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How psychotherapy groups can help change our internalised family systems

Family backgrounds and values

From our earliest times, we absorb the emotional systems of our family environment. As we make our way in the world we take our families with us, internalised and manifesting consciously and unconsciously in many, if not all, aspects of our lives.

While the societal and cultural context of the family is a key aspect in determining some dominant aspects of the family system, in this piece I am more concerned with the unique emotional variations of individual families. Thinking about our own families of origin, for e.g., we might ask ourselves – what emotional values dominated? What feelings were allowed and what feelings were not allowed?

As we enter adolescence, and then adulthood, we become more able to step outside our original family systems and compare them with those of others. This can help us also see how our own family culture has impacted and shaped us as individuals.

These insights can lead to some deliberate rejections of family values and behaviour. There are many decisions, significant and small, many make as adults to try and separate and ‘do it differently’. What is more difficult to disentangle from, however, are those parts of the system which have been unconsciously assimilated and which we therefore can’t recognise in ourselves or perhaps even in our family. This unconscious maintenance of our family culture is at its most complicated and hidden in our emotional life and is very likely to surface in our relationships.

The family system and the psychotherapy group system

When someone joins a psychotherapy group, they unconsciously expect the group (as well as the therapist) to behave like their family. A little like the stereotyped ‘Brit abroad’, they are expecting things to be like it is ‘back home’ even though they have made the journey initially for something different. Because their own family culture is what they know, the individual feels in some way that they’re going to be safer if the group behaves in this expected way.

In these scenarios two things are likely to happen.

Firstly, the group will, at times, unconsciously repeat for the individual experiences that replay the family culture.
In psychotherapy, past experiences will always resurface in some shape or other. This is an opportunity for the individual to tackle difficulties head on and ‘in the moment’. While the group will inevitably repeat some aspects of the family system, it is not the family and as a therapeutic system it will allow these experiences to be explored. Sometimes, this can happen quickly but often it is an ongoing process over time.

Secondly, the group and therapist will, also at times, confound the unconscious expectations that the individual’s family culture will be recreated.

As I said above, the therapy group develops its own culture and system based on therapeutic values rather than the old family values. This new group system will eventually override or at least reshape the old system of the individual’s family.

This is quite explicit when group members expect a shaming or critical response when they reveal or expose some thought, feeling or behaviour that would not fit with their own family values – consciously or unconsciously. It can be a moving and an important experience when they’re met with a typical therapy group response of acceptance, empathy and understanding.

In addition to those more obvious moments, as the individual becomes immersed in the group culture, they allow this new – more benign, and therapeutic – system to replace the old. This deeper process takes place in a complex way over time.

Summary

We are all shaped by our family cultures. Problematic aspects of our emotional lives and relationships can often be traced back to our family experiences and the systems we have internalised. Group therapy offers an opportunity to engage with these internalised parts of ourselves and through the group therapeutic process separate from limiting or harmful family assumptions and values.

 

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

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.  She offers a free telephone consultation for anyone interested in exploring further the possibility of joining a therapy group.

 

Further reading by Claire Barnes – 

Is a Therapy Group Right for Me? Am I Right for a Therapy Group?

What happens in Therapy Groups? The role of the Therapist

What happens in Group Therapy: Mirroring

The Problem with Change

What is it like being in a Psychotherapy Group? Case study – Joe

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Love and family

The family is our first social group. It is the crucible in which our passions are born and our capacities to love and to live are shaped – and misshaped. The family imbues its members with its own specific culture, habits and attitudes.

As an organism, it too is shaped by the cultural moment and the social environment, the hopes, fears and attitudes of the day. It is the bedrock of our most durable and intense emotions and the fertile soil of our satisfactions and discontents. The family reconfigures with each new life that enters and exits. Constantly changing, constantly staying the same it is both dynamic and flexible, coded and predictable. We are all indelibly touched, one way or another by its authority. We learn to love in the context of ‘family’, each in our own idiosyncratic way. Every family has its own cast of characters ((step)parents, grandparents, (step) siblings, aunts, uncles etc). All players in a unique drama. Family is a stage where universal themes are navigated, power, sex and money, hierarchy and democracy, passion and ambivalence, in all their dark, tumultuous, devastating and innocuous glory.

Universal themes

From Greek myth to Shakespearean tragedy, the depths and breadth of family relations provide a turbulent, brooding backdrop to moral, ethical and philosophical considerations of a universal scale. So often in these epic tales, we are reminded what an unruly emotion love is, indeed how uncomfortably close it resides to its shadowy counterpoint hate. Disowning his most beloved youngest daughter Cordelia, King Lear in a fit of vanity and rage is consumed by vengeful hate, abdicating love and reason in its wake he casts her out. Her failure to satisfy his insatiable need for flattery and primacy, to go against her own nature, disrupts their bond, unleashes chaos and eventual tragedy. This is an epic tale of family conflicts, of power, love and greed. Most family dramas do not play out on such a grand scale, but remain hidden in the shadows of secrecy, shame and trauma, creating a legacy that can trickle (or cascade) down through generations to come.

