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Online Therapy In the Press

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Is Happiness the Opposite of Depression?

It’s not a secret that most people presenting for therapy come with symptoms of depression or anxiety and in many cases both – more about that later.

And it is also not uncommon for people unfamiliar with psychotherapy to simply want to be ‘happier’.  After all, don’t we all on some level wish to be happier?

What is depression?

Depression is a word that has become part of daily vernacular.  People often will use it to describe feelings of prolonged sadness as in ‘I have felt really depressed lately’; people will use it to describe feelings that are actually grief and it also it is also a medical diagnosis for which medication is prescribed.

In my view as an analytically informed psychotherapist, depression is a state of inner ‘deadness’.  It is heavy and dulls down life so that very little seems to have any meaning at all.  In this sense it therefore would seem to be the opposite state of happiness, however, this is too shallow and reductionist an interpretation and limits further thinking around questions of meaning and purpose.

Is psychotherapy about making me happy?

Happiness is an enjoyable feeling but it is just that – a feeling – and feelings are fleeting in that they come and go.  The key to this sentence is that feelings ‘come and go’, or at least, they should.

Psychotherapy is about many things but not least about learning to listen to our feelings and then to think about those feelings.  Neither thinking nor feeling can, on their own, guide us through life.

If we rely solely on our feelings as our navigation system, then we are prone to be reactive and can confuse feeling states that belong in the past, with events occurring in the present.

Conversely, to rely solely on thinking renders us unable to access our inner world and unable to understand the inner worlds, and thus the experience, of others; we become in essence like a version of Star Trek’s Dr. Spock.

Psychotherapy is not about making people happy – in fact, the process of going through open-ended therapy is one that can be immensely difficult and at times painful.  So why do it?  Because it is only through grieving what we have either lost or never had, and then learning to navigate by listening to our emotional world – our deepest desires and wants – that we can start to lead a fulfilling life.  Fulfilled lives should include moments of happiness (I hope many) but most importantly they bring meaning and purpose, which is far more valuable than some fantasy notion of perpetual happiness.

Why depression and anxiety are two sides of the same coin

I stated earlier that many patients/clients present for therapy with symptoms of anxiety and or depression – why is this?  On the face of it depression – a state of deadness, and anxiety – a state of agitation, seem very far removed from each other.  However, both originate from the same cause: the inability of feel alive in the world.

Feeling alive in the world is arguably what a successful outcome of psychotherapy should be – again, not to be confused with being happy.  Feeling alive is being able to feel and to navigate those feelings and make sense of them as signals telling us something important.  Navigating ‘in the world’ is the next step, which is taking those signals, understanding them and converting them into action in the world as it is presented to us.

People who cannot really feel and are too fearful or limited to bring their desires into the world and into their relationships, become stuck and will likely oscillate between depression and anxiety.

Is there an opposite to depression?

I hope that it is now clear that the opposite of depression is aliveness and that aliveness is defined by being in touch with both our inner world, the world of feeling and emotion, and our outer world, finding a sense of purpose and meaning in our community based on what we desire.

‘In our dreams we can have our eggs cooked exactly how we want them.’

Anna Freud, Sigmund Freud’s daughter, and an enormously influential psychoanalyst in her own right, used the above expression to talk about the maturity and courage it takes to take a desire or fantasy (the idea of a plate of eggs) and risk turning that into reality.  Anna’s point was that once we turn a desire into reality it will not be as we expected and so we must tolerate that – ie. once we cook we eggs we have imagined, they will always turn out slightly differently to how we imagined.  They may exceed expectations, they may disappoint, but however they turn out, they will differ to our idea of them.  And so it is with all of our desires: we bring them into the world and we learn to accept that once we set them free in reality we will, to some extent, lose control of them.  However, coming back to Anna Freud, she would argue that a plate a of real eggs is always superior to a fantasy as at least we can actually eat them!

Being in the world, and thus feeling alive, is about breaking eggs and finding satisfaction in the outcome even if it differs from what we expected. This is the opposite of depression.

 

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

Are People with Mental Health Problems Violent?

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

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Loneliness and CBT

People feel lonely for a wide range of reasons. Loneliness can be linked to mental health difficulties such as depression, anxiety, social anxiety, perfectionism, low self esteem or eating disorders. It can also be linked to autism, loss, difficulties disclosing, early adulthood, elderly. This is not an exhaustive list but illustrates how many factors can be linked to the problem of loneliness.

Loneliness is the perceived discrepancy between what we want and what we’ve got, a mismatch between actual and desired social situation, a lack of meaningful relationships. Social isolation doesn’t have to equal loneliness. We can be alone without feeling lonely.

Triggers to feeling lonely can be internal psychological factors, such as attitudes to participating in social interaction / having a negative interpersonal appraisal, e.g. other people don’t like me; or external factors, such as bereavement or living far away from friends and family. These factors evoke an emotional response such as anxiety or sadness
and can lead to counter productive behaviour such as avoidance and a decrease in valued social contact or unhelpful cognitive processes in the social domain, e.g. self focused attention or hypervigilance to rejection. This then impacts on our perception and our interpretation of our relationships / social situations and can inadvertently become a
perpetuating cycle of loneliness.

Social media also has a big impact on loneliness, particularly in early adulthood. People share and post what they want us to see and we can end up comparing ourselves to others. The pandemic too has had an impact on loneliness. Spending less time with friends and family, self isolating and shielding are all contributory factors to feeling lonely. If we struggle with technology this too may play a part.

So how do we change things? In CBT we look at four domains: the individual, their relationships, social relations and the community. In terms of strategies behavioural activation is key with a focus on increasing the amount of social interaction, social contact and social networks. We can explore values and once we have identified these set goals to
help meet where the person wants to be in their values. We can introduce and identify unhelpful thought patterns and beliefs, and learn techniques to restructure these. We can learn strategies to reduce rumination and use behavioural experiments to make changes and gather information, e.g. finding out what happens if you do disclose and share with others. Additionally whilst engaging in behavioural activation we can practise exposure
whilst reducing safety behaviours.

