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The Therapeutic Relationship and the Unconscious

Freud believed personality and behaviour come from the unique interaction of conflicting psychological forces that operate on different levels of awareness: the preconscious, conscious and unconscious. He believed these play an important role in behaviour. During therapy, we tap into our unconscious mind to discover more.

How Therapy Works

Therapy is often referred to as a relationship. It’s an approach that focuses on the relationship between the therapist and client to work through their behavioural and psychological issues. During this relationship, the therapist will consider the client’s past and current relationships, their race, gender, sexuality and much more to ensure the client feels understood and revived.

The therapist will encourage the client to speak as freely and openly as possible and will listen to the client’s words, actions and behaviours to feed back their understanding or interpretations.

From the therapist’s training, they will be able to find patterns, words and emotions that arise for the client and how the client relates to them. When something useful has been understood by the therapist, they will share their findings.

Therapy and The Unconscious Mind

During therapy, therapists may be able to understand things without the client consciously knowing. This can be more helpful to the client; however, many find this unnerving. We assure you; this is essential in interpreting your emotions and behaviours effectively.

In our unconscious mind, there are repressed thoughts and memories and things we don’t want to know about ourselves. Although these things are known at a certain level, we use a great amount of energy trying not to know.

How We Can Help

During therapy, one of the things we will explore is the interplay between your conscious and unconscious mind. This may cause internal conflicts in the way you process thoughts and emotions. Getting to understand the unconscious parts of ourselves may be scary, but it can be a relief to know and accept these parts. Although you may think these are bad parts of yourself, they are usually normal human characteristics.

We will explore your inner conflicts and unexpressed or repressed emotions to more easily understand why they have become so ingrained.

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

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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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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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How to find a Therapist

When it comes to therapy, the therapist you choose can be the difference between getting the most out of your therapy and getting nothing out of your therapy. Having a therapist whom you feel comfortable opening up ensures you can talk about your issues in a safe space enabling you to overcome challenges faster.

Brett Kharr argues that there are countless types of therapies to choose from. And we think this reflects the consumerist age we live in which makes starting therapy more confusing.

Richard Chessick, a Psychoanalyst, writes that;

“It is the experience of the therapist’s personality and the encounter with the therapist as a human who is truly present, rather than any verbal exchange, that makes the fundamental difference in therapy. It forms a link, that brings the patient in consistently over years of treatment, even at times when the patient is very angry or upset.”

When starting therapy, it’s important to think about the type of therapy and the therapist you choose. Sometimes, you may feel comfortable with the first therapist you meet after carrying out some research online or acquiring a recommendation from a friend or family member. Other times, you may find it’s not a match at all.

Why Consultations Can Help

Consultations are a great way to see if you feel comfortable with a therapist, and we are all more than happy to do this for you. We would always advise our clients to be as open and honest as possible with the therapists they meet so they can gage their reaction first hand. In any situation where you feel uncomfortable, they may not be the best choice.

Make sure to think about your goals ahead of time so that you know from the first meeting what you are working towards. This can help you determine if the therapist is the right fit for you.

Be Honest

When Mark and Sam at Brighton & Hove Psychotherapy began their training, they remember one piece of advice on how to choose and get the most out of therapy:

“Make sure to give your therapist hell”.

The meaning of this statement is to be as brutally open and honest as possible during therapy. Especially when it comes to things you don’t want to say.

When meeting your therapist for the first time, it can be a strange feeling. You may find your therapist isn’t a good match for several reasons from feeling like you can’t open up to simply finding them annoying.

Therapists who have been through therapy themselves won’t take it personally. They know the importance of having a good connection for your own benefit. Being honest about why it isn’t a good match may even give the therapist something to reflect on and work on.

Where Do I Find Therapists?

At Brighton and Hove Psychotherapy, all our therapists are listed on our practitioner’s page. Here, you can find out more about each practitioner and the areas they specialise in. From here, you can contact them directly or get in touch with us to find out more.

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

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

Face to Face and Online Therapy Help Available Now

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The Contemporary Consulting Room

Following on from the post featuring Andrew Robinson’s photographs of the rooms at Brighton and Hove Psychotherapy, I want to think about the objects in the room in which therapy takes place.

“Both room and house are psychological diagrams that guide writers and poets in their analysis of intimacy.” (Bachelard, 1958/1994:38). This implies we have a tacit (a felt but not easy to express in words) understanding of the psychology of physical space. I suggest that the surroundings in which therapy happens are part of the therapy.

