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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

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

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

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

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

 

Psychodynamic Psychotherapy

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

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

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

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

 

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

 

Further reading by Paul Salvage –

Analytic Therapy for Addictions

Loss

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconscious

Face to Face and Online Therapy Help Available Now

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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

Face to Face and Online Therapy Help Available Now

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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

In this blog, I wanted to write about Loss and try and explain a bit about what the hell we are supposed to do with it! I think loss is perhaps one of the things that I find it hard to think isn’t a feature of almost every encounter I experience as a Psychotherapist, and perhaps as a human, it is a pervasive part of being human, a painful part but a part none the less.

I encounter loss in the therapeutic encounter in a huge range of experiences, from the sudden tragic losses due to bereavement; due to the more ambiguous everyday losses of identity due to the ongoing vicissitudes of life and changing circumstances. These include the loss of who we are when our situations change, the loss of childhood experienced by parents and their children, due to adolescence, the loss of much-loved work identity in retirement and of course the frequent and painful losses when relationship change or end. So what do we do when, as a colleague poignantly put it, “ the glue dissolves”.

During my training, and in the literature, there is much talk of processing these losses, the need to mourn etc. and about what can happen when these things get stuck, but what do  these things actually mean?“

I think a lot of what I’m doing as a therapist is trying to reflect mentally through my experience and the sharing of my experience of being with someone, a mirror to them so they can come to understand what it is they are doing. Often in grief, there is pain and this pain has to be managed, feelings have to be managed. I will seek through this reflective process to help clients understand what they are doing to manage their grief, not to judge it as good or bad but simply to bring some awareness to it, so it can be thought about. Often, through this exploration of these important-survival strategies, and over time, the experience of grief often so raw and frightening can start to be experienced, to allow it bit by bit to be felt, the good and bad of what has been lost to be experienced and allowed to pass, or at least survived. Sometimes a loss has to examined from many different angles, many times over. Loss is painful and hard to stay with.

Darian Leader in his excellent book, The New Black, revisits Freud’s concepts of Mourning and Melancholia, to explore a more nuanced experience of loss and argues that, modern society has created a pressure to package and treat loss and that this has created a simplistic definition that can be biologically defined and then treated by adjusting the chemicals within the brain via medication. This has led to the many complex and often unconscious causes of depression being narrowed and linked to biological markers that can be targeted via drugs. That’s not to say drugs can’t be helpful, they can be, but they rarely resolve the underlying causes.

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 the way in which they share the process of mourning.

For me I am struck by the Musician Nick Cave and his wife; Susie’s, much-documented loss of one of their twin boys, aged 15. Nick Cave, has since that loss and after a period of retreat, sought to engage with his audience and to open himself to the experience of loss, he writes a webpage called the Red-letter diaries, has gone on speaking tours and often engages and shares in the stories of loss with his audience. He cites this as an essential part of what has helped him survive this tragedy. As he says there are an awful lot of mourners out there.

Both Cave and Leader cite the Buddhist story of a Mother who loses her baby and has the dead baby strapped to her chest, a monk says that she must find some mustard seeds from a house that has experienced no loss and as she goes from house to house in search of these, never finding a house that has experienced no loss, but as she comes into the contact with the various losses of each house and in the sharing of their grief’s she is eventually able to lay her baby to rest.

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

 

Further reading by Paul Salvage –

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconscious

A Nation Divided

Adolescence: the trials and tribulations

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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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.

Face to Face and Online Therapy Help Available Now

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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.

Face to Face and Online Therapy Help Available Now

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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?

Face to Face and Online Therapy Help Available Now

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Post Natal Depression in Mothers & Fathers

In this blog, I want to write about post-natal depression, revisiting and summarising a classic paper by Lawrence Blum, an American Psychiatrist and Psychotherapist. The paper was written originally in relation to postnatal depression in mothers, however, because it essentially explores the conflicts aroused in becoming a parent and caregiver, particularly in relation to our own experiences of caregiving.  I think it applies also to fathers and to same-sex couples and heterosexual couples where the caring of the infant is more equally shared.