Everyone is different and because loneliness can be for many different reasons there is no one size fits all. Other strategies may also be used, such as social skills and communication training, mindfulness, mapping social opportunities, emotional awareness and psycho-education.

To address loneliness in older adults Age UK and the befriending service, such as Silverline, can be a great resource. Age UK offer all sorts such as social activities, lunch clubs, IT Training, transport, day centres. Younger adults may benefit from Meet Up groups, Young Minds or The Mix.

Reaching out, connecting with others and using the supports that are available to us are fundamental in combatting loneliness. Remember we all feel lonely at times in our lives.

 

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults.  Rebecca is available at our Brighton and Hove Practice.

 

To enquire about psychotherapy sessions with Rebecca Mead, please contact her here, or to view our full clinical team, please click here.

 

Further reading by Rebecca Mead –

Is that a fact or an opinion? 

As we come out of lockdown, will a number of us be feeling socially anxious?

New Year’s Resolutions

Making Changes

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Demystifying Mental Health Issues

In the last few years there has been increased awareness of mental health issues in the media, way before the pandemic hit. Mental health professionals are seeing a growing mental health epidemic which has become significantly worse due to the human and financial cost of Covid-19, prolonged lockdowns, and a general shift in how people live, work and study. Nowadays, most of us know someone with a mental health issue or have experienced it ourselves.

Mental Health Issues are Human Issues 

The language used in the mainstream media to describe mental health does not adequately portray the issues people present with in therapy.  Terms such as trauma, anxiety and depression are often overused and do not describe their full meaning. Most of us experience fear, grief, sadness, and fluctuation in emotions. Whether we choose to acknowledge it or not, most of us have been through a challenging life event(s) or loss(es) with significant emotional and psychological impact.

Anxiety and Depression – An Emotional Accumulation 

I often hear people say that they or someone else “suffers with” anxiety or depression, or “has a mental health issue”. My first thought is: what does this mean? Though these terms have been fed to us through both clinicians and the media, I believe there are much better ways of describing someone’s experience in a less diagnostic, medical and all-encompassing way. 

Although some of us may say “I feel anxious” or “I feel depressed”, anxiety and depression are not actual feelings but a cluster or accumulation of many things. Feelings and emotions when undealt with (supressed) and poorly understood, can result in what we currently describe as depression or anxiety. 

For instance, a prolonged period of low mood which we call depression can ensue as a response to anything from prolonged grief to suppressed anger, feelings of powerlessness and helplessness, just to name a few. Depression can range from low mood to intense depressive episodes, depending on cause and other psychological and biological factors. 

A prolonged or chronic state of high alert resulting in unpleasant feelings of fear or dread which we call anxiety, often manifests when we are responding internally to a certain situation that we perceive as a threat of some description, either actual or imagined. Like depression, anxiety symptoms range from generalised anxiety to panic disorder, depending on the level of accumulation of emotions, life circumstances, personal resilience, previous trauma, etc. 

Finally, our mood is also impacted by environmental and physiological factors such as sleep, hormones, mood altering substances such as caffeine, alcohol and drugs (illegal or prescribed), exercise, fresh air and sunshine, screen time, etc.

The Role of Psychotherapy

Is to help people make sense of why they feel the way they do. To understand what is behind the symptoms that people label as anxiety or depression because they do not know what they are experiencing and why. Uncovering the ‘why’ is a big part of the process of getting better – the more we know why, the more we know ourselves.

Elsewhere on this website we list the issues that people commonly seek therapy for. Anyone who comes to therapy seeking help with a particular issue or issues, also brings with them a rich context and personal history. Making links between symptoms and experience (past and present) is an essential part of understanding, accepting and therefore overcoming some of the barriers we face in feeling mentally well and more at ease with ourselves. 

 

Sam Jahara is a UKCP Registered Psychotherapist and Clinical Supervisor and Executive Coach. She works with individuals in Hove and  Lewes.

 

Further reading by Sam Jahara

Women and Anger

Why all therapists and mental health professionals need therapy now more than ever

Fear and hope in the time of Covid – part 2

The Pandemic and the Emerging Mental Health Epidemic

What shapes us?

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Out of sight, out of mind

Available entertainment over the recent end of year break included the chance to laugh at the prospect of us all being killed. The climate crisis satire, ‘Don’t Look Up’ presented a mirror of our times, with scientists struggling to communicate imminent planetary annihilation by comet to a disbelieving public.

This new year sees the 60th anniversary of Rachel Carson’s landmark environmental work, Silent Spring. Her ‘fable for tomorrow’ begins with a stark picture of a rural American town that has died, its people taken ill, its farm animals barren, its insect life no more and all birdsong silenced. Recognizing the widespread harm caused by indiscriminate use of highly toxic insecticides, her book inspired an emerging environmental protest movement, leading to stricter regulation and a new awareness of how human activity was damaging the natural world.

Separated by sixty years of change, what strikes me most about both these works of warning is they seek to call attention to signals in the environment others have missed – or simply cannot see – and each insists these signals have meanings, with implications for the need to take action for purposeful change.

Not seeing the bigger things

In the same decade that Carson was warning of environmental collapse, a pioneering psychiatrist turned her attention to another neglected area of human experience. Conducting over two hundred interviews with dying hospital patients, Elizabeth Kübler-Ross gave moving shape to their stories with a new theory of how we cope with loss.

In her equally ground breaking publication, On Death And Dying, she proposed five separate stages of coping: denial, anger, bargaining, depression and acceptance. Although later critiqued for proposing a linear ‘stage’ process to change, her assertion that our primary response to loss is ‘denial’ holds truest for me.

