Counselling Archives | Brighton and Hove Psychotherapy

February 11, 2019 by Brighton & Hove Psychotherapy Leave a Comment

A Couple State of Mind

This is the first in a series of blog posts about couples therapy. In this post I want to talk about what Mary Morgan from Tavistock Relationships calls a ‘couple state of mind’.

Why if our partner is ‘right’ for us don’t they understand us completely? There are limits to how much we can ever fully understand or know another person. As we move from away from the early stages of being in love or infatuation it can be disappointing when our partner doesn’t live up to our expectations, ‘You aren’t the person I married!” or “You’ve changed since we first met.”. What we mean is “You haven’t become the partner I imagined you would be.”

When we become a couple we are two separate people with our own ideas of what it means to be a couple and what each of us should be prepared to offer and can expect to receive. These ideas are likely to be based on how we experienced our parents’ or carers’ relating to each other, as well as the community and culture we grew up in. As a couple we will inevitably be sharing psychic space as well as physical space, the tension between wanting to be held and close and wanting our own space and freedom can be challenging.

At times we might find our sense of our self and our reality is threatened by our partner’s version of what is happening. For example, we might feel our frequent phone calls and texts show how attentive and caring we are but our partner may feel overwhelmed and claustrophobic. One of us may feel it is important to regularly spend time apart to not become tired of each other, but this might make our partner might feel rejected and isolated. These polarised positions highlight the difficulties of holding two perspectives on what it means to be in a couple relationship.

Couples coming to therapy often do not have a sense of themselves as a couple. Thinking about what your relationship needs is not the same as thinking about what you need. This may sound obvious but it is easy to lose sight of when you are finding life is a struggle. One role for the couples therapist is to help partners contain or tolerate their differences long enough to create a shared space to think, a couple state of mind. A couple state of mind can be understood as a third perspective, a position which gives a couple a chance to step back, look at their relationship and explore what they could hope for and create together.

Couples therapy also gives each of us the chance to see our partner relating to the therapist, showing ways that two people can think together in a close and trusting way. Seeing someone as familiar as your partner connecting with another person can be surprising, they can be revealed in a different light. The therapist offers a safe and supportive environment where a couple can think together and explore a couple state of mind, to see if they can continue to develop as individuals whilst enjoying the closeness and intimacy of being a couple.

Morgan, M. (2018) A Couple State of Mind: Psychoanalysis of Couples and the Tavistock Relationships Model. London. Routledge.

Angela Betteridge is a couple and family therapist working at our private practice in Lewes. She is available to see adolescents individually or with parents /carers.

March 12, 2018 by Brighton & Hove Psychotherapy Leave a Comment

The Menopause: Women of a Certain Age

For many women in the 21^st century, the menopause leads to a sense of freedom, independence and creativity. Of course, I want to celebrate this, but I also want to talk about less welcome aspects. Culturally, the menopause is still somewhat feared and is something of a taboo. It is also open to derision and often referred to with euphemisms or jokes.

Sharing the experience

Things might be changing. Recently, a few women celebrities have used the media to share their physical and mental struggles through several years of the menopause. I believe that sharing these experiences publicly is especially important in a culture that does not take the reality of the menopause seriously. Think about the photographs of post-menopausal celebrities on the front pages of women’s magazines, looking glamorous with their obligatory bobbed and highlighted hair, subtle yet sexy make-up and carefully co-ordinated outfits. I do not want to dismiss women’s aspirations for wanting to look good at any age, but the demands for women to look sexually attractive can be punitive. The hostility Mary Beard received for appearing on television apparently unmade-up and with her hair worn long and grey is telling.

Physical symptoms and emotional wellbeing

Physiologically, the menopause is the cessation of menstruation and is medically defined as one year with no bleeding. Other physical symptoms include hot flushes, night sweats and insomnia, dry skin and hair and weight gain. We are likely to feel less sexually attractive, whatever our sexual orientation. There may be a drop in libido and physical changes in the vagina can make sex difficult or painful.

Fortunately, there are hormonal and medical interventions that can treat these physical symptoms with some, but not complete, success. Along with the physical changes in our bodies, psychological symptoms related to the menopause can affect our emotional well-being and leave us feeling vulnerable. Changes in how we experience ourselves, such as being unusually grumpy or depressed, voicing our frustrations or losing our temper can be disconcerting and make us wonder if we are going a bit crazy. This is especially so in a culture where women are rewarded for being nice, kind and caring.