Changing Families

Whilst the major human themes endure in families across generations, the architecture of family life and living is continually changing with the socio-political and economic tides. Every generation spawns its own raft of experts on the family and its constituent members, from the institutions of religion, state, medical and social science and philosophy. The current moment, in particular, is one in which the couple is the central organising pillar upon which the success of the family depends. Bred in ever smaller numbers, the modern child is also a major focus of scrutiny and opinion. As the birth rate has decreased so children’s value has increased. Parents invest heavily in their offspring financially, emotionally, educationally etc. We dedicate ourselves to their health and happiness, often discounting our own in the process. As an antidote to our high tech fast-moving, demanding lives we create a utopia of childhood and perhaps (without knowing) locate many of our own unmet hopes and passions in our beloved and precious innocents.

Love them or hate them (and indeed it is within our families that we learn about both) idealise or reject them it is within the context of the family that we learn about the social world and our place in it. It is in this original grouping that we have our first experience of grief and loss, it is where we learn to trust (or not) and to express (or inhibit) our desires. Family life is fraught with misunderstandings and pain and is the vessel in which our virtues are forged, kindness, loyalty generosity and fortitude. Interestingly, even when we grow up and leave them we will most often seek out another with whom we wish to form a family. At this very particular COVID moment, we are all forced to reconsider what family means to us.

 

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

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin

Understanding sexual fantasy

Fear and hope in the time of Covid

Relationships, networks and connections

Paying attention to stress

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Helping children to ride the waves of big emotions

Quite a few people this week have asked me about tips for supporting children at times of high emotional stress (e.g. anger, rage or anxiety). For this reason, I thought I would share with you some generic pointers for parents that I use in clinic, but which could apply to most children. These are predominantly drawn from the principles of Dialectical Behaviour Therapy (DBT) and Dyadic Developmental Psychotherapy (DDP), which you may have heard of.

1. When a child is calm, help them to understand that emotions (of any kind) are a bit like waves… they rise, they peak and they fall. They come and they go, but they DO eventually end.

2. When a child (or their parent) notices that they are starting to become distressed (or to ‘fall out of their window of optimum arousal’), they can be supported to try the TIPP approach:

T = TEMPERATURE
Helping a child to change their body temperature (e.g. by splashing the face with cold water or eating or drinking something cold) can help them calm, as the body naturally gets hotter when distressed or aroused.

I = INTENSE EXERCISE
Engaging in intense exercise to match the level of emotional arousal (e.g. star jumps or running) provides a healthy outlet for anxious tension. – Ideally this should be a rhythmic exercise as it is more likely to activate a child’s earliest neural pathways of feeling soothed from when they were rocked as babies.

P = PACED BREATHING
Slow breathing, concentrating on their breath and (importantly) breathing out for longer than they breathe in, helps children to regulate the bodies. This is because longer exhalation naturally slows their heart rate and activates the Parasympathetic Nervous System (PNS), which in turn helps the body to calm.

PAIRED MUSCLE RELAXATION
Supporting a child to tense and then relax parts of their body, supports muscles to release tension. Relaxed muscles require less oxygen, so heart rate and breathing naturally start to slow down.

3. Having a calm box – Supporting a child to develop a pre-prepared box of all their favourite textures, smells, photos, games, sensory toys, etc., can be a lovely way to start to talk about emotions with a child and help them to feel a sense of self-efficacy in managing their own emotions. As time goes on, a child might start to ask for their box before becoming overly distressed.

4. Parental matching of the affect – When a child’s brain is distressed, it regresses to a much earlier developmental form of itself, whereby it does not register language or logic in the same ways. For this reason, a parent needs to ‘match’ the emotional intensity of the child in their non-verbal behaviours (e.g. when a child is shouting: using a loud (but not angry) voice, using BIG physical gestures, maintaining intense eye contact, etc.). The very act of ‘mirroring’ a child to themselves helps them to feel held and contained. The parent can then gradually lower their voice and soften their gestures, which the child will match in turn. I think of this as ’emotional hand holding’.

5. Having a cuddle – Following an emotional outburst, close physical connection instigated by a safe adult, is one of the most soothing and regulatory activities to do with a child to bring them back into a state of optimum arousal. It also enables them to learn that no matter what they have done or said, they are still loved, which is so important for developing a secure and healthy attachment. Once they are physically and emotionally calm, you might then want to talk about the actual behaviour if this needs to be addressed, however, the key is…’Connection before Correction!’!

I hope that you find some of these tools helpful. It is of course important to note, however, that what causes (and maintains) emotional distress in children can vary hugely from child to child. It is also important to note that for some children, what causes and maintains their distress can be very hard to determine. In such cases, parents should feel empowered to seek professional advice regarding a targeted assessment of their children’s specific needs.

Happy surfing everyone…!

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 with us. Online therapy is available.

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Helping Children With Loss Through Story Books

Children, like all of us, encounter loss in their lives, temporary and permanent. They may lose a treasured possession, a loved one who dies, a parent who leaves or is imprisoned, a friend who moves away, or a valued teacher in the transition between year groups or schools. Some are unlucky enough to lose their health or abilities they once took for granted. Others lose their home or their country and there are those who lose their innocence through exploitation and with it perhaps their sense of self and any respect and trust they had for the world.

With loss comes associated feelings, held in the conscious or unconscious mind or both. Support in processing losses may or may not be available and the degree to which children show lasting difficulties will vary accordingly. Stories are just one tool which can help children connect with and work through internal emotional conflicts associated with experience of loss.

Like art, stories help us to take new perspectives and understand ourselves, others and the world differently. They can offer comfort or challenge, enliven or unsettle us. By engaging the imagination, not only can stories transport us to another time and place but they can also open up a rich emotional landscape which might otherwise be off limits to the defended conscious mind.