Although now commonplace to hear talk of someone being ‘in denial’, this can often sound critical, as though there were something dysfunctional about this deeply human response.

For Kübler-Ross the denial she encountered in her patient interviews struck her as a ‘healthy way of dealing with the uncomfortable and painful’.

I think our human propensity for denial is testament to our powerful capacity to use our brilliant imaginations for self-protection. When faced with the intolerable, we unconsciously block out what threatens our fundamental sense of security.

Not seeing the smaller things

Because denial has acquired this shade of critical meaning, I find a more psychotherapeutic term, the process of ‘discounting’, much more helpful to use.

This theory emerged from a school of thinking in Transactional Analysis in the 1970s, when it was recognised that patients struggling to manage their lives and relationships had one big thing in common: they each engaged in ‘discounting’, whereby their thoughts and behaviours were often based on being plainly unaware of significant aspects of themselves, other people or wider reality.

Just as we can deny our larger reality in a life crisis I believe that an unconscious unawareness of smaller things is part of our day to day human experience. We all regularly discount some aspect of ourselves, of others and the world, simply in order to live in the best way we can. And as our denial must eventually give way to our awareness for change and growth to happen, so must our discounting.

The uses of psychotherapy

Psychotherapy often involves the paradoxical question, ‘What is it, that at some level, I am unconsciously choosing not to notice, and why?’ I see the process of psychotherapy as a sustained collaborative inquiry between therapist and client, so that clients can move at their own pace from self-protective discounting to self-expanding awareness.

In Carson’s fictional doomed American town, her explanation for the crisis is, ‘The people had done it themselves’. And just as her work helped many people to become aware of what they were not seeing and begin to account for healthier ways of relating to nature, so the business of psychotherapy can liberate individuals.

It can do this through carefully exploring their beliefs, feelings and behaviours in order to increase awareness of other ways of being and discover new options for change. In this way, psychotherapy at its most effective helps people, in the only way possible, to do it for themselves.

 

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

Chris Horton is a registered member of the British Association for Counselling & Psychotherapy (BACP) and a psychotherapeutic counsellor with experience in a diverse range of occupational settings. He works with individuals (young people/adults) in private practice.  He is available at our Lewes and Brighton & Hove Practice.

 

Other reading:
Carson, R. (1962) Silent Spring Houghton Mifflin Co. Inc
Kübler-Ross E. (1969) On Death and Dying Routledge

 

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Pornography and the Online Safety bill

Having just come off a phone call with the Child Sexual Abuse and Exploitation Policy Lead, my thoughts have been drawn to the enormity of the problem we face with pornography and the ‘pornification’ of society, particular the world of young people.

Pornography use has become ubiquitous and normalised to the extent that increasingly the world of pornography seems to influence and infiltrate wider society through body shape, appearance, hair removal, sexual behaviour, dating, all the way through to the core of our identity.

From my perspective as a clinician, I have no particular moral take on what consenting adults do behind closed doors and indeed, it is my job to hold curiosity about this as with any other aspect of my clients’ lives.  It could be argued that pornography falls into this category.  However, whilst I have no particular moral take on (some) aspects of pornography (consumed by adults), I have a strong healthy perspective on the issue much like I do on the consumption of alcohol for example.

A person may choose to live their life drinking a bottle of wine per night.  Other than this they don’t negatively impact society, they maintain a job and pay their way in the world.  However, I would hold a health perspective on this issue and whilst as a lay person I am as aware as anyone else about the physical health risks of excessive alcohol consumption, I believe that in my role as a psychotherapist I can claim an expert position on the mental health impact of excessive alcohol use extending to the wider social context.  And so it is with pornography.

It is easier for anyone to access pornography via the internet than it is to buy alcohol.  At the very least, alcohol must be physically purchased and paid for whilst porn is free – in the monetary sense.  However, I believe that what seems free to consume is in fact a Faustian deal in which the consumer sells their soul – in this case their mental and emotional health.

It is also extremely disturbing and concerning that it is easier for children to access pornography of virtually any description than it is for them to be able to access alcohol.  Let’s be clear, I am not advocating children have access to alcohol, however surely it should be at least as well regulated and policed and the risks considered? To date, the impact of pornography use by children, teenagers and young people has been vastly underestimated and as a mental health professional, I and my colleagues see the fallout of this.

We face a pornification of society whereby the young now trade in sexual pictures of each other and sexual acts that would until very recently have been considered ‘fringe’ at best, have become normalised such as non-fatal strangulation.  The effects of this pornification of our young is leading to enormous self esteem issues, relational problems and mental health conditions such as eating disorders, depression and anxiety.

As a society we therefore need to safeguard children from child abuse – and to be clear, permitting children to view pornography constitutes child sexual abuse.  The online safety bill aims to do just this – it is imperfect and won’t solve the problem in that legislation can never solve social ills, however the first port of call is to safeguard children and then a more nuanced consideration of the insidious effects pornography is having on society can take place.

Psychotherapy is about relationships and at its core it is about helping clients to have a healthy relationship with themselves and others in a two-person world.  Pornography is by its very nature perverse – it is narcissistic and is about voyeurism and exhibitionism rather than relating.  It is therefore by its nature in conflict with the very essence of the psychotherapeutic journey and a healthy society.

 

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?

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

 

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Space: The Final Frontier of Manic Defence

As a boy I was fascinated by space travel. I remember being glued to the television set with awe as the Space Shuttle blasted off into space back in the early 80s – I was born after the epic Apollo programme came to an end and was just the right age to appreciate the engineering accomplishments in launching the Shuttle, without having fully lost my sense of wonder and amazement at the idea of man (and woman) going into space.

In recent years and months it seems a new type of space race has emerged – one that for me lacks much of the romance of the Apollo and even the Shuttle programme and instead halls of something very different indeed. I am referring to the race which seems to be be the vanity project of three of the richest (one middle-aged, and two bordering on elderly) men – Bezos, Branson and Musk.