Blum’s paper, titled the “Psychodynamics of Postpartum depression”, is available on the web.

The paper draws a distinction between baby blues which he defines as the hormonally induced depression resulting from pregnancy and childbirth, and post-natal depression, which has typical features of depression, – ‘sadness, crying, insomnia, or excessive sleep, low mood, low energy, loss of appetite, agitation and self-critical thinking.’ 

He describes the external factors that can contribute, such as prior anxieties and depressions, low external support, difficult relationships, difficulty conceiving, stressful life events, etc. He summarises the studies at the time into the results of different therapies and concludes that supportive counselling, CBT and Psychodynamic Psychotherapy were all superior to the control and that Psychodynamic therapy had the biggest impact on depression, as defined by the DSM 111. 

The focus is then on the possible  ‘psychodynamics’ of the depression and these are what I shall briefly outline here as these are what can really be usefully explored and alleviated by Psychotherapy. Three principle emotional conflicts are outlined; Dependency conflicts, Anger conflicts and Parent conflicts. 

Dependency Conflicts

In order to care for a baby, there is a need to be utterly depended upon, this is tiring and emotional and benefits from support. If there is a conflict about receiving support, self-denial of the caregiver’s own needs, they can seek to repress their own essential vulnerability and needs and get depressed.

Often people manage this part by becoming carers and end up in caring roles, such as therapists (a good reason as any why therapists need their own therapy!) This counter-dependent strategy can work until it doesn’t. Someone who seems to be managing everything well, suddenly finds the balance has tipped too far. A baby can stir up the caregivers previously unconscious or sleeping wishes to be cared for, hidden by a display of independence.

Anger Conflicts

A conflict with feelings of anger, which can feel counter to the role of the caregiver. Parents can feel they don’t have a right to be angry, feel guilty about it or frightened of it, yet may have experiences and histories, which have left them feeling angry. Anger can be felt towards the baby, either as a projection of past hurts or for the very real things it has done to the parents lives; tuned them upside down, deprived them of sleep, money, jobs, sex, etc, while carrying on with its incessant demands obliviously. The danger apart from depression in all of this, is that these feelings are denied and controlled and ‘loss of control can follow from over control as internal pressure builds up”, and has to be released, either threatening the relationship with the baby or more commonly being displaced onto partners.

Feeling the anger, tolerating it, and judiciously putting it into words, easy for the clinician to say, is the difficult and essential task for the person who is looking after the baby.

Parenthood conflicts

Caring for a baby can stir up unresolved and unprocessed feelings about the caregiver’s own experiences of being cared for, whether a mum or a dad by a mum or a dad. Although a negative experience of being cared for can positively inform the ways in which the caregiver feels they don’t want to be, it doesn’t necessarily translate into clear ideas of how or what to be. In addition, the caregiver, giving the baby what it didn’t receive, can be gratifying but can also stir up the wounds of what they, the caregiver, didn’t receive. 

I would like to finish with Donald Winnicott,’s, (a British paediatrician and Psychotherapist), funny but true reasons why a mother, (or father or caregiver), hates their baby, with the intention in which they were written, to provide relief from the day to day conflicts, that can be felt in the rewarding, important but by no means easy job of nurturing an infant:-

  1. The baby is not her own (mental) conception. 
  2. The baby is not the one of childhood play, father’s child, brother’s child, etc. 
  3. The baby is not magically produced. 
  4. The baby is a danger to her body in pregnancy and at birth. 
  5. The baby is interference with her private life, a challenge to preoccupation. 
  6. To a greater or lesser extent, a mother feels that her own mother demands a baby so that her baby is produced to placate her mother. 
  7. The baby hurts her nipples even by suckling, which is at first a chewing activity. 
  8. He is ruthless, treats her as scum, an unpaid servant, a slave. 
  9. She has to love him, excretions and all, at any rate at the beginning, till he has doubts about himself. 
  10. He tries to hurt her, periodically bites her, all in love. 
  11. He shows disillusionment about her. 
  12. His exciting love is cupboard love so that having got what he wants he throws her away like orange peel. 
  13. The baby at first must dominate, he must be protected from coincidences, life must unfold at the baby’s rate and all this needs his mother’s continuous and detailed study. For instance, she must not be anxious when holding him, etc. 
  14. At first, he does not know at all what she does or what she sacrifices for him. Especially he cannot allow for her hate. 
  15. He is suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt.
  16. After an awful morning with him she goes out, and he smiles at a stranger, who says: ‘Isn’t he sweet!’ 
  17. If she fails him at the start she knows he will pay her out forever.
  18. He excites her but frustrates—she mustn’t eat him or trade-in sex with him. 

Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74. 

 

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

 

Further reading by Paul Salvage –

The Therapeutic Relationship and the Unconscious

A Nation Divided

Adolescence: the trials and tribulations

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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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What causes insomnia?

Insomnia is defined as being a habitual, or regular, inability to sleep.

Whilst it can be linked to medical conditions, the most common causes of insomnia are lifestyle related as well as anxiety, depression and stress related.

With regards to anxiety, depression and stress, insomnia is not only caused by these conditions, but it further exacerbates them too creating a vicious circle.

What can I do to help with my insomnia?

Improve your sleep hygiene

Sleep hygiene is a term used to describe a holistic approach to sleeping encompassing who you are as an individual and your sleep environment. Improving sleep hygiene involves thinking about where you sleep, how you sleep and what may work best for you.  Sometimes this will involve a degree of experimentation, for example, do you sleep better with the window open or closed? 

Stick to a routine of sleeping and waking

Research has shown that we are biologically predisposed to sleep and wake at the same time each day, ideally in synch with the setting and rising of the sun.  Whilst the latter is a far cry from modern life, coming up with a routine and sticking to it can be extremely beneficial to both your sleep patterns as well as your physical health.

Avoid stimulants

We all know that caffeine and alcohol will impact on the quantity and quality of our sleep.  However, watching a disturbing drama right before going to bed – or the news – can have an enormous impact on the ability for us to get to sleep.  It is much better to consume the news in the morning when we have the mental capacity and waking hours to digest it.

Why do anxiety and depression make insomnia worse?

Anxiety and depression are two seemingly different mental health problems that frequently find themselves side-by-side in the same sentence.  This is because they are essentially two-sides of the same coin.

Anxiety is an uncomfortable (at times, unbearable) feeling that gives us the sense that all is not well with the world.  It is an ordinary element of being a human being and many scholars believe that we are ‘cursed’ with anxiety due to our (largely unconscious) awareness that we are going to die.

Anxiety causes restlessness and many people deal with anxiety by channelling it into activity – something that fails when it comes to going to bed.  Anxiety is often described as ‘free-floating’ and will seek to attach itself to something.  We can then convince ourselves that the ‘thing’ our anxiety has attached to is the real problem, however, this is rarely the case.

Depression is a state of inertia but an uncomfortable one.  Anxiety (and stress) can have the function of protecting us from depression, however, eventually, anxiety will give way to the hopelessness of depression.  One may think that sleep would come easily in a state of depression but this is often not the case as hopelessness can feel unbearable.

Can counselling or psychotherapy help with insomnia?

If a client presented with insomnia than I would want to understand what may be causing the insomnia and to work with the client to gain a deeper understanding of what their feelings may be telling them – particularly any anxiety or depression.

Whilst anxiety is a normal element of being a human being, it should not be debilitating and an ideal is to engage in a meaningful life whereby the anxiety is channelled in a healthy way. 

Alongside this is a deepening of the relationship with ourselves in order to learn to better tolerate difficult feelings without becoming overwhelmed by them.

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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Psychotherapy can change your life – but you may not want it to

Anyone who is or has been in “psychotherapy proper” will tell you that it can be really hard work.

First, you begin by telling a total stranger about the most intimate things in your life. Things you never even said out loud because it was all too difficult to admit to yourself, let alone to another human being.