The menopause, life events and relationships

The physiological and psychological effects of the menopause coincide with inevitable life events for women in their 40s and 50s. These include decreasing fertility and the end of child bearing or the hope of ever giving birth. In an age of increased life expectancy, the hope of having time in later to do what we have always wanted may vanish as we see ageing parents need care and support. It is also a stage in life when children leave home, another kind of painful loss that can throw the focus onto the dissatisfactions of a marriage or partnership. Long-held resentments towards a partner can be a factor in a lack of sexual desire. If both partners feel less interested in sex, a less active sex life is part of growing older together. However, clinical research tells us that a decrease or cessation of sexual desire and sexual activity is one of the most pressing and distressing concerns for menopausal women (Kolod 2009). It is probably the most difficult to talk about because of a sense of shame and a feeling the situation is hopeless. Depression is an understandable result. For women not in relationships or without children, or affectionate children, the menopause may be an acute reminder of the lack of an intimate or physically loving relationship.

How counselling and psychotherapy can help

Exploring these questions in a safe and supportive environment is a chance to think about and express the experience of the menopause without judgement. In this setting, losses, regrets and unrealised dreams can be grieved without recrimination. Working with a counsellor or psychotherapist can help us come to terms with these physical and social changes and lessen the emotional distress and negative impact on daily life. It is an opportunity to look at what getting older means for us and the choices and freedoms we have to live our own futures.

Reference: Susan Kolod (2009) Menopause and Sexuality, Contemporary Psychoanalysis, 45:1, 26-43, DOI: 10.1080/00107530.2009.10745985

Angela Rogers is an Integrative Psychotherapeutic Counsellor working with individuals in Lewes and Hove.

January 15, 2018 by Brighton & Hove Psychotherapy Leave a Comment

Psychotherapy supervision

The relationship between a psychotherapist and their supervisor is a very important one. Supervision is a vital place to reflect on clinical dilemmas, talk about professional issues and learn from someone more experienced. It can also be a self-care exercise. It feels good to talk to a trusted colleague about our work in a confidential setting. As I learn and reflect more on psychotherapy supervision, it has made me think about the supervision I’ve received throughout my career so far. During a recent group discussion with other professionals, we asked ourselves, “What constitutes good supervision?”

From my own learning and experience, including trial and error with supervisors who did not meet my needs, I thought about the importance of the following elements in supervision:

Education
Ethics
Political and social awareness
Relationship to power and authority
Self-awareness
Supervisor/therapist compatibility
Theoretical and philosophical values
Trust

Education

I want to be able to learn from my supervisor and absorb the knowledge of someone more experienced who will positively inform the work I do. Therefore, I have chosen to work with supervisors who keep up to date with the latest research and enjoy both learning and developing others.

The way supervisor and supervisee think together is vital for a productive relationship. This doesn’t mean always agreeing with one another, but having a strong alliance where difficult issues can be discussed and resolved.

Ethics

Ethics and client safety is paramount to the work we do. Therefore, an ethical supervisor needs to be able to explore, question and reflect honestly with their supervisee whilst always holding the client’s wellbeing and safety in mind.

Political and Social Awareness

We all exist in a social, political and cultural context. Therefore, this surely needs to be a part of supervision. Like in psychotherapy, a politically and socially aware therapist and supervisor will think about the place in society of their client and supervisee through their culture, sexuality, gender, age, class, ability and relationship to their identity.

Relationship to Power and Authority

This takes me to the supervisor’s relationship to power and authority and how they use, or potentially abuse, their role. A supervisor needs to hold their authority and personal power in a way that acknowledges the power imbalance in the supervisory relationship, whilst being open to being challenged and learning from others. Granted, this is a fine balance to strike and one which is entirely possible to hold if the supervisor him/herself is willing to have an ongoing enquiring relationship to their power and authority and be honest with themselves in these areas.

Self-awareness

This relates to the point above. For a practitioner to be able to supervise others in an ethical way, they need to practice what they preach. Senior practitioners can fall into the trap of thinking they know it all and don’t need to be professionally supervised or have therapy. In my opinion, this attitude can lead to a fall in professional standards, and even to professional negligence or malpractice.

Supervisor/therapist compatibility

Lack of compatibility between supervisor and therapist can have significant consequences for career development. Often, trainee therapists end up with a supervisor who is allocated to them, rather than actively choosing the right practitioner for them. As a trainee therapist, this experience led me to staying in supervision with an allocated supervisor for way longer than I should have. In the end I left feeling resentful and frustrated with the lack of compatibility between us in theoretical approach and professional direction. My learning had stalled and was hungry for someone that could help me grow professionally. I was lucky to then find the right person from whom I learnt immensely as a professional.