What drives them?

Well, I am a good psychotherapist but cannot mind read. Nonetheless, there is some commonality between the three which I shall cover further on in this piece. What we can easily derive is that what drives these men has very little in common with the values and ideologies behind the original space race between The United States and The former Soviet Union.

The original space race was about many things but none more so than an affirmation of superiority over the other. Superiority in the space race meant, symbolically, superiority as a culture. Why does this matter? Culture, it can be argued from an existential perspective, is fundamentally religious in nature in that it provides us all with a mechanism be become ‘heroic’ and belong. Culture, whether the so called ‘primitive cultures’ of the world through to the now globally dominant Western culture all have three things in common : a story of how we got here, rules on how to behave whilst we are here and lastly, and perhaps most importantly, a story of what happens after we die. This is ostensibly why ever war ever fought is a war of one culture against another or, put more purely, one religion against another whether Christianity versus Islam or Communism versus Capitalism (or Freedom, as the Americans like to call it).

Bezos, Branson and Musk all share the reality that they have immense and almost infinite wealth. However, whilst this wealth is currently propelling them towards space like modern day space cowboys (a reference to Bezos’ cowboy hat attire after his space trip), they share something even more concrete than their wealth and it is something they share with the rest of us: no matter how wealthy, they are hurtling towards their own finitude (death) just like the rest of us and this renders them anxious.

Existential anxiety

Existentialists have long argued that to feel anxious is to be human; that our very being is defined by a knowing anxiety as we are, as far as we can discern, the only species on the planet who has such a profound awareness of our being that we also know we are going to die. This is unbearable for us and so we invent ways in which to stave off death anxiety – back to the raison d’être of culture.

Bezos, Branson and Musk all live on the same planet as the rest of us mere (financial) mortals – a planet that is reaching its limits on almost every level: we are fast running out of space, clean air, clean water and temperature ranges that provide liveable conditions for us and our animal cousins.

However, to engage with this is deeply anxiety provoking, not just for billionaires but for all of us and to contemplate the planet’s finitude is to be reminded of our own finitude.

A flight from death

Imagine how much good could be done with the combined wealth of these three individuals on this planet: third world debt could be resolved, huge investment created in renewables, diseases eradicated and so on. However to do this it would mean living within the constraints of reality – within the context of finitude. It would mean that each of these men would have to accept that despite their billions, they are mere mortals who are going to die.

Manic defence

A manic defence is a process (unconscious) that humans employ to distract themselves from uncomfortable truths, thoughts and feelings. It is, if you wish, the polar opposite of depression, where one is consumed by negative thoughts and feelings and nothing possible can be accessed.

It is a normal developmental process for infants to pass from a state of denial and splitting to the depressive position whereby reality, with all its disappointments, can be tolerated – not the same as clinical depression.

Whilst the latest wave of space travel is couched as progressive and future orientated by each of these billionaires, in reality what seems to be emerging is simply an expensive and highly polluting contest from see whom has the biggest ego (or other appendage if one is to reference the phallic shape of Bezos’ rocket ship). And what are they offering the world? The ‘opportunity’ for others who are wealthy, but slightly less so, to invest in this egotistical immortality project by becoming ‘space tourists’.

The little boy in me dreamt of space and the idea of being a space tourist. I now am firmly (and uncomfortably) rooted in the reality in accepting my own finitude and that of the planet we all share. Perhaps if the three protagonists in question had spent just a little of their fortune on a curiosity in exploring their inner ‘space’, they would be more able to tolerate actual reality themselves and rather than resorting to mania to defend against existential angst, find culturally heroic ways of making a difference and leaving their mark.

 

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

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

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

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Unexpressed emotions will never die

Short sharp, to the point and written by Freud. His full quote is ‘Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways’. What does he mean and is he right? 

With this statement Freud is defining on the pillars of psycho-analysis and psychotherapy – to uncover repressed and unconscious memories and provide a relationship in which those ‘traumas’ can be expressed through language and contact. 

What evidence is there that unexpressed emotions don’t die, after all, is passage of time not a great healer as the popular expression goes? We know that unexpressed emotions don’t die because otherwise people with traumas would simply recover and live contented and fulfilling lives.  Instead we know that this is not the case and trauma gets ‘stuck’. 

And with regards to the glib statement that ‘time heals’, this is only true when feelings can be expressed – losses grieved – and reality come to terms with, otherwise the past will continue to repeat itself in unconscious ways in the present. After all, the unconscious has no concept of time. 

How do unexpressed emotions come forth?

Unexpressed emotions – in other words emotions that cannot be acknowledged for fear of their impact on the psyche – express through a variety of means and present in an infinite number of actual behaviours or presentations. For me it brings to mind a quote from a Woody Allen movie where a character (played by Allen) says ‘I never get angry …. I grow a tumour instead’. 

Some of what we see as clinicians with clients who are defending against expressing difficult feelings can be: 

Acting out – Engaging in behaviours that are destructive to self and or others the reasons for which the client is often unaware of; 

Mania – Frantically ‘doing’ to avoid being in touch with one’s inner world; 

Depression – A pervasive deadness and inability to be in touch with desire as a result of emotions  being unexpressed. Being dead is preferable to feeling; 

Repetition compulsion – The compulsion to repeat an event or behaviour over and over again without an ability to clearly think about and consider why that may be; 

Reaction formation – A defence against the anxiety produced by feelings towards something causing the person to over-compensate in the opposite direction – an example would be someone terrified of death who engages in dangerous sports or activities; 

Mental illness – This is a catch all phrase, a product of the medicalisation of psychiatry whereby clusters of ‘symptoms’ are given different diagnoses. Essentially, mental health diagnosis or not, the work remains the same. And psychosis can be seen as the mind protecting itself from unbearable feelings and emotions by ‘going mad’. 