Most children speak and understand the language of play and they live stories, in their everyday playful interactions with food, sounds, textures, objects, animals and people. And, of course most are introduced to and love books, from a young age. Well-told children’s stories tap into a child’s thirst for make-believe, for adventure and for powerful emotive themes such as love and hate, despair and hope, failure and redemption.

For this blog, I have selected 6 story picture books which I will briefly summarise:

Amos And Boris by William Steig (1971)
This beautifully written tale of enduring friendship focuses on the unlikely alliance of a mouse (Amos) and a whale (Boris), who become acquainted when Amos falls off the boat he has made (which is sadly lost forever) and Boris rescues him. The two travel together, learn about their differences, survive a falling-out, share ideas and develop “a deep admiration for one another”, becoming “the closest possible friends”. Coming one from land, one from sea, the time comes for them to separate: “. . . we can’t be together . . . I’ll never forget you though.” Years later, Boris is beached by a hurricane and Amos, aided by elephants, is then able to save his life. The wrench of what may be
their final parting is sad and tender yet secure in the knowledge that each will continue to be remembered in the other’s heart and mind.

Badgers Parting Gifts by Susan Varley (1984)
This story opens with the inevitability of the ageing Badger’s death and his awareness of the loss his friends will feel after he’s gone. When he dies, Badger is sorely missed by all the animals but especially Mole, who feels “lost, alone and desperately unhappy.” The friends’ sadness is intensified by Badger’s absence, as it was he who had always been there for them in times of trouble. And in missing him, they start to come together and share memories. This, in turn, highlights to them the gifts which Badger has left behind, skills he taught each of them when he was alive which they can now remember him by and use to support each other. Gradually, sadness gives way to a comforting and emboldening remembrance and gratitude.

The Red Tree by Shaun Tan (2001)
This story tells of a girl who loses her sense of purpose and place in the world, and with it any sense of hope. Through unique, extraordinary, incredibly crafted images, and condensed, graphic text, we travel into the girl’s mind, inhabited by surreal, exaggerated and often frightening forms and scenes which overwhelm her. She is not seen, heard or understood and oscillates between these worlds of chaos and a relentless nothingness. A happy, colourful life is out of reach and all seems doomed and irresolvable. She has lost everything and become lost herself. And then, suddenly, life returns (thankfully!) and with it hope and joy. This speaks to the immense value there is in sitting alongside and fully taking in the realities of another person’s bleak experience. As the reader, we witness the
girl’s pain, perhaps helping her to mourn her losses and then re-discover herself.

The Day The Sea Went Out And Never Came Back by Margot Sunderland (2006)
Eric the sand dragon lives on a beach and adores the beautiful sea beyond, which in its daily rhythm comes and goes predictably, with the tides. One day the sea goes out and does not return. This is devastating for Eric who waits and longs for the sea to come back and is then overwhelmed with the pain of his loss. He becomes trapped and isolated inside himself. Eventually, attracted to the vulnerability of a dying wild flower, which he then saves, Eric is drawn back into life himself. He saves more flowers and a rock pool garden is created. Eric starts to feel safe enough to fully mourn his loss and in so doing discovers that remembering his beloved sea builds a treasure store in his mind which
he can keep forever.

The Lonely Tree by Nicholas Halliday (2006)
Set in the New Forest, this original book uses the seasons to chart the forest life-cycle through the friendship between an old, story-telling oak tree and a young, curious evergreen. As the oaks sleep for the winter, the evergreen becomes acutely lonely and, when spring finally comes, all hope is cruelly crushed when his oak-tree friend fails to wake up, his long life ended. The evergreen cannot comprehend what has happened but holds onto his cherished memories, through the sadness. Hope returns as a fallen acorn germinates and a new oak is born, destined to form a new friendship with the evergreen. Stories of the forest are retold and, as they are, the trees’ roots go “deeper and
deeper into the ground”, reminding us that with companionship we can endure and process the pain of loss and live a more enriched life.

The Heart And The Bottle by Oliver Jeffries (2010)
Beautiful illustrations alongside a concise narrative makes for great dramatic effect, telling the story of a delightfully curious and creative little girl who experiences the apparently abrupt and unexplained loss of an adored grandparent, with whom she had discovered and shared many wonders. She puts her heart into a bottle for safe keeping but as she grows up becomes limited and encumbered by its seclusion, which she finds she is unable to reverse. It is only through connecting with her own daughter’s zest for life that she allows her heart to be freed and re-discovers treasured memories of her beloved grandparent who she can now enjoy remembering. Her inner-child, in league with her actual child become the unwitting healers.

These books, like many others, model that feelings are okay, they are a normal response to loss and are to be expected. This is an important message to our children, particularly given that many of us are still filtering cultural and familial influences in our own lives which would have us discount feelings in order not to rock the boat or blow other people’s stiff-upper-lip cover. Children are expert at tuning into our sensitive pressure points and while they may push our anger buttons quite readily, they may avoid talking about sadness if they sense we may be uncomfortable and find it hard to hear and hold them. In turn, to avoid burdening others or being alone with pain, their own natural defences against connecting with sadness can become strengthened and entrenched.

A story book can serve as a helpful third party, a neutral but enriching messenger, able to venture into forbidden territory within the safety of metaphor. Connection with characters breeds understanding and empathy for one’s own pain. We can read the story exactly as it is or go off piste, filling in blanks with a child, co-creating a personalised narrative, re-writing the ending and reflecting all the while. Repetition can work wonders, enabling a child to use pictures as prompts and retell the story from memory. Each retelling can add meaning and a layer of digestion for the child, outside of his/her awareness, whether or not any overt life parallels are drawn.

