapy is only happening when a client feels either positive or negative feelings towards their psychotherapist (and vice-versa).  If the relationship is neutral, nothing is happening.

It is easy to bask in the glow of a client’s adoration but beware, a fall will come.  And so it should.  As psychotherapists we are not there to be liked – we are there to remain constant in the face of our client’s emotions.

And being constant means ending the session on time.

 

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

 

Further reading by Mark Vahrmeyer –

How being ordinary is increasingly extraordinary – On the role of narcissistic defences

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

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So what actually is a Psychologist?

It’s important to note that the term ‘psychologist’ is not actually a protected title.  So, anyone can technically call themselves a psychologist.  If someone claims to be a psychologist, then the question to ask is, what kind of psychologist are they, and perhaps more importantly, what qualifications do they have.

Undergraduate degrees may be undertaken as either a Bachelor of Science or of Arts.  Completing an undergraduate degree in psychology gives a good basic introduction to a wide range of psychological theories and applications, but not necessarily expertise in any one area.

The British Psychological Society describes psychology as:

‘the scientific study of the mind and how it dictates and influences our behaviour, from communication and memory to thought and emotion.  It’s about understanding what makes people tick and how this understanding can help us address many of the problems and issues in society today.’

There are many areas of both theory and application within psychology; health, educational, forensic, counselling, occupational, clinical, sports and exercise, and neuro.  Becoming qualified in one of these fields requires post-graduate study.

In the example of Clinical Psychology; the current route for training is a 3 year doctoral degree (after the undergraduate degree) which involves both university teaching days and days on placement with the NHS.  In order for someone to call themselves a Clinical Psychologist, they must have completed an approved training course, and be registered with the Health and Care Professions Council (HCPC).

The HCPC regulates all applied psychologists within the areas above. The below are protected titles, which means people can only use them if they have completed an approved training course and complete ongoing appropriate Continuing Professional Development.

  • Practitioner psychologist
  • Registered psychologist
  • Clinical psychologist
  • Forensic psychologist
  • Counselling psychologist
  • Health psychologist
  • Educational psychologist
  • Occupational psychologist
  • Sport and exercise psychologist

Any other titles, such as Media Psychologist, Celebrity Psychologist or TV Psychologist, such as are often seen in the media, say nothing about the qualifications or expertise of the individual.  Understandably this is often misunderstood by the public.  As a Clinical Psychologist it concerns me that people may put their trust in, or even pay for services delivered by, unqualified people.  In addition it is concerning that the reputation or credibility of the profession may be damaged by unqualified people providing a poor service.

It is a very confusing area, however, probably the most important thing to remember is if you are considering working with a psychologist in any of the fields above check that they are registered with the HCPC on www.hcpc-uk.org

 

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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Online Therapy

We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?

There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.

There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?

Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.

Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.

A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.

Here are a few points you might want to consider if you want to access therapy online:

  • You will need to have a good, stable internet connection for the duration of your session.
  • It is best to have a few connection options available – such as wifi and data, and a couple of different options of apps – such as Skype and Zoom, to allow for tech difficulties.
  • You need to be comfortable working online and familiar with the tech you are using. It’s a good idea to turn off any notifications for the duration of your session as these are very distracting when you are trying to work with your therapist.
  • You need to ensure that the location you are in is private and confidential.
  • You should check the credentials and qualifications of your therapist before you engage in any online therapy. There is a growing number of people setting up online as ‘therapists’ with little or no training. Make sure your therapist is registered with a professional body such as UKCP.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

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The Therapeutic Relationship and the Unconscious

Therapy is often referred to in terms of it being relational, or as a relationship, albeit a particular type of relationship, one that has very specific parameters, particularly around money, time, touch, and about whose inner life is there to be explored.

Despite this, in some ways, very one-way relationship, an awful lot of what goes on is a kind of relating. The therapist will encourage the client to speak as freely as possible and through a careful listening to the client’s words and to what is evoked in themselves, through this listening, they will try and relate as closely as possible to the clients experience and will feed this understanding back via their own comments, or interpretations.