Somatic (body) symptoms – Back to the Woody Allen quote – in lieu of feeling, many of us develop physical ‘pains’ far less dramatic than tumours, but chronic nonetheless. Examples could be  gastro-intestinal problems (IBS), migraines or other more obscure symptoms. 

Dissociation – We all dissociate, which broadly means to ‘zone out’, however dissociation can manifest in powerful and extreme ways whereby the person ‘splits’ their mind akin to ‘the left hand  not knowing what the right hand is doing’, however rather than it being about one hand not knowing what the other is doing, it is in reality one hand not knowing what is BEING DONE to the other. 

And this list is by no means exhaustive or conclusive. 

Expression vs repression – living vs dying 

Expression of emotion is essential, however, cruelly paradoxically, those who have needed to repress have done so because there has not been a sufficiently available adult (in chronological as well as psychological terms) to be in relationship with. This is the role of the therapeutic relationship. 

Without titrated expression of emotion – I am no fan of new-age catharsis – and done in the context of relationship, living is simply not possible; only existence is possible where the client is at the mercy of powerful unconscious forces and exposed to their repressed emotions coming forth later in uglier ways. 

Grieving is part of living 

Grieving is extremely painful – whether that is grieving a loss in the present, or grieving the loss of what never was. However, without grieving we cannot feel alive – we cannot be born. 

Being born in the biological sense means leaving the safety of the womb, but also the ‘nothingness’ of the womb. In the womb we cannot experience reality other that filtered through our mothers. And so it is psychologically too – being born through psychotherapy means to face losses and bear reality, however painful that may be, and through that to come alive. If loss can be borne then desire for life can emerge and emerge it will. 

Psychotherapy is about expressing what has previously been inexpressible and it is in the context of the therapeutic relationship and encounter using language that this takes place: language gives trauma shape and form.

 

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 ready 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?

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Psychiatry, Psychology and Psychodynamic Psychotherapy

It’s easy for psychiatry, psychology and psychodynamic psychotherapy to be confused, so in this article, we will provide definitions and distinctions between them all. As the psychodynamic model is what we do, we may be biased. However, there is research that suggests the effectiveness of therapeutic approaches is pretty equal, and that the relationship with your therapist is more important than the model of therapy.

Psychiatry

Psychiatry isn’t necessarily a therapy, but focuses on the diagnosis, treatment and prevention of mental disorders. It takes a scientific, biological pathway to the treatment of mental disorders with the main treatment being medicine or drugs like anti-depressants or anti-psychotics.

In psychiatry, mental disorders are seen through chemical imbalances known as biological psychiatry. People seek psychiatry for many reasons such as panic attacks, hallucinations, suicidal thoughts or hearing voices. In psychiatry, there are other areas like social psychiatry which challenge the typical view that mental illnesses are caused by abnormal thoughts as well as biological and social factors.

Counselling Psychology

Counselling provides a safe space for you to talk to a trained professional about your issues and your concerns. You will work with your therapist to explore your thoughts, feelings, and behaviours to help you develop a better understanding of yourself. During counselling psychology, a counsellor will not give you their opinions, advice or prescribe medications, they will help you come to your own solutions. Whether that be making changes to your life or finding coping mechanisms.

Counselling psychologists use a broad range of treatments to help people who are struggling with stress, anxiety, emotional crises, or behavioural disorders. 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, to form conclusions that are based on sound scientific methodology.”.

Although counselling psychology helps many people, there are critiques surrounding the scientific methods. For example, scientists at Amgen, the biotechnology company, set out to replicate 53 landmark studies that ended up being accepted as fact. However, they were only able to replicate 11% of the time. This proves that science is fundamentally flawed when carried out by humans as it is often driven by unconscious bias.

Psychodynamic Psychotherapy

Psychodynamic therapy is a type of therapy that helps you understand your current feelings and behaviours are shaped by your past experiences. It is important during this therapy to have a good relationship with your therapist that is accepting, trusting and open. This encourages you to talk freely about topics like your childhood and your relationship with your parents.

A downfall to psychodynamic psychotherapy is that it is often unfocused with no clear goals. Barnaby Barrat, a radical psychoanalyst defines psychodynamics as “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’”.

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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Living with Borderline Personality Disorder

Borderline Personality Disorder (BPD), also know as Emotionally Unstable Personality Disorder, is a thought to affect between 0.7 and 2% of the general population. While estimates vary, it is considered that the disorder is predominantly diagnosed in women (75%).

So what is BPD? On a generic level, BPD is characterised by having difficulties in how you feel and think about yourself and other people. This can manifest in feeling insecure in relationships and consistently worrying that people will abandon you. This can bring about intense feelings that are very painful and difficult to mange, and they can last anything from a few hours to many days. This can make it hard to make and maintain stable relationships as the intense emotions and abandonment fears can push other people away. People with BPD often don’t have a strong sense of self and will try to change who they are depending on the person they are relating to.

The difficult feelings that are associated with BPD can often lead people to act impulsively, have strong feelings of anger that are hard to control and often self-harming or suicidal feelings. At the most difficult times, they may also experience paranoia or dissociation.

The causes of BPD aren’t clear, but there are some factors that appear with most people that can lead to a diagnosis of BPD. These are environmental factors when growing up, such as feeling unsupported, afraid or upset, with little validation. Family difficulties such as addictions in the parents or any kind of neglect or abuse can also lead to BPD. In additions to these factors, having an inherent emotional sensitivity can also be a factor that can lead to BPD.

So what should you do if you have been diagnosed with BPD? The first thing to consider is whether or not the diagnosis is correct. BPD is a controversial diagnosis as in itself it is hard to diagnose. The disorder shares a lot of commonalities with other personality disorders, and also with other conditions such as depression, bipolar-disorder and PTSD. For some people the diagnosis is a relief as the difficult feelings they experience now start to make sense. For others, having the label of BPD is unhelpful and doesn’t seem to capture their experience. Whatever way you feel about your diagnosis, it is important to get help so you can learn to manage your difficult emotions.