All 5 of these books also convey a sense of hope, always integrated into the experience of loss. Again, this is a powerful lesson in a world which all too often splits artificially the good from the bad. We might not long for loss or wish it upon anyone else, but when it comes we, alongside our children, can do what we can to to feel it, to know it, to share it and to find new life somewhere within it.

 

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 with us. Online therapy is available.

 

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Educational Psychotherapy (2) – developing empathy, mind-mindedness and self-discovery

In Educational Psychotherapy (1), I explain how Educational Psychotherapy first evolved and how, as an approach, it can help promote social and emotional development as well as the thinking skills required for learning.  This was illustrated through the aspects of a child’s first six months in therapy. Here, I highlight three areas of further progress over the next 12 months of work with the same child. Again, this account is disguised and anonymised.

Empathy and feeling understood

One of the most exciting benefits of Sammy’s becoming more emotionally literate was the opening it allowed for me to make connections between his experiences with family and friends and his feelings and then providing empathy for Sammy’s felt experience.  This enabled Sammy both to feel held and understood by me at an emotional level and to experience his feelings as making sense. Over time, Sammy came to welcome this and it seemed to encourage him to actively seek openings to make further connections between his experiences past and present and his thoughts, feelings and behaviours.

Mind-mindedness and social connection

Early on in the therapy, Sammy found it difficult to engage in wondering about his own mind or about others’ minds, in either imaginary or real contexts.  There were times when he seemed to think I should have already known what he was thinking. Things began to shift when trust developed and Sammy allowed himself to become more openly curious about me, what my life might be like and how I might perceive him.  He grew increasingly accepting of the idea that I had a mind separate to his and that learning about each other involved a shared process. He started to wonder about my own mental state and thoughts, perhaps partly in response to my modelling of a mentalising approach with him.  This capacity to be “mind-minded” was also reflected in Sammy’s accounts of social interactions at school when he openly wondered about various students’ motivations for particular actions and how they might have been feeling about a situation.  This included an understanding that people might have mixed feelings at times.

Therapeutic journey

It was Sammy’s journey of mental-emotional-social self-discovery which came to shape the bulk of our sessions and it was an encouraging and rewarding journey to be a part of.  The significance to Sammy of this work became increasingly evident as I began to talk about the sessions coming to an end several months before the final session.  Sammy found this very hard and would avoid or deny the subject in various ways.  However, in time, we were able to talk more about what this avoidance meant and Sammy moved into a period of some weeks when, unprompted, he became highly reflective about what the sessions had meant to him, bringing in memories of particular activities and commenting on changes which he felt had taken place within himself.  He also made reference to ways in which our working relationship had changed.  He spoke with confidence and resilience and a certain assurance that his memory would remain in my mind after our sessions had come to an end – and it has!

 

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 with us. Online therapy is available.

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Educational Psychotherapy: (1) supporting social-emotional development and learning

Educational Psychotherapy was developed by Irene Caspari in the 1970s, an Educational Psychologist working at the Tavistock Clinic in London.  She was interested in understanding learning difficulties from a psychoanalytic and attachment perspective. In order to address both learning needs and emotional difficulties together, she pioneered a method of blending structured (educational) tasks and free expression within a 50-minute weekly therapy session.  Treatment usually lasts 1-2 years but some work continues for longer or is adapted for shorter periods or extended assessments. Trainees are typically experienced teachers or learning support staff and undergo their own therapy during training. Many continue to work in schools and adapt their learning to therapeutic teaching and attachment-aware, trauma-informed practice.  

What follows is an anonymised, disguised case study which illustrates how Educational Psychotherapy can begin to support social-emotional development and learning.

11-year-old Sammy was referred for therapy by his key worker on account of difficulties he was having with relationships, expressing and understanding emotions and understanding the world. An earlier Educational Psychology assessment had suggested that high levels of anxiety were impacting on Sammy’s capacity to make full use of learning.  Therapy took place over 18 months.  

Sammy soon engaged with a variety of word, number and drawing games and activities, offered within the context of a supportive relationship.  Tasks which combined cognition, physical activity and relational connection proved an effective way to build trust, stimulate thought and enliven Sammy’s felt experience in the room.  Shared story writing and the free use of paint and clay facilitated expression and imagination. Conversation also had a significant place, at the point of checking in, within and around activities and, over time, for sustained periods.

Over the first 6 months of therapy, progress became evident in the following foundational areas:

Sense of self and reciprocal interaction
Sammy came to enjoy the process of co-creation with craft activities and solving problems together, including making up physical word and number games and negotiating the rules between us.  He became more comfortable with what he didn’t know  and embraced the opportunity to find things out, explore new skills and introduce me to new areas of learning.  Sammy also started to talk more about himself and grew comfortable with the routine of checking in at the start of a session, when he would share a happy achievement or discovery or an experience of frustration, disappointment or confusion.

Tasks and learning

Persevering at a challenging task requires the use of Executive Function skills, such as being able to monitor and evaluate where the difficulty lies, use problem solving skills to work out and plan the next steps, use working memory, inhibit distracting thoughts and so on.  Young people like Sammy, who have difficulties in these areas, require considerable “scaffolding” to help them develop and practice skills and tools for thinking. To begin with, Sammy found it hard to take instruction or support from me but as trust grew he became a little more comfortable with not knowing and clearly more curious.  My sense was that a space for thinking opened up in his mind which enabled him not to panic but to consider what was required next in order to proceed. 