In contemporary psychotherapy there is a concern about the blurring of the boundary between the personal and professional. In the psychodynamic model if the therapist’s life comes too much into focus the client’s therapeutic potential can be compromised. It is a commonly held belief that therapy should ideally happen in a neutrally private room. However we would want to avoid any resemblance to anything cold, clinical or cell like. Freud is well known for his iconic rug covered couch and his large collection of figures that stood like a group of silent watchers in his consulting room.

A positive approach to the objects and disclosure can provide opportunities for working things through. Let’s think about books on display in the consulting room. A collection of psychotherapy books could be reassuring, showing that the therapist is well informed and takes their professional development seriously. If a client shows an interest in a particular book it can open up an area for exploration.

The impact of objects in the room can become important when a counsellor moves or there is a change in the room. Lapworth describes how when he introduced a sculpture into his consulting room, a client re-saw the room and noticed the books that had been in the room all along. When her attention was drawn to the books by the arrival of a new object, they resonated with her father and she talked about him for the first time (Lapworth, 2012:8).

Field notes the need for counsellors to take transitional objects with them, for example a rug on the floor. When she moved her consulting room a client was relieved to see the rug reappear in the new room. “We came to understand that it was symbolic of my perception of him: that I accepted him as he was; in his words ‘scruffy, imperfect, colourful and well travelled!’ ” (Field, 2007:174).

Therapists can use objects and images to support themselves in their work. A small sculpture or photograph with personal associations or special memories can help a therapist keep an open mind and feel connected with their own resources. Clients can sooth themselves through difficult times by finding reassurance when looking at familiar elements in the room.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

References

Bachelard, G. (1958/1994) The Poetics of Space.

Field, R. (2007) Working from home in independent practice.

Lapworth, P. (2011) Tales from the Therapy Room.

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An Interview with Mark Vahrmeyer – Viva Lewes March ’19

Mark Vahrmeyer was recently approached by Viva Lewes for an interview on ‘Mending the Mind.  Below is a scanned copy of the full interview:

 

Mark 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.

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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 Rogers is an Integrative Psychotherapeutic counsellor working with  individuals and couples in Hove.

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The Menopause: Women of a Certain Age

For many women in the 21st 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.

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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

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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

Further reading:

The therapy room

The role of the therapy room in the clinical frame

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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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Mutual Disappointment – Surviving a Long Term Relationship

At a recent clinical supervision session in Lewes, my supervisor and I were discussing the realities of being in a long-term relationship. By long-term, we were thinking about decades, rather than months or years, and in this context, we were together considering what individuals must accept about a long-term relationship and thus about themselves.

It is a relatively recent phenomenon in social and human development that we pair-bond for reasons of love (rather than status, wealth or lineage) and thanks to modern medicine and increased living standards, we live much longer than our recent ancestors. The former brings great expectations around what our relationship should offer us; the latter means that long-term relationships can last for many decades.

In working with couples, I often invite them to think about the purpose of their relationship. This may not sound romantic and idealistic. However, every human needs a purpose (generally multiple purposes) and every relationship requires a mutually held sense of purpose to bind the couple together. And with longevity and changes to social structure now meaning that the sole purpose has ceased to be to raise children, the objective of a romantic relationship is likely to change throughout the time the couple spend together. I will write more about the purpose of a relationship in the future. However, for now, let us return to the cheery topic of mutual disappointment.

There comes a point in most relationships where there is a realisation that the person we have chosen, the person we lusted after and loved – were willing to change the direction of our life for –  is simply not who we thought they were going to be. I don’t mean that we are struck, as is so often the case, with the shattering of a delusion when we see our idealised partner do something human for the first time; we must all go through that shift where lust wanes, and we accept our partner is a fellow human with his or her faults. No, mutual disappointment is something deeper. Perhaps it strikes when we realise on a more profound level that the person we picked, with whom we built a life and chose to have children, has not delivered us the life we had imagined. Thus, mutual disappointment is not about discovering that our newly acquired lover snores, or leaves the cap off the toothpaste. It is a reflection of our disappointment and mourning of how our imagined shared life with our partner simply is not the reality.

It all sounds terribly negative. However, I would suggest that mutual disappointment in a relationship need not necessarily lead to rupture and conflict, as it is, in fact, less about our partner and more about ourselves. We must come to terms with the reality of our lives and accept that many of our youthful dreams for ourselves, and the partner who would perhaps rescue us from mundanity, cannot be fulfilled. Nor should they.