While there are a few treatments available for BPD, the one that is recommended by the NICE guidelines is Dialectical Behaviour Therapy (DBT). In DBT therapy, you will focus on acceptance and change. Accepting yourself is a fundamental part of building a sense of self, and leads the way to making positive changes in how you experience life. You will also start to learn emotional regulation skills so you are not swamped by difficult emotions, but instead learn to accept them and let them go. One of the key tools for this is mindfulness, as this allows you to really see what you are thinking and feeling, and allows you to distance yourself from these thoughts and feelings and stay rooted in the present moment. DBT therapy does take commitment to change, but it can allow you experience life in a more positive and balanced way.

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 –

Online Therapy

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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Loss

You can hold yourself back from the sufferings of the world, that is something you are free to do and it accords with your nature, but perhaps this very holding back is the one suffering you could avoid.”? Franz Kafka

Loss is a feature in almost every encounter we experience as psychotherapists. It’s a common part of being human. In this article, we will look at what loss is and what we can do with it.

What Is Loss?

Loss is a term we use to describe many experiences and not just death. Although bereavement is what we associate with loss, more everyday losses that we experience include loss of identity, the loss of childhood experiences, the loss of friendships or relationships or simply the loss you feel from a change in situations. Loss can be experienced in a range of different ways, and if not properly processed, it can have a profound impact on your life and mental well-being.

How To Cope with Loss

Experiencing a loss can make you feel like you have a lack of control. It’s therefore helpful to look at the things you do have control over and do things to make you feel more in control. Breaking things down into smaller, more manageable pieces ensures you don’t overwhelm yourself. For example, maintaining a routine and slowly introducing smaller goals can give you a sense of purpose.

Therapy is also a great tool for working through your loss, whatever that loss may be.

How Therapy Can Help With Loss

Talking to a professional psychotherapist can help you understand your feelings of loss and support you in overcoming them. As therapists, we reflect mentally through our own experiences and mirror them onto our clients, so they feel understood. Grief and loss cause pain, and this must be managed to ensure a healthy life.

This reflective process helps clients understand what they are doing to manage their grief. We’re not here to judge, but to bring awareness to it so it can be looked at more in-depth. Over time, through exploration of these survival strategies, the frightening experience of grief will pass. Sometimes, a loss must be examined from different angles to be able to move forward.

As therapists, we don’t judge. We provide a safe, calm space to listen to you. We understand that people who have experienced loss have so much going on in their lives and can struggle to make sense of it. We help you reflect on what is happening and help you to navigate through it.

Darian Leader’s book, The New Black, revisits Freud’s concepts of Mourning and Melancholia and explores the more subtle experience of loss and argues that modern life holds pressure to treat loss with medication. However, this adjusts the chemicals within the brain which has led to complex and unconscious causes of depression. Although drugs can be helpful, they rarely resolve the underlying cause of loss and depression.

Leader while praising Freud’s new thinking about depression, argues that he misses a vital element of mourning, its communal aspect and looks at various cultures and how they share the process of mourning.

In the book, Darian Leader argues that Freud missed a vital element in mourning: its communal aspect. In different cultures, many share the process of mourning, and mourning should be shared whether it’s a death or more everyday loss.

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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Interpersonal Therapy (IPT) Explained

When we are feeling depressed it is common to withdraw from those that we are close to, to shut ourselves away, turn down social invitations and generally pull away from friends and family.  By doing this we are refusing the help and support of others, possibly because we feel bad about ourselves or that we have failed in some way, or that we will burden others. Friends and family may feel hurt and rejected by our withdrawal, they may not understand and feel that they are being shut out consequently may start to pull away from us.  We may then interpret this behaviour as confirmation of our view of ourselves as ‘a burden’ or ‘a failure’ consequently perpetuating, and even increasing, our symptoms of depression. Thus a vicious cycle is inadvertently created.

This example illustrates the fundamental concept of IPT – that depression can be understood as a response to current difficulties in relationships and in turn depression can affect our relationships. If a focus on your current relationships makes sense to you then IPT could be the therapy approach for you.

IPT is time limited, usually between 12 and 16 sessions, its structured and is recommended in the NICE Guidelines (National Institute for Health and Care Excellence). NICE is like the NHS Bible and recommended treatments are well researched and evidence based.   

The main focus of treatment is on relationship difficulties and on helping you to identify how you are feeling and behaving in your relationships.  IPT typically focuses on the following relationship problems:

  • Conflict within relationships – this can often be difficulties within a significant relationship where the relationship has become ‘stuck’ in arguments or disagreements  and has become a cause of stress and is having a significant impact on mood.
  • Change in circumstances such as redundancy, breakup of relationship or other life event that has affected how you feel about yourself.  This can include happy changes such as becoming a parent or moving. However significant change can be difficult to adjust to and have an impact on how we feel about ourselves and others.
  • Bereavement – it is natural to grieve for the loss of a loved one however sometimes we don’t seem to be healing from the loss.  We can continue to struggle to adjust to life without that loved person.
  • Isolation – Difficulties in forming and maintaining relationships – this can be due to not feeling close to others or not having many people around.  Not having company or support of others can be stressful and leave us feeling very alone.

During the first few sessions of therapy we will gather information about your difficulty, create a time line of your symptoms and discuss current and past relationships in your life.  Once we have gained a good understanding of the problem and the connected relationship difficulties we will collaboratively agree on which of the 4 areas therapy will focus on.

The benefits that IPT can bring include:  Improvement in relationships, including relating to others and communication, learning to cope with emotions and life changes, problem solving, processing loss and grief, and overall an improvement in mood and psychological distress.

 

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults.  Rebecca is available at our Brighton and Hove Practice.