Thinking about and talking about feelings

The development of a language for feelings was a significant area of development.  In early sessions, Sammy would habitually say that everything was “fine” or “normal”, almost seeming oblivious to the relevance of emotional experience or reflection.  After a time, Sammy disclosed that he had been getting into rages at home and taking out his feelings on objects which had sometimes become broken.  He acknowledged that this was confusing, upsetting and problematic for him and that he wanted help with it.  Activities like squeezing paint directly onto paper or working with clay enabled Sammy to express himself viscerally and then reflect on how he connected with the images created.  We also thought about activities Sammy could do at home to self-regulate.  

In time, thinking about feelings became an area that Sammy would actively seek.  He talked about experiencing fear and how this had caused him to adopt particular behaviours as an avoidance mechanism.  It seemed that the naming of these fears was enough to create some distance and enable Sammy to make a choice about how he wanted to act.  Sammy also talked about sadness and acknowledged that he had grown used to keeping his feelings to himself.  He started to voluntarily make links between his expressive material in artwork and his own thoughts and feelings inside.  

 

In part, these conversations involved psycho-education, helping Sammy to understand more about how feelings work, that it is normal to experience a wide range of feelings and that it can help to be self-aware and to share some of what we feel with trusted others.  At times, we were able to do this through playing board games or through role-play with miniatures.  Sammy showed that he could recognise the difference between actions held in mind and actions lived and that he could think hypothetically about possible future consequences of taking a particular course of action.  

This phase of the work paved the way for more profound developments which were to follow.  Sammy was now ready to take more risks. (Read more about this in Educational Psychotherapy (2) – article will be published shortly).

 

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 with us. Online therapy is available.

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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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Curiosity: how can children’s behaviour help us understand what they need from us?

“Watch your plants and see what they’re telling you” (Ollie Walker, Hosta grower, Gardeners’ World, BBC2, 14.6.19).

Ollie Walker has fallen in love with the diversity of Hostas and delights in watching them grow.  This is some dedicated watching: the nursery he works at stock over 800 varieties.  Noticing small changes in thousands of plants, he knows exactly which nutrients are needed for the healthiest growth.

Many babies are fortunate enough to be watched with arguably much greater devotion than this.  For starters, the care-giver: cared-for ratio is much better – 1:1 attention at least.  The sense of wonder surrounding a new-born breeds connectedness which begins relationship. It gives the baby an experience of felt safety, of being held psychologically as well as physically. This is just as well.  We now know that early attachment relationships are a foundation for all forms of later development.  As Winnicott said, “there is no such thing as a baby.” [i]  Infants cannot exist independent of someone to look after them.

An attuned care-giver is open to a baby’s non-verbal communication -her cry, gaze, gesture, smell, touch or muscle tone – and finds meaning there. “Good enough” parents provide consistent, appropriate care and interaction enough of the time. Inevitable mis-attunements are further food for curiosity, opportunities for adjustment and repair which strengthen attachment and resilience. Toddlers and children of all ages, continue to require the mind of a benignly curious adult to scaffold development.  Behaviour is a window to a child’s inner world of thoughts, feelings and body states.

All children, at one time or other, behave in ways which cannot be dealt with easily or quickly and might be perplexing, concerning, maddening or all three.  Those children growing up in environments where their needs are not sufficiently met or where they are unsafe will be more likely to do this.  We may find that even our best intentions and the most tried and tested behaviour management strategies are not effective.  This is often because they have not evolved from a relational understanding of the child’s needs and what is being communicated through the behaviour.

Staying curious can be hard if there is pressure from friends or family to quickly stamp out unwanted behaviour. Or we may be driven by a need to make something better and hurry to provide instruction, fix a problem or eradicate pain without first considering what the matter might be.  These can also be the behaviours which trigger our own vulnerabilities.

In addition to highlighting aspects of our own internal make-up, intense emotional experiences inside of us can be an effective clue as to what children themselves are feeling.  This is central to Wilfred Bion’s development of Melanie Klein’s theory of Projective Identification.[ii]  Bion proposed that not only can unwanted feelings be projected into another person, who then feels those feelings, but that this process serves the purpose of communication.  For example, a looked after child who sabotages her own birthday meal after a lovely family day out may cause a foster carer to feel rejected and resentful.  This could be thought about as the child (unconsciously) letting her carer know about both early experiences of rejection and how hard it is to believe in her own capacity or deservedness to sustain states of joy in the present.

For children with experience of trauma, challenging behaviour and Projective Identification may be the only means they have of telling the emotional story of what has happened to them.  It can seem counter-intuitive, but we need to welcome this and, alongside setting appropriate boundaries, seek to find meaning in it.

Symbolism in the child’s play and other activity can be very revealing about a child’s inner world and language itself can be thought about beyond its literal meaning.  For example, a child who repeatedly says she is hungry, when we know she has recently eaten, may be letting us know she is hungry for connection, as opposed to food.

It is the wondering process here which is as or more important than the resulting care itself.  Through close observation and knowledge of the child and attention to his/her own emotional response to what is happening, a care-giver takes in the communication of discomfort, frustration, distress, fear and so on, reflects on it, digests it, and feeds it back in a more manageable form, often through words, as well as through tone/ gaze/ affect/ posture/ actions.  Correspondingly, the child feels accepted, held and understood and receives a message that his/her care-giver is able and willing to be alongside and help manage emotional pain.