We are all bombarded by celebrity lifestyles on a daily basis. Programmes abound promising instant stardom, wealth and fame, which judging by viewer ratings, have an almost manic appeal as vehicles that offer us a chance of being rescued from our lives, and thus death. But the vast majority of us slowly, often unconsciously, let go of many of the unrealistic dreams we once held for ourselves that protected us against the harshness of life. With that, have to accept our partners as fellow humans who have disappointed us, whom we have disappointed, and who themselves are disappointed with who they turned out to be.

Framed like this, holding mutual disappointment in a relationship, making sense of it and mourning it potentially offers an opportunity for a deepening of the reality of what the relationship actually is – a mirror through which to experience ourselves and a system in which we can be understood. That, or we can have a ‘mid-life crisis’, buy a Porsche, divorce our partner and keep on running from the inevitable –  how the passage of time and the knowledge of our own mortality brings with it disappointment of what could have been, but what was not.

If you would like support in navigating the complexities of your relationship in our modern world, please contact us to arrange a consultation with one of our Couple Psychotherapists in either Hove or Lewes.

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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Counselling and Psychotherapy – Differences

Two of the most frequent questions we get asked is are there any differences between counselling and psychotherapy and which do I need?

Well, one way of thinking about the difference is that counselling is more about having someone walk alongside you during a difficult time.  Sometimes this is all that’s needed – someone who is able to empathise, listen and be present with you as you find your way – for instance, after a bereavement.

Other people experience challenges in life as a result of more deep-rooted issues and patterns of relating that can leave them with low self-esteem, shame or depression, for example. This is where a trained clinical psychotherapist can be more helpful in navigating those issues.

Counselling therefore tends to be over a shorter period of time and deals with less complex issues than psychotherapy.

There are also significant differences in level of skill and training for counsellors and psychotherapists. Psychotherapists train for longer at a post-graduate level, have an in-depth understanding and experience of a range of mental health diagnosis and have had their own personal therapy.

Both Mark Vahrmeyer and Sam Jahara are UKCP registered psychotherapists, trained to work at depth with both individuals and couples.

If you are unsure about what you may need, get in touch with us and we will be pleased to refer you to the right clinician.

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The Value of Therapy Quantified

We live in an age where increasingly our value of anything comes down to money.  Even environmentalists are needing to show the value of ecosystems and specific species of animals, in order to put forward a robust case for conservation.  Little wonder then that the question of the value of counselling and psychotherapy in monetary terms raises its head from NHS commissioners through to money-conscious clients.

Until recently this has not been a simple question to answer.  Therapists know that therapy is valuable – whether directed towards specific behavioural change or as a process of self-enquiry and self-reflection.  However, quantifying the benefits in monetary terms has not always been that simple.  Sure, if a compulsive gambler stops gambling, the financial pay-off can be immediately visible, however, I would suggest that the benefits (financial and emotional) go much further than the savings made from avoiding the betting shop and breaking an addiction.

Well, research undertaken at the University of Warwick seems to be getting closer to quantifying the value of therapy, at least versus receiving direct financial reward and it turns out that psychological therapy is 32 times more valuable than money in increasing our well-being!

We all need money to meet our basic needs such as food, shelter, water etc. in order to survive – cue Maslow’s Hierarchy of Needs.  However, once our more basic needs have been met, additional money seems to have little to no correlation to happiness and well-being.  The research paper entitled ‘Money and Mental Health: The Cost of Alleviating Psychological Distress with Monetary Compensation versus Psychological Therapy’ suggests that in the developed world, despite huge economic gains and a political focus on economic growth during the past 50 years, national happiness has not increased.  In fact, quite the opposite: mental health seems to be deteriorating across the globe.

Through comparing 1,000’s of data sets of participants reporting on their happiness, the researchers looked into how happiness changed due to therapy compared to sudden increases in income such as through lottery wins or a jump in salary.  The results showed that a four-month course of therapy, equating to an investment of £800, led to an overall increase in well-being equivalent to a pay rise or windfall of £25,000.  In purely financial terms, therapy could be 32 times more effective at improving well-being pound-per-pound than money.

Interestingly, an additional point raised by the paper discusses how ineffective financial compensation is when dealing with trauma – e.g. the court system – and that psychological therapy could be a significantly more effective way of supporting people in overcoming their traumas.

So there we have it.  Therapy works.  Us therapists always knew this but now we are starting to get a grasp of how much it works in financial terms.

Link to research paper: http://www2.warwick.ac.uk/alumni/services/eportfolios/psrfbb/boycewood_hep_website_copy.pdf

Mark Vahrmeyer

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