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The dangers of over medicalising

Earlier this month (October 2019) the government announced a new service for gaming addicts aged 13-25 at the Centre for Internet and Gaming Disorders.  According to the World Health Authority Gaming Disorder is a pattern of persistent or recurrent gaming behaviour so severe that it “takes precedence over other life interests”.  This description could equally be applied to any addiction be it an addiction to gaming, alcohol, dieting, exercise, drugs or sex to name a few.

New addictions and other mental health categories are being ‘discovered’ almost weekly.  The current version of The Diagnostic and Statistical Manual of Mental Disorders – DSM-5 published in 2013 contains 541 categories of mental disorders. This version replaced DSM-IV published in 1994 containing 383 disorders.  That’s an increase of 158 categories in 19 years – just over 8 new categories per year, a little more than 1 every couple of months.

GPs, psychiatrists and other mental health clinicians use the DSM to diagnose their patients.  Each category has a list of symptoms and as long as the patient presents with a required number of symptoms within the category a diagnosis is given.  Alongside a diagnosis there is a choice of treatment or treatments which will typically be a combination of medication and/or some form of psychotherapy to treat the symptoms.

So far so good, however with new diagnostic categories based on surface symptoms springing up so regularly the structural causes that lie beneath these symptoms are given less and less attention.  Two people may present with the same surface behaviour, for example, a pattern of persistent or recurrent gaming behaviour.  In both cases the person might describe significant impairment in important areas of functioning like work, relationships, their social life, education or occupation and so the label gaming addiction may be applied.  Dialogue however may show that for one the symptom is linked to how they wish to escape from feelings of anxiety and depression whereas for the other it is a consequence of the delusional belief that the gaming world they enter is in fact the real world and one in which they have a real place.  Similarly we might consider two people who are persistently restricting what they eat leading to weight loss or a failure to gain.  Again a discussion may show that for one person the reason they are dieting is because they imagine that the thinner they are, the more lovable they will be whilst another person may be refusing food because they believe it to be poisoned.

In this way the same symptom covers two very different causes and psychological structure.  In order for the symptoms to be reduced the underlying cause needs to be explored.  This is the work of long term psychotherapy where the person is treated as a whole and is encouraged to speak about themselves and their relationships both as they are now and also as they were in the past.  Personal history and family dynamics are thought about so that the meaning behind the symptoms can slowly emerge.

 

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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Don’t just do something, sit there! On the role of manic defences

We have all heard the phrase.  Often shouted at a moment of crisis on a television programme or film: “Don’t just sit there, do something!”  As if ‘doing something’, anything at all, will make a difference.  Of course, the reality is that doing something does make a difference, if not to the outcome of the crisis, then at least to how the protagonists in the crisis feel.

Doing something – anything – at a moment of crisis or even simply at a moment of inner discomfort, can be a common way of avoiding uncomfortable feelings.  Doing something can convert those feelings into an external activity whereby they, at least for the duration of the ‘doing something’ do not need to be consciously experienced.

We call defences, such as these manic defences, as their purpose is to rigorously protect us from having to be in touch with uncomfortable feelings.

Is manic defence linked to depression?

Most people associate the term manic defence, or ‘mania’ with depression and in particular bipolar disorder.  And whilst it is correct that some sufferers from bipolar disorder experience acute manic episodes which may or may not include psychosis, all of us use manic defences as an unconscious way of protecting ourselves against psychic pain.

The clinical bit

Manic defences arise developmentally sometime between the age of six months and a year.  This stage is when the infant is starting to come to terms with the fact that his/her primary carer (I shall use the term mother here for simplicity) is separate to them.  In other words, the mother is not a ‘part’ of the infant and that therefore she will frustrate and anger the infant in not being perfect in meeting their needs.  Manic defences protect the infant against painful feelings of control, contempt and triumph, according to Melanie Klein.  Manic defences, therefore, protect the infant against their own uncomfortable feelings and protect the mother, from the infant’s rage.

How do we use manic feelings?

Manic defences come into play to stave off a whole range of difficult feelings from boredom, through to rage and anger – often feelings where we feel impotent, helpless or fear our own strength of emotion.

An example could be to go shopping after a tough day at work.  And, with the advent of the internet, ‘shopping’ is invariably always at our fingertips.

What’s the problem?

The developmental process of growing up is one in which we should all learn to be able to face our emotional and mental discomfort and then use it in a growth-orientated manner to move forwards in our life.

Without this, we remain at the mercy of early, primitive defences that stop us engaging with who we are and how we feel and severely limit our capacity to become an integrated whole person.

How can psychotherapy help?

In order to grow up in a methodical way using our wisdom to make sense of our internal and external world, we must rely on others to teach us what is required.  This is ideally the role of a parent, however, if we have a parent who has been unable to truly separate from their parents and relies on manic defences to navigate the world, then we cannot learn this from them.

Psychotherapy offers and represents a relationship in which our inner worlds can be understood and tolerated.  This is not an easy process, but it is a fulfilling one: when the going gets tough, the tough go to therapy.

Returning to the title of this piece, perhaps the challenge for us all is in being able to resist doing anything, and to simply sit there and observe our internal process and acknowledge our feelings.  This is the mature response, but does not make for dramatic television!

 

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

 

Further reading by Mark Vahrmeyer –

Can Psychotherapy or counselling be a business expense?

The difference between Counselling and Psychotherapy

How do I choose a Psychotherapist?

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Post Natal Depression in Mothers & Fathers

In this blog, we explore postnatal depression and summarise a classic paper by Lawrence Blum, an American psychiatric and psychotherapist. It was originally written in relation to postnatal depression in mothers, but also explores the conflicts that appear when becoming a parent and applies to fathers, same-sex couples and couples where caring for the child is more equally shared.

How Postnatal Depression Can Affect Fathers as Well as Mothers

Although understandably, we focus on new mothers in the postnatal period, dads and other co-parents also need support.