This is what Bion called “containment”, the parent as “container” the child as “contained” – in my view, one of the greatest gifts we can give to the younger generation. Through repeated experiences of this kind, children develop their own capacity to think about and process feelings.

In addition to patience, true curiosity requires flexible thinking, open to the myriad nuances of human behaviour.  The same actions can have different meanings for different children or even for the same child, such as a troubled 7 year-old boy who would regularly take himself into the corner during a PE lesson and sit with his head in his lap.  Over time, staff learned that he would do this both when he was hyper-aroused (worked up) and needed space away from others to calm down and when he was hypo-aroused (switched off) and in need of company and livening up.

In psychotherapy with children (and in therapeutic parenting work) we are often dealing with issues which have felt too difficult to think about and make sense of.  The therapist’s task is to engage, observe, listen to, accept, be curious about and sit alongside a child, gently helping to make thinkable the unthinkable.  This takes time.  Emotional defences are there for a reason and require sensitive handling.

Holding steadfast to curiosity is one of our soundest investments with children.  If we can start to wonder about a child’s behaviour, we stand a much greater chance of coming up with an effective way to meet his/ her needs.  As Gerda Hanko (Educational Psychotherapist) and others have said: “Don’t just do something, stand there!”

 

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 with us by telephone or email. Online therapy is available.

 

Resources – 

[i] Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship. Int. J. Psycho-Anal., 41:585-595.

[ii] Bion, W.R. (1962b). Learning from Experience. London: Heinemann

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“Ghosts in the Nursery” – The Power of Family Scripts

 

 

As much as we might fight it, our own experiences of being parented, create within us blueprints or ‘internal working models’ of what it is to be a parent. These models only become fully activated when we become parents ourselves, and often take us by surprise. For instance, we may find ourselves ‘turning into’ our parents in ways we hadn’t intended. Similarly, memories from our past can be unexpectedly invoked in us when our own children reach the same age. 

Selma Fraiberg (1987) emotively referred to this phenomenon as “ghosts in the nursery” – the idea that without conscious effort to alter entrenched family patterns, family life can essentially become a ‘rehearsal’ for the next generation. More commonly, we refer to this phenomenon as the enactment of ‘family scripts’. John Byng-Hall (1985) proposed three ways in which these family scripts may manifest – 

  1. REPLICATIVE SCRIPTS: 

These scripts are a direct replication of the parenting that we received ourselves. They can include replication of positive scripts (e.g. family rituals, ways of nurturing children, ways of enforcing boundaries, certain sayings, etc.). They can also include replicating negative (unresolved) scripts, which may be consciously replicated (e.g. “smacking never did me any harm”) or unconsciously replicated (e.g. needing to hide one’s sad or angry feelings from a parent can make it harder for these children to later recognise or respond to these feelings in their own children).

  1. CORRECTIVE SCRIPTS:

These family scripts are a conscious decision to offer our children a different experience of being parented to what we received ourselves. The danger for this type of script, however, is that because they are driven from an emotional response to our past, there is a risk that we will go too far the other way (e.g. feeling hard done by as an older child, so favouring our own eldest child).

  1. IMPROVISED SCRIPTS: 

These family scripts relate to the ability to flexibly and creatively amalgamate what we most value from our own experiences of being parented, with what we now value and learn from new relationships, education, culture, etc. We generally consider that the most resilient and healthy families adopt this form of script. 

Difficulties can arise when damaging or unhealthy replicative family scripts cannot be consciously thought about by parents. In extreme cases, these can negatively impact upon a parent’s relationship with their child and therefore, their child’s subsequent emotional well-being. For the most part, however, activation of family scripts is normal, inevitable, and actually helps children to become embedded within the familial and social context to which they belong. Indeed, almost all the parents that I meet in my work (myself included), offer a fascinating mix of all three of the above scripts to their children.

References:

Byng-Hall, J. (1985). The family script: A useful bridge between theory and practice. Journal of Family Therapy, 7, 301-305

Fraiberg, S., Adelson, E. & Shapiro, V. (1980). Ghosts in the nursery: A psychoanalytic approach to the problem of impaired infant-mother relationships. Journal of the American Academy of Child Psychiatry, 14, 3.

 

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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Family Therapy for Beginners

Professor Richard Layard, one time ‘Happiness Tsar’, wrote, ‘in every study, family relationships, (and our close private life) are more important than any other single factor in affecting our happiness’.

It’s hard to grow and feel safe and content in the world if our family stories are causing us distress and discomfort. This is especially true for children, and young people when their family is their world. When they are struggling with emotional and behavioural problems or maybe unexplained physical ailments a ‘systemic’ approach can be revealing.

Systemic therapy is relational, that means looking at the spaces in between people and their relationships with others, as opposed to looking inside individuals. Systemic therapists are interested in the ‘systems’ that people belong to, such as our families, school, work places, peers and friendships. Exploring the context of tension, distress and unhappiness can help us illuminate the possible causes.

For example we may find stories of divorce and separation, estrangement, sibling rivalry, family illness and disability, bullying, academic struggles, financial problems, loss and bereavement, or drug and alcohol use Family therapy is about having conversations that can be difficult, exposing, controversial, and upsetting.