What makes this different from other listening conversations, is that the therapists understanding and feedback will be influenced by the therapists training, specifically their own therapy and their learning of theories, which provide maps of mental structures and types of human experience and distress.

The therapist as well as listening to the stories, will also listen for patterns, for words, they will try and be attuned to what is going on emotionally for the client and also pay attention to the actions of therapy, to the how the client goes about relating to the therapist. When the therapist feels something useful has been understood, they will share this.

Sometimes this may not have been consciously known by the client, and this is why it can be useful. However, it can also be unnerving, as we like to believe we are the masters of our own houses, independent and not in need of the help of another.

Freud said there have been three great blows to man’s ego, the Copernican discovery that the solar system didn’t revolve around the earth, Darwin’s discovery that we are descended from animals, and share an essentially mammalian brain structure and Freuds own discovery that we have a dynamic unconscious, that the rational beings we like to believe ourselves to be is only one part of the story.

Part of this unconscious is the repressed unconscious, the place where we store the things we don’t want to know about ourselves, however these things are known at some level and we can expound a great deal of energy trying not to know them.

Getting to know and understand these parts of ourselves although often frightening to begin with, can actually be a huge relief as we come to know and accept these parts of ourselves, parts of ourselves that may seem like monsters under the bed and cast scary shadows but are usually essentially human characteristics.

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

A Nation Divided

Adolescence: the trials and tribulations

Does the male mid-life crisis exist?

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How do I choose a psychotherapist?

Deciding that you want or need psychological help can be a difficult position to arrive at.  Choosing the right practitioner to work with can feel like a daunting task with so many different fields of talk therapy, types of therapy and professional bodies overseeing the field.  This blog is a guide to helping you find your way to the right psychotherapist for you.

Counselling, psychotherapy or psychology?

Counselling, psychotherapy and psychology all broadly fall under the category of ‘talking therapy’.  They have much in common, yet are also very different.  I have previously written a piece on the difference between counselling and psychotherapy; the former being largely for shorter-term work and the latter being appropriate for deeper and long-term work on the personality.  We also have an in-depth page on psychology here so I shall not go into more detail about that here.

Depth of work

In choosing a psychotherapist, it can be helpful to have a sense of what it is you are seeking to gain from therapy.  Generally, psychotherapy is longer term than counselling and rather than working with one specific issue, is instead a relationship through which the client can work through relational patterns (with themselves and others), formed in childhood that they wish to change. Depth relational psychotherapy takes time – months to years – to understand and process relational, or attachment, losses. It is a commitment to a process of therapy and to oneself with sessions being as a minimum weekly, at the same time and on the same day each week.

Professional Body

There are a few professional bodies who offer voluntary registration to counsellors and psychotherapists – the BACP and UKCP. Whilst the BACP includes the ‘P’ for ‘psychotherapist in its acronym, the minimum training requirements of the BACP for someone to call themselves a psychotherapist are quite low. The UKCP, on the other hand requires all registered psychotherapists to undertake a minimum of four years of post-graduate training at an accredited training institution alongside a mental health placement and four years of personal therapy, before permitting applicants to join.  At Brighton and Hove Psychotherapy, all of our psychotherapists have trained at least to this standard and many far beyond.

Training

Psychotherapy training is long, challenging and requires the candidate to be in their own personal therapy throughout the training period.  Most training institutions are located in London, or further afield, and so a great deal of commitment is required to reach the necessary training standards. One of the main aspects that sets UKCP registered psychotherapists apart from counsellors is that they have been trained to ‘formulate’, which is another work for diagnose, or understand, more complex trauma and mental health issues.