Dads have a lot to take on board when a new baby arrives due to the huge life change. Money problems, sleep deprivation, new responsibilities and new relationship dynamics can leave dad feeling overwhelmed, emotional, and even depressed. On top of this, it’s easy for dads to feel guilt for not being able to take on the responsibility of breastfeeding as their partner is still recovering from labour and birth.

It’s important to seek help if you’re a father feeling the negative effects of new parenthood, or if you’re a mother who has noticed a negative change in your partner. Talking therapies can be a great help in overcoming depression.

The Difference Between ‘Baby Blues’ And Postnatal Depression

In the paper, Blum explains the difference between ‘baby blues’ which is a hormone-induced depression, and postnatal depression which more closely relates to depression. Many factors contribute to postnatal depression, including:

  • Lack of external support
  • Stressful life events
  • Difficulty conceiving
  • Previous mental health issues
  • Low self-esteem
  • Anxiety

To help with postnatal depression, supportive counselling, CBT, and psychodynamic psychotherapy were the most effective in controlling the issue.

What Is Psychodynamic Therapy?

Psychodynamic therapy had the biggest impact on depression. This type of therapy focuses on the psychological roots of emotional suffering. This approach combines many different types of analytic therapies and works on the idea that each person’s unconscious thoughts and perceptions are developed through their childhood.

When working with a psychodynamic therapist, a mother will be encouraged to talk about relationships with their parents and other people to uncover the unconscious reasoning behind their depression.

There are different psychodynamics of depression which we will outline below. There are three principal emotional conflicts, these are:

Dependency Conflicts

When you become a new parent, you are completely depended upon by your new child or children. This is extremely tiring, emotional and in some ways, draining. Support at this stage of becoming a new parent or carer is extremely beneficial, however, if there is a lack of support, parents may feel a sense of denial of their own needs which can result in depression.

Anger Conflicts

Anger is a normal part of depression, and it can make parents feel guilty for feeling this emotion. Anger can be felt towards the baby as a projection of past hurts or for how their lives have changed in terms of money, sleep, jobs, social life and sex life.

The dangers of feeling anger as a parent are that when these feelings are denied and controlled, the feelings can build up and eventually be released which threatens the relationship with the baby or, more commonly, the partner.

Parenthood conflicts

Becoming a parent and caring for a baby can bring unresolved and unprocessed feelings about a parent’s own experiences of being cared for to the surface. Negative childhood experiences can positively affect how you raise your own child as you want more deeply to give your child what you didn’t receive, however, on the other hand, it can also stir up old wounds which can heighten the risk of depression.

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

The world today seems smaller than ever before.  We think nothing of travelling to once exotic destinations for our annual holiday and more and more of us are choosing to live in countries other than that of our birth.

Alongside these effects of globalisation is that of children who are now growing up in cultures other than that of their parents and yet remaining to varying degrees apart from the culture of the country they live in.  These children are known as Third Culture Kids.

What defines a Third Culture Kid?

The term Third Culture Kids (TCKs) was first defined in the 1950’s to give a classification and understanding to American children growing up outside of the United States.  Technically it refers to a child who is likely to have parents (or a parent) who are working in a foreign country (or countries) for a period of time and the child therefore spends a significant part of their development growing up in that country; they therefore neither really belong to their original nor host culture and are defined as being of a ‘third culture’.

Effects of globalisation

More and more children are growing up as TCKs as people think less and less of living and working in other cultures and countries.  The benefits of being a TKD are obvious if not always ubiquitous: TCKs learn to mix with other cultures; they frequently speak multiple languages; they are more likely to undertake a degree and can easily feel at home anywhere.

So, are there only positives?

Put simply, no.  If a child grows up as a TCK and has a ‘secure base’ – is securely attached to their caregivers – then the experience can often be largely positive though still comes with a price such as a loss of belonging, limited contact with wider family, confused loyalties etc.

However, if a child has a less than ‘good enough’ home environment then the experience of being a TCK can exacerbate their lack of boundaries and can make neglect and/or abuse more likely as there is no wider family network or community to care for the child.

It takes a village to raise a child

In my clinical work I have come across individuals who have survived extremely neglectful or virtually non-existent parenting, who have nonetheless managed to locate enough consistency in adults around them in order to be OK.  In other words, there is great truth and wisdom to the old adage that it takes a village to raise a child and often, the village is the container and parent for the child where their biological parents have failed them.

Third culture kids and loss

Loss is a key aspect of growing up as a TCK.  There is often the initial loss of ‘home; to overcome – house, town, culture, extended family, friends, identity – which can be a significant shock in itself.

However, the losses continue to define TCKs as it is extremely likely that if they are growing up as part of an expatriate community, friends, teachers and familiar faces will come and go fairly frequently as contracts end and jobs take the adults elsewhere in the globe.  This can be a particular challenge when it comes to the frequent and ongoing loss of friends which is often the hardest part of a TCKs experience.

On a psychological level the losses combined with a lack of cultural embeddedness and identity can lead to difficulty in settling down, committing and fitting in.  This can then translate to anxiety, depression and a sense of free-floating dread.

A rolling stone gathers no moss

Third Culture Kids can grow up to become Global Nomads, relishing the confidence that being able to settle anywhere brings to them.  However, this is also often not the case and TCKs can oscillate between a dread of not belonging versus a fear of putting roots down and building an ordinary life with substance.

As with most experiences, whether something is positive, or negative is so very often contingent on how secure a child feels in the relationship with their parents.  With a secure base, we feel safe enough to venture further from home, even when that means exploring other cultures.

Mark Vahrmeyer is a UKCP registered psychotherapist and a self-defined Third Culture Kid who, by the age of 12, had attended 10 schools across five countries.  He speaks four languages and is attuned to working with Third Culture Kids, Global Nomads and Existential Migrants, as well as anyone struggling with cross-cultural experiences. Mark sees clients in Hove and Lewes.

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