Brighton and Hove Psychotherapy

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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 nonverbal.

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 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 other. 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 infants reciprocal response to the parent.

It is not that in an 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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Why does psychotherapy matter in the modern world?

On the face of it, a process that is long-term, happens at the same time, on the same day, each week, would seem to be in stark contrast to modern life.

We are promised, and expected to subscribe to, a world where our wants and needs can be met almost instantaneously, where we can have things exactly as we want them and everything – society, identity, gender and sexuality – is up to debate and can be changed. And changed and changed again.

Social media floods our senses with messages about how to be happy, grateful and fulfilled whilst espousing ‘hacks’ and quick fixes for depression, anxiety and every human condition in between.

The shelves in book shops buckle under the weight of the latest ‘self-help’ guru or fad and life coaching promises tangible change in a few sessions. And if it does not work for us? Well, then we are simply not trying hard enough.

Psychotherapy subscribes to, and offers, none of the above.

It is not quick, it is not an experience where you can get immediate gratification or a relationship that will affirm you as always being right. It is something very different.

In many ways, psychotherapy is an antidote to all of the above. It is about learning through relationship to be in relationship with ourselves.

Through relationships we begin to see ourselves through the separate eyes of another who is compassionate, boundaried and can withstand us; nobody should become a psychotherapist if they want to be loved.

Psychotherapy is the opposite of Instagram and Facebook – it is about deeply knowing and accepting who we are and learning to live a meaningful live of substance and depth: it is about learning to be ordinary. And it is about accepting the realities of life: that life is unfair, often hard and that the only substance is to be found in relationship.

Car crashes

Car crashes have a nasty habit of drawing our attention. And then, of course, the likely outcome is another crash. When we see a car crash it takes a mature mind and person to not join it; to keep their eyes on the road and focus on their own experience.

The modern world is comprised of ever more car crashes – not necessarily in the literal sense, but in the many dramas (real and streamed to us) that draw our attention away from the road. Psychotherapy is an antidote to this – helping people steer a steady course through the chaos and drama and remaining in relationship to themselves. In this sense, psychotherapy matters very much in the modern world.

Mark Vahrmeyer is UKCP Registered and is one of the Brighton & Hove Psychotherapy Co-founders.  He 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 our Lewes and Brighton & Hove Practices.

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