First Appointment

If you have never previously been in therapy, then the prospect of the first appointment can be daunting. It is the job of your psychotherapist to set clear boundaries and create an environment that ‘feels safe, but not too safe’.  What does this mean?  Psychotherapy is about learning to tolerate difficult feelings and your psychotherapist is there to facilitate this process through their relationship with you.  They are not there to be liked, or to be your friend, as this would not be beneficial to you or to your process. If all goes well at the initial consultation then you and your psychotherapist may ‘contract’, or agree, to work together.  This means that they have assessed what work is required to facilitate change for you and you have decided that you are going to enter into an intimate relationship unlike one you have perhaps ever had before.

Length of Contract

How long is a piece of string?  Most psychotherapy can last for months or years, however little can be inferred from the duration.  For example, someone attending a year of therapy is not necessarily ‘healthier’ or ‘saner’ than someone who attends weekly for many years.  It is entirely dependent on the work required, how the client wishes to ‘use’ therapy and the relationship formed. Freud famously believed that therapy only begins when the client is no longer in a crisis.

Final Thoughts

Finding a good psychotherapist begins on paper but ends with a feeling, or a set of feelings.  As it is in the relationship that the unravelling of the past takes place, it is critical that as a client, you feel you can build a therapeutic relationship with your psychotherapist. The capacity to do this will hinge on their degree of training, clinical experience and therapeutic boundaries, as well as on it being a relationship that feels ‘safe enough’ – not too safe to not be challenging – within which the therapeutic process can unfold.  

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.

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Why does empathy matter?

When you begin therapy you enter into a particular (perhaps peculiar) type of relationship, one with well-defined boundaries and ethics. Beyond its method and structure, at the very heart of this relationship lies empathy.

As a therapist empathy means doing all you can to understand your client from inside their own experience. It requires an ability to communicate this understanding in ways that are sensitive, meaningful and useful, both verbal and non-verbal.

It is a powerful experience to feel understood, listened to, cared for and respected. Over time it can make it easier to have empathy for yourself, to take your own personal pain and suffering seriously, to judge it less, as trivial, stupid or simply a product of your own personal weakness.

When we begin to take our own struggles seriously, we gain access to another layer of empathy: compassion for the child that we were, often a child who made sense of what troubled them by deciding that there must be something wrong with them – that they were the problem. In the context of an authentic and empathic connection with another human being the shame or disgust or guilt that has become so entangled in our sense of self can begin to make way for new feelings. Sadness (perhaps) for what was lost and loving regard for the child who did the best they could at the time.  When there is more space in our imaginations for the reality of our own struggle, we can begin to see other people differently too. When we experience the power of feeling understood we may also experience greater internal space for new thoughts and feelings, both about ourselves and about others.

The therapist as the client

All psychotherapists have had their own experience of being a client in therapy. Sharing the most intimate and often painful moments of someone’s life is made possible when you have felt and expressed your own. It is not that as a therapist you become an expert on life (not even your own) but that having undergone your own therapy you will be more equipped with the clarity to differentiate your separate self and experience from that of another.  To understand whose feelings are whose and to have the versatility and flexibility to step into and out of another person’s shoes.

The circuitry of empathy

Empathy is a complex system of mutual cues and responses that regulates each persons experience of self and others. We observe this very clearly in parent/ infant interactions. How attuned a parent is to the (myriad/micro) communications of an infant will inform the infant’s reciprocal response to the parent.

It is not that in ideal world infants and young children would be perfectly attuned to at all times. Over-attunement can be stifling and intrusive. What’s more important is the experience of an ongoing relationship in which misunderstandings and mis-attunements can be repaired.

Emotional neglect and emotional intrusion are flip sides of the same coin. Anyone who has suffered either will have good reason to believe that they may never be understood.

As a therapist we cannot “know it all” for our clients, we cannot tell someone how it is they feel or what is true for them. What we can provide is an open-ended, respectful curiosity for our clients and a willingness to share in the important project of “getting it.”  Paying close attention to the unique form of connection that exists with each client means understanding empathy as a mutually influencing system. From this perspective, the communication of empathy becomes much more a mystery to engage with than a tool to master.

 

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

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