But also about reconnecting, understanding, sharing and being surprised. Feeling heard, understood, loved and believed. Explaining your side of a story, hearing family stories that help you understand current struggles and appreciating other people’s point of view. Feeling proud and united, relieved and supported and wondering together how you can move on.

Any therapy involves taking a risk; family therapy provides an invitation to be brave and accept that families may be worried, sad or confused about someone they love. Or maybe family relationships are feeling tense and strained, or they are missing someone who played an important role in your lives.

Established, repaired and revisited relationships give families a rich resource for healing.  Family Therapy sessions usually last 90 minutes, and as many family members who are available are welcome.  Work would begin by exploring why it had been decided now was the time for family talking and noting individual and family goals to help focus the work. Some family members may be initially reluctant to attend, its important for them to be aware that just be attending they are showing their support. They do not have to contribute verbally if they do not want to – this could be agreed at the beginning of the session. By just turning up they are able to listen to other expressing their views and will usually join in when they feel comfortable and safe within the process.

A genogram or family tree is usually constructed looking at the current family structure and remembering older generations. This provides a map of the family and a cultural context for the current problems. It generates stories, sometimes forgotten, about how positive and negative patterns and traits may have been inherited by the family in the room. This can be a revealing and emotional, with younger people hearing about relations that may have died before they were born and older ones remembering stories that help build to a clearer understanding of the family’s identity. A time-line constructing a chronology of family births and deaths and other family events is also useful. Again, this begins reveals its own narrative, which can help a family begin to plot the life story of a problem.

Family Therapy is always driven by the goals of the family and continual feedback allows the therapist to ensure that the family are having the conversations they want and need to have. Sometimes it may feel useful for family members to meet individually, in couples or sibling groups as part of the therapy.

It is not necessary to meet weekly; sometimes families find one or two sessions are enough to feel they are able to move forward. In my experience family therapy can be a powerful process with the family leaving more connected with and appreciative of each other.

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

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Acceptance: What does it have to do with managing children’s difficult behaviour?

The Paradoxical Theory of Change[i]  states that we can only change aspects of ourselves when we first become what we are.  Likewise, in order to support children’s development, we also need first to see them for who they really are and accept where they are at.

This can be a difficult thing to do.  To begin with, we need to be present with children for long enough and with sufficient attunement to really get to know who they are and how they are doing.  This is perhaps one of the greatest challenges for many parents today, with the pressures of work and the distractions of technology.  I once passed a young boy walking with his Mum who was on her phone.  “Mum, you’re not listening” said the boy, tugging at her sleeve. “I am listening” she said, not looking up.  “But you’re not hearing me” the boy replied.

Quantity of time together is important, but quality of contact is what matters most.  Setting aside a block of time for a planned activity at home or a trip out will usually be very well received.  In addition, briefer periods are valuable windows of opportunity for everyday re-connection through child-directed play, shared tasks and focused listening.

Really being present with a child can be challenging for other reasons.  When we look and listen we can be alerted to traits and behaviours  which we may find irritating or displeasing.  This can leave us feeling that we have failed as practitioners or parents and, at desperate times, that perhaps we made a monumental error ever choosing to take on a role of responsibility with children.  We may feel disempowered, at a loss as to how to help and so we look the other way as the task seems too big. Challenging child behaviours may also reflect vulnerabilities in our own character that we would rather not acknowledge.

For children who have experienced complex developmental trauma (repeated adverse experiences over time), there can be an additional avoidance, in society at large and even in adults providing care and support.  These insecurely attached children usually develop their own defensive patterns of behaviour.  These can be aimed at either deflecting adult attention by presenting as pseudo-independent or drawing adults in to collude with their own negative self-view through becoming critical, rejecting or punitive towards them.  Adults and systems taking up these scripts struggle to see beyond the child’s surface behaviours and may unconsciously be finding a way not to witness and sit with the child’s emotional pain, the enormous elephant of loss in the room.  This protects individuals and services from the powerless anguish of imagining the horror and injustice of what life might have been like for a child during periods of abuse or neglect.

Once present and engaged with children, our next task is acceptance. In Dan Hughes’ P.A.C.E. approach to parenting[ii], the ‘A’ – Acceptance, is the fore-runner to Curiosity.  This is not about condoning or encouraging negative behaviours.  It is about being real and seeing the whole child for who he or she is.  By accepting what is happening for a child, we are joining him/her and building a bridge, making it possible to develop understanding and then convey empathy.

This kind of acceptance is about taking an integrated view of human beings, steering clear of both idealisation and demonising.  We accept that all of us have different parts which includes parts that we might think of as positive and negative.  We go on existing, despite our apparent contradictions.  Vulnerable children often need help with this as they split the world into either good or bad and fear that we will reject them if their less favourable parts are visible or made conscious. We can model integration for children by talking about different parts of ourselves – our cake-loving part, our grumpy part, our forgiving part.[iii]

True acceptance is not about putting up with behaviour and it is more welcoming than tolerance, more than bearing and giving permission to another’s way of being.  It is about setting judgement aside as much as we are able, and privileging connection and relationship.  It says “I am going to be with you no matter what you do and I am going to stay open and engaged to you, whatever you try to do to push me away”.

Acceptance is therefore unconditional.  Even in their darkest, wildest and most hurtful moments we accept children and stay open and engaged.  Without this, connection is lost and curiosity, understanding and empathy become marooned. This can feel like a radical, even reckless, position to take, but it is essential for building emotional resilience and enabling relational repair, both in the home and the therapy room.