Then, you find out that most things you were taught about yourself growing up turn out to not be true. Well, that’s a relief in most cases, especially since many of us are taught to believe pretty horrible and untrue things about ourselves like: “you’re stupid”, or “you’ll amount to nothing”, or something a bit subtler like “your sister is the good one”.

Next, you are encouraged to feel things you haven’t or couldn’t feel before because no one cared or knew how to deal with it. So, once you start learning that the stuff you swallowed in your childhood was more about your parent’s inadequacy rather than anything to do with you, you begin to feel pretty angry about this, or sad, or disappointed, etc

All of this inevitably leads to the painful realisation that your early life wasn’t as rosy as you thought it was, and therefore you are now feeling very anxious or depressed about seemingly unrelated things like work or your relationship.  This then leads to more mourning of the loss of good experiences that you never had. And because you can’t go back in time and no one else can make up for these experiences, you then have to gradually come to terms with it.

Of course, this is all very uncomfortable and plus it turns your world completely upside down, which you weren’t expecting at all cause you just came here to talk to a lady (or man) with a nice face and (hopefully) a soothing voice.

But then, because you are feeling all this sad and angry stuff that you never felt before, you realize that you are also feeling other things, like relieved and happy. And that over time, you feel more and more alive and happy than sad and miserable.

This leads to you being more attractive to other people and them wanting to spend more time with you because you are a nicer and more interesting person.

You also get more secure in yourself and find better work, which in turn leads you to feeling even better about things and, oh gosh – a positive loop begins!

But of course, being sad and miserable has its advantages. People feel sorry for you and they try to rescue you. Plus, you don’t have to make any fundamental changes or feel very uncomfortable feelings and make some difficult realizations. It’s the devil you know, right?

Well, being in psychotherapy might change your life for good – it’s up to you whether you want to.

(P.S. The process of psychotherapy can take many different avenues, depending on what you are bringing and where you want to go. The above is only one general example).

Sam Jahara is UKCP Registered, CTA, PTSTA and is one of the Brighton & Hove Psychotherapy Co-founders.  She is a Transactional Analysis Psychotherapist with experience of working with individuals and couples in short and long-term therapy. Sam is available at our Lewes and Brighton & Hove Practices.

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The Truth of the Myth of Anti-Depressants

The Truth of The Myth of Anti-Depressants A Response to Johann Hari’s Book  – Lost Connections

As a psychotherapist, I welcome honest debates about mental health, as they can help reduce the stigma and isolation of many sufferers experience.  Recently, a book has been published by controversial author Johann Hari, that has created a bit of a storm,  in which he claims to dispel the myth of anti-depressants and provides us with the Nine Factors that lie at the root of anxiety and depression.  Here is my two-cents worth:

Do anti-depressants work for some people?

Yes they do.  And furthermore, they can be essential ‘life rafts’ for clients who simply cannot cope.

They are compatible with psychotherapy in as much that clients need to be thinking about and taking responsibility for choosing healthier ways of coping.

Are there ‘Nine Factors’ contributing to Anxiety and Depression?

This idea really concerns me.  It is less about whether Hari’s ideas or suggestions are valid (some are), but rather seems to be reminiscent of a reductionist trend of identifying and listing the problems of the human condition, with a view to us being fixed if we address the list.  The many causes of depression include biological, social, economic, genetic, epi-genetic, existential and more beyond.  And they are all interconnected.

The Problem of Being Human

Since the dawn of time, man and womankind have pondered the purpose of life.  Existential thought and theory has much to teach us on this matter and the many tomes published on the topic have never identified a specific number of causes.

Perhaps what we are ultimately left with is that anxiety and depression are part of the human condition.  Whether this is a random fluke of evolution, or brought about by us being (as far as we know) the only species who must live life knowing we shall die – existentially an unbearable proposition – or a combination of the two, I do not know.

My view is that being a successful human being is about learning to come to terms with the past and to learn to tolerate our feelings and then navigate by them.  If anti-depressants help us bear the unbearable for a while, they have a place and a role which can be lifesaving.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes.  He is existentially informed and has a background of working in palliative care.

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