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Subjective Perception, Shared Experience

Nel Tuo Tempo…….In Your Yime

The artist Olafur Eliasson’s exhibition ‘Nel Tuo Tempo’ was described as addressing the ‘subjective perception and shared experience’ of a Florentine building.

He did this using light, colour and shadow. Some of the twenty exhibits were complex structures, others were more about how we see the building in which the exhibition was staged. In one room, a series of lights outside the building cast shadows of the windows on an adjacent surface, be it a wall, floor or screen. The windows were high on the wall, but the shadow was right there in front of us. Detail that wasn’t possible to see in the window became crisp and clear in the reflection and shadow. The minute particles in the glass were visible in a way that was impossible to see without the artist’s intervention.

Artistic works can resonate with us emotionally in ways that are unexpected. These exhibits not only provoked an emotional response, but also raised question about what we could understand about the fabric of the building.

Moving between detail

Psychotherapy is about how we experience and relate to our emotions and that through our emotional world we can gain insight into the ‘fabric’ of ourselves. We begin thinking about how we feel now, what is going on in our world and how we relate to it. The gentle exploration of emotions, history and our lived experience gives a sense of what makes us who we are. Like the exhibits in the museum, we can be curious about so much more than what we see.

You could observe people moving in close and seeing the details of the glass panels, then standing back and looking at the window as a whole felt. This felt like moving between detail in a similar way to how we move between thoughts and feelings during psychotherapy. The detail of daily life, which puts emotional demands on us, alongside a wider view of life and history, shifting between thoughts to build a complete picture. Like the artist does, it’s about creating a space in which we can be curious about what is there and what is less easy to see, moving from what is subjective into something shared. Asking ourselves if it’s possible to not fully understand and remain curious.

Subjective Perception, shared experience

The connections and considerations of psychotherapy and art are numerous and much commented on. This exhibition brought to mind the fact that both art and psychotherapy can give us a much greater insight into our emotional world, by moving beyond what is seen and what is not seen, but is felt. It can also reveal some of how when we engage with certain art works, we also mirror what goes on therapeutically between the practitioner and the client. Shifting between detail, emotions and understanding, the subjective perception becomes the shared experience.

Psychotherapy is about moving from the subjective to the shared. Being heard and seen as a means of gaining a deeper understanding of who we are and our relationship with our selves and those around us.

 

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove . To enquire about psychotherapy sessions with David , please contact him here, or to view our full clinical team, please click here.

 

Further reading by David Work –

In support of being average

Collective grief

The challenge of change

Thinking about origins

Bridging Political divides

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Finding Contentment in the Age of Discontent

The official definition of contentment is “freedom from worry or restlessness: peaceful satisfaction”. I would define contentment as a state of inner quiet and peace, and a satisfaction with oneself and with life. This is not linked to material satisfaction, which is usually temporary and unsubstantial, but more of an acceptance of who one is and a coming to terms with choices and situations in one’s life. This is usually linked to how a person perceives themselves, others and the world. One example would be the ageing process. Some people may struggle with getting older, and all the changes that our bodies go through. Others may see ageing as a natural process and one that can be embraced and even enjoyed.

How can we practice contentment in our everyday life?

As said above, contentment is linked to how we perceive ourselves and others. Freedom from worry or restlessness comes by cultivating patience and working on how we perceive things. It is also linked to an ability to trust in oneself and those who are close to us. Building and maintaining good relationships, spending time in nature and engaging in meaningful activities are some ways of achieving contentment.

Can external factors (politics, economy, capitalism etc) affect how we can feel content?

Contentment may sound like a luxury when there are serious external factors affecting our survival. However, if our basic needs are met and there is no imminent threat to our life or livelihood, contentment can be cultivated and maintained despite the ups and downs of political and economic factors. Contentment comes from within, so although external factors impact how we feel about the world and ourselves within it, it is also important to hold the bigger picture in mind and remember that we live in an ever changing world with no ultimate guarantees or certainty. I have seen people who are very content and live with very little under difficult circumstances. I have also seen people who have everything they can wish for materially but live in a contact state of anxiety and worry. This is not to say that environmental factors do not impact the way we feel and I believe that improving social and political factors can and will lead to a better society with is happier generally.