 

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 with us by telephone or email. Online therapy is available.

 

Resources – 

[i] Beisser, Arnold (1970) The Paradoxical Theory of Change  https://www.gestalt.org/arnie.htm

[ii] Golding, Kim (2017)  Everyday Parenting with Security and Love.  Jessica Kingsley.

[iii] Bomber, Louise (2007)  Inside I’m Hurting.  Worth Publishing.

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The role of ‘attunement’ in relationships with babies and young children

Babies are not born with the neurological capacity to understand distress, or even to differentiate between discomfort and mortal danger. To ensure their survival therefore, babies are biologically programmed to communicate all forms of distress to their primary caregivers through very primitive means (e.g. crying, screaming and reaching out).

Under ideal circumstances, these ‘signals’ from the baby will elicit a sensitive (‘attuned’) response from their caregiver, whereby their caregiver will utilise their more developed brain in order to empathise with the infant’s distress, to soothe them and overtime, to give them words to better understand and communicate their distress. Repetition of this pattern over time, coupled with a deepening joy of the relationship, is not only the foundation for a secure attachment relationship, but the building blocks for other important skills such as developing empathy and emotional regulation.

When working well, attunement enables a child to feel truly understood, accepted and ‘felt’ by their caregiver. Inevitably however, “getting it right” all the time is not possible and sometimes signals will be missed or responded to incorrectly (‘mis-attunement’) – also known as a ‘relationship rupture’. Ruptures are normal and actually present opportunities for a child-carer relationship if the carer is able to repair the relationship appropriately. Indeed, it is estimated that for a secure attachment to develop, carers need to attune correctly around one third of the time (Hoghughi & Speight, 1998), which is reassuring!

Over the years, researchers have examined the importance of attunement on an infant’s mental health. This includes Ed Tronick’s (2007), ‘still face experiment’, which illustrates the distressing disintegration of a young child, whose parent temporarily stops responding to their cues (Youtube link). It also includes the work of Lynne Murray, who demonstrated that even warm responses to infants are not regulating unless they are exactly timed with their cues. This is important as for some parent-infant dyads, ruptures can be severe and chronically prevent the carer from being able to sensitively attune to their infant – ‘toxic mis-attunement’. This might occur when factors specific to the child get in the way of them being able to communicate their needs effectively (e.g. speech and language difficulties or neurodevelopmental difficulties), or when factors specific to the parent stop them being able to receive and process the child’s distress signals appropriately (e.g. mental health difficulties or substance misuse problems). There may also be external stressors impacting on the relationship (e.g. domestic violence or poverty). In these cases, it is imperative that mental health and social support services are proactively mobilised to offer early support to both the child and the carer.

Hoghughi, M. & Speight, A. (1998). Good enough parenting for all children – A strategy for a healthier society. Archives of Disease in Childhood, 78, 4, 293-296.

Murray, L. & Trevarthen, C. (1985). Emotional regulations of interactions between two-month-olds and their mothers. In T. M. Field & N. A. Fox (Eds.),Social perception in infants (pp. 177-197). Norwood,NJ: Ablex.

 

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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A Nation divided

There has been much talk of how Brexit has divided our country, and indeed, in my own extended family I have members on both sides of the debate.

In this blog I want to write a little bit about how we as humans are divided and how Psychotherapy can ease some of the conflict contained in that. This divide, or split, can happen when we think or do things that don’t accord with what we believe to be our own beliefs. Beliefs about ourselves as doers of good, thinkers of pure thoughts etc. 

Freud describes how these splits can be repressed, by quoting Nietzsche’s phrase: –

“’I did that’ says my memory; ‘I cannot have done that’, says my pride and refuses to yield. Finally – memory gives way.’”

Splitting is not necessarily a bad thing, it is often a way to manage something that cannot be managed at the time, so, cleverly, the psyche represses it. However, this repression is never total so the thing that wasn’t able to be managed, perhaps due to it being too overwhelming at that time, seeks to come out in some other way. 

The outpouring of grief at Princess Diana’s funeral, for instance, was not only about the sad and untimely death of Diana but also presented a triggering of an outpouring repressed and split off grief in so many people and perhaps goes to show how much grief so many of us carry around. 

Another way splits can occur is when we have, as we almost always do, conflicting feelings of love and hate to those we are close to. This can sometimes create a terrible conflict, where the anger or disappointment or hurt, feels like it can’t be expressed for fear of hurting the one that is also loved and therefore potentially causing us to lose that person. 

However, the feelings are still there, so find other ways to come out; – road rage, shouting at the TV, getting into arguments at work, etc.  Most of us want to be good and can find these parts of ourselves distasteful and best not thought about. However, that has side effects, sometimes serious ones and that is when a person will sometimes seek psychotherapy. 

The psychotherapist will work to facilitate the unearthing of these conflicts in a way that is sensitive, non-shaming and understanding, in order to allow their expression and lessen their negative effects on the client’s life. 

To start with this can seem strange and almost feel like the therapist is only interested in their ‘bad bits’.  However, it is not that the therapist wants to humiliate the client, but rather to do the opposite of colluding with the sometimes-long history and input of well-meaning friends and family who have tried to make them feel better by joining in the game of pretending to look the other way. 

As Carl Jung said :-

“One does not become enlightened by imagining figures of light, but by making the darkness conscious.” 

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.

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