Theoretical and philosophical values

I believe that supervisor and supervisee need to be on the same page on the fundamental basics of what constitutes effective psychotherapy or counselling. Also, on the level of training and skill needed to offer an ethical and professional service which is of sound therapeutic value to the client.

Trust

Arguably, without trust there is no relationship which can withstand the challenges of this key professional alliance. The supervisor’s role is, in my opinion, the most important support system of a clinician. Hence, there needs to be enough trust for the therapist to be open and honest, and feel able to navigate through difficult issues with their supervisor. Both are required to acknowledge and respect that mutual trust is vital for the benefit of all involved: supervisor, supervisee and, ultimately, the client.

Sam Jahara is a UKCP registered psychotherapist, certified transactional analyst and clinical supervisor. She works with clients and supervisees in Hove and Lewes.

Further reading

Clinical Supervision

Self Care 101 for Therapists

November 20, 2017 by Brighton & Hove Psychotherapy Leave a Comment

Therapists’ rooms

Andrew Robinson, an MA Photography student from the University of Brighton, recently visited our Hove clinic to photograph our rooms for a project around the therapist’s chair. We are delighted to be able to share some of Andrew’s images on our blog. His artist’s statement can be found below. Andrew can be contacted via baronbouchard@hotmail.com.

In 1938 Sigmund Freud came to Great Britain, exiled from Nazi Austria. Amongst the possessions rescued from Vienna was his famous couch, which still resides in his home in Hampstead.

In the modern therapist’s room, the décor is bland, but the room is a place of trauma and heightened emotion.

The chairs are a site of trauma, of a fleeting intense ideal relationship that is secure and completely private. The relationship only exists in the space of that room. At the end of each session, a parting occurs that presages the end of the relationship for ever – the end of the therapy. The chairs then stand empty.

Sometimes that relationship is strained, awkward, confused. Sometimes it is concurrent. Sometimes only the client struggles. The only thing that matters in the room is the relationship between the people who use the chairs, in a room that has no other function.

Andrew Robinson

How does counselling or psychotherapy work?

I have written in depth about the differences in counselling and psychotherapy – the work and the training of the clinician. So, for the sake of this blog, I will treat the terms as interchangeable, even though they employ vastly differing depths of work and skill.

How does counselling work? This question often comes up when we are contacted by people who know they need some help, but are unclear how “talking to a stranger” can help them.

Irrespective of a therapist’s modality of training (how a therapist works) – fundamentally, the success of the work is dependent on the quality of the therapeutic relationship and on how the therapist works within this relationship. The latter is extremely important and is often overlooked by less qualified therapists. More on this shortly.

What is the Therapeutic Relationship?

A relationship with your counsellor or psychotherapist is a unique relationship. In the early stages, it may feel a little odd. It is a relationship based on clear boundaries. You know when and where you will meet. You know where you will be sitting. You know that you will not go for a coffee with your therapist after the session. It is also a very intimate relationship where you will, in time, risk sharing thoughts, feelings and memories that are painful and difficult. You might not have shared these thoughts with anyone else before. Paradoxically, it is the boundaried nature of the therapeutic relationship that makes intimacy safe and possible, at least, with time.

So talking with a counsellor or psychotherapist is safe?

Yes and no. Safety in the shape of boundaries is important, indeed, it is vital. However, therapy should not be too safe. For therapy to be effective, it needs to feel safe enough (which is part of building that therapeutic relationship), meaning that the therapist’s role is to challenge appropriately from within the relationship.

Is it Simply Talking?

It may look like that at first glance, but significantly more is going on. Therapists listen to the content of what the client brings, but perhaps more importantly they listen for the feelings behind the content. This is what makes therapy an intimate process, as we allow our vulnerability to be seen by another and validated.

Grieving

Talking is a way of giving shape, form and understanding to experiences. Through language, previous unprocessed experiences can be processed. I often think of the example of Eskimos and their 50 words for snow. Leaving aside whether this is completely accurate, the principle stands; the Inuit people of North America have far more words for the different types of snow than the average British person. These differentiations in the types of snow enable the Inuit people to make sense of their surroundings and navigate safely.

By giving shape and form to our losses through language, we can start to process them and grieve.

Working in the Relationship

Returning to the concept of working in the relationship, this is where the skill of a good counsellor or psychotherapist comes into its own. It means to form an authentic relationship with the client; to experience our own emotions in relation to the client and pick through what is theirs, what they are evoking in us and what is simply ours. This is often summed up as working in the transference (see blog on transference). It is a subtle, complex and ultimately transformative way of working whereby the therapist helps the client give shape, form and language to their losses which are played out in the relationship between the therapist and client: what remains unresolved in us is destined to be repeated.

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

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