Feeling contentment in a materialistic world

I hope there is a movement towards prioritising contentment over material gain, however the rise in inequality around the world tells a very different story. Maybe there are certain sections of society who are able to make the changes they need in order to live better lives. Mental health has been in focus for a while now, and some people are realising that living a stressful life comes at a high cost.

If you want to cultivate contentment…

Start looking at what causes you discontent. Then look at these feelings in some depth – are these feelings about self-perception or external changes that you need to make? Work towards cultivating qualities and activities that lead to more contentment. And finally, simplify your life.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.
Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading by Sam Jahara

What causes low self esteem?

Online therapy: good for some but not everyone

The psychology of mindful eating

Defining happiness

What are the benefits of counselling and psychotherapy?

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The Medicalisation of Mental Distress

The foundation of the paradigm shift in how we now view mental health, or as I prefer to consider to consider my field, emotional distress, is one where the problem is increasingly located in the individual as a disorder, rather than in the environment that the individual finds themselves.

The inception of this paradigm in thinking began with the publication of the third version of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) produced by the American Psychiatric Association (APA) which had a specific focus on meeting the needs of a wider clinical audience in the field of mental health. It was never specifically intended as a guide to clinical treatment and despite the introduction of specific clinical categories, there was an assumption that prior clinical wisdom across the field would endure, however, in practice it was the clinical categories that took precedence.

In no other field of medicine – which is the direction that mental health has taken – is symptomatology clustered together as it becomes fundamentally unreliable and invalid in understanding what may bring about a syndrome, condition, or as the DSM prefers to refer to it – a disorder.

For example, how mental health disorders are clustered is based on symptoms and were this to be replicated in the field of physical medicine, we would have groupings of ‘fever disorders’, ‘limp disorders’ or ‘headache disorders’ – an idea that would be absurd and yet is the basis for psychiatric classification.

The reality is that there is no consensus in psychiatry about what exactly causes ‘disorders’ and yet the list of disorders continues to grow with every revision of the DSM and with it more and more ‘disorders’ become both labels and terms of abuse in popular culture – after all the problem is now firmly located in the individual. We have seen an explosion of disorders from around 106 in the 1970’s through to 365 in the latest incarnation of the DSM (DSM-V)! And, not only has the number of disorders increased exponentially, but in parallel so too has the bar been lowered at which point a patient qualifies for having a particular disorder.

In clinical practice we now see the normalisation of these disorders with patients using disorder terminology to ‘self diagnose’ so rather than presenting for therapy with a statement such as ‘I notice that I feel very shy in social situations’, we are increasingly presented with statements such as ‘I have social phobia’. The problem with this is that it can serve to eradicate curiosity around why a person may feel shy in certain situations and inherently positions them as ‘wrong’ rather than suggesting a position of openness towards how this may be adaptive behaviour learnt during childhood.

Under pressure

The profession of psychotherapy is increasingly under pressure to comply with this new world of diagnostic criteria in that the language has been adopted by general practice in medicine, public health and by insurance companies. The latter meaning effectively that patients cannot get psychotherapy sessions reimbursed without a patient meeting the criteria for a disorder.

Arguably what has underpinned this shift in the field of mental health is how the sector has responded to meeting the needs of the economy, rather than those of the sufferers. The focus of public mental health and overarching classification system for psychiatry has shifted from being patient centred to being directly linked to economic productivity.

An example o this is how in the UK, The NHS’ mental health initiative ‘Improving Access to Psychological Therapies’, now renamed Talking Therapies for Anxiety and Depression has its foundations in getting people back into work. Whilst there is nothing intrinsically wrong with a drive to enable people to return to the workplace, in many instances it is a normal human response to environmental stressors that lead a person to feel anxiety or depression. This is the crux of the schism – are mental health disorders located in the individual and therefore indicative of a failing or are they responses to the external environment?

Suffering has been turned into a commodity

The problem is located in the individual rather than seen as an adaptation to past or present environment. This eliminates both a capacity for curiosity as to cause and blame – a person simply has a disorder. From a macro systemic perspective governments can provide a health service that treats’ the problem in the individual rather than consider how societal issues lead directly to emotional suffering – mental health problems.

Secondly, the industry that benefits from the drive towards specific disorders located in the individual is the pharmaceutical industry, which, despite there being little to no evidence of increased efficacy in psycho-pharmacological treatments over the past 40 odd years, This question pervades all types of emotional suffering and the past well-trodden path of linking emotional suffering with a broader and deeper developmental, social and economic narrative is being cast aside in favour of a diagnostic super-highway with disorders based on symptoms and neat psycho-pharmacological solutions. Essentially the invitation is to disconnect the threat response from the threat; to increasingly shift away from asking ‘what’s happened to you?’ to simply ‘what’s wrong with you?’

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

Further reading by Mark Vahrmeyer

Can chatbot companions relieve our loneliness?

What are feelings anyway?

Client or patient; patient or client – does it matter?

The psychological impact of the recession

Why do people watch horror movies?

 

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Does your Life Story make Sense?

Why are stories so important to us humans?

Human beings are the story species. From the earliest mythic hunts retold around tribal fires to the modern-day family evenings spent bingeing on the latest Netflix series, stories have captivated us. And yet, when it comes to our own life story, we are more liable to tell well-practised narratives that are unable to explain our struggling relationships, our lack of fulfilment or a life we feel adrift from.

As the human mind and its cognitive powers exponentially increased over millennia, humans found themselves increasingly at an evolutionary advantage. Like no other species, humans were able to learn from the past – through memories recalled and pored over – and imagine and shape future possibilities. This way of experiencing ourselves has placed us at the centre of our own story-world with us as the protagonist of a story moving from the past to the future in a continuous present. This uniquely human experience, where we can out-think our competitors, also tends to mean that we get pulled along by the mesmerising, dreamlike narrative.

Is what we experience and do in our awareness?

Though we believe we live in our own lives close-up and in technicolour, the truth is that much of what really happens is hidden from us. This can be a difficult thought to accept. We get a sense of this being true, however, when we try hard at our relationships, for example, but they keep breaking down in similar patterns, or when we achieve a life-long goal but it doesn’t make us happy. We can get a sense that our stories don’t match up with our experience.

The majority of the processes that the body and mind carry out – such as controlling our heart rate to deciding if we trust a person we’ve just met – are performed out of our awareness. This can be likened to an iceberg where only one tenth of its mass is visible above water. Nine tenths are out-of-sight below the surface.

How the past presents in the ‘now’

Another key factor is that many of our life decisions were made in childhood. This might sound strange, perhaps even outlandish, but think about it. Did you decide the family and culture you were born into? Or did you choose the personalities who surrounded you and their specific needs and struggles? Of course not. You – like all of us – did the only thing you could as a child: you adapted to your environment to try and get your needs met. While the impact of that process and what the cost was to you is often unseen.

Within early and intimate relationships, we do the best with what’s on offer to receive some level of acceptance and approval. These hidden life decisions, based on the logic of a young, immature mind, set us on a course for life as we try to make sense of experiences and create an unconscious working model of how we can be in relationships with others and who we are in those relationships. As a consequence, our self-stories have likely faced little challenge through their life journey to where we are at this very moment.

Through our life, we have been surrounded by other people’s stories – in our family, with friends, in the broader culture. These can have a positive, reinforcing impact on us. They can also overly influence us, make us maladapt and even make us lose touch with our own stories. Or trying to make our life fit someone else’s story.

How psychotherapy is about your story

People come to psychotherapy often due to problems encountered in their immediate lives, such as suffering from depression or a relationship breakdown. These issues however often point to deeper, underlying issues. Therapy offers the opportunity to look at what is going on underneath the one tenth of the iceberg. We do this together, therapist and client, in a collaborative process, using curiosity and compassion. It is through this unfolding process that a fresh and more connected story can emerge.

Through this therapeutic re-storying process, you engage with your personal narrative as the adult you are now, not the younger version of yourself who found themselves locked in rigid narrative episodes. As Jeremy Holmes, psychiatrist and writer on attachment theory and narrative, said, “Each story is there to be revised in the light of new experience, new facets of memory, new meaning” in a process of “narrative deconstruction and construction”. It is through this therapeutic work of review and rebirth that “narrative truth” and new meaning can surface and your story not only becomes understandable and real but it again becomes yours.

The mythologist and academic Joseph Campbell, who wrote about the ‘monomyth’ or common hero stories common across cultures, said, “I don’t believe people are looking for the meaning of life as much as they are looking for the experience of being alive.”

And perhaps this is a key aim of working with story in therapy: through opening up and meeting your self-story afresh, you can make sense of it, reclaim it and play an active part in its ongoing development. This offers the possibility of living a fuller and more engaged life, where you feel more here and more alive.

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

Thad is an experienced psychotherapeutic counsellor and a registered member of the British Association for Counselling and Psychotherapy (BACP). He works long-term with individuals in our Brighton and Hove practice.

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Practical Examples for ‘Food and Mood’

This blog follows on from my previous one called ‘Food and Mood‘ and provides you with food examples.

Wholegrain cereals, peas, beans, lentils, nuts, seeds, fruits and vegetables are rich in a range of vitamins and minerals that your body needs to function well. They also digest slowly, helping to provide a slow and steady glucose supply to your brain and body.

Start the day with breakfast, such as wholegrain cereal with milk and fruit, multigrain toast with a poached egg, or fruit with yoghurt. Have no more than 150ml of fresh fruit juice or smoothie to drink.

Include some starchy food (such as boiled potatoes, rice, pasta, and granary or multigrain breads) at lunch and dinner. If you are short of time, then go for a sandwich or jacket potato (filled with fish or low fat cheese and salad) or even a bowl of cereal and some fruit.

Between meals include snacks such as fruit, vegetables, nuts, yoghurts, and oatcakes or crackers with low fat cheese, meat or fish.

Caffeinated drinks, such as coffee, cola, energy drinks, tea and chocolate, should be limited.

Other non-caffeinated drinks, such as fruit squash, lemonade or herbal teas are good alternatives.

Limit your intake to no more than two to three drinks on no more than five days per week. It is however important to remember that alcohol itself is a depressant and may contribute towards depression or make your symptoms worse.

Eat regularly throughout the day to make sure your brain has a steady supply of energy.

Include starchy carbohydrates, protein and vegetables or salad at each meal.

Choose wholegrains, pulses, beans, lentils, and fruit and vegetables.

Minimise processed/packaged foods and instead eat a variety of the items listed above to get a range of different vitamins and minerals.

Eat a good balance of healthy fats to maintain the cell structure of your brain. Include oily fish (omega 3 fatty acids) and unsaturated fats in your diet.

Drink plenty of fluid (six to eight glasses non-caffeinated drinks) to keep hydrated and allow your brain to work as best as it can.

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.

 

Further reading by Rebecca Mead –

Online vs in-person therapy

Loneliness and CBT

Is that a fact or an opinion?  
As we come out of lockdown, will a number of us be feeling socially anxious?

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Food and Mood

The links between mood, mental health, sleep quality and nutrition are areas of research interest. Associations between the type and quality of a person’s diet and risk of anxiety and depression are increasingly described in literature. Complexities around the multidirectional relationship between diet and mental health are becoming more understood (Firth et al 2020) and it has been long established that poor sleep increases inflammation and stress hormones in the body.

Brain function requires a steady supply of glucose as its primary fuel which comes mostly from starchy carbohydrates. Energy which is slowly released, such as low glycaemic index carbohydrates, provide the optimal energy release for use by the body https://glycemicindex.com/. The brain also requires dietary fats as it is made up of 50 per cent fat, with brain cells needing fats to maintain their structure. Data supports unsaturated fats and omega-3 helps to ensure the brain is well nourished. Whereas trans-fats found in processed and packaged foods (meats, cakes, biscuits) seem to be harmful to brain structure and function.

Protein is essential for the growth, maintenance, and repair of all body cells, including the brain. Total protein intake and the quality of protein intake is important to ensure the body receives all the essential amino acids required for health. Good sources of protein include fish, chicken, lean red meat, meat substitutes, beans, quinoa, and nuts. Furthermore, protein contains tryptophan, an essential amino acid which is a precursor of serotonin synthesis and is thought to help with less depressive symptoms and anxiety. Tryptophan sources include fish, poultry, eggs and game, some green leafy vegetables such as spinach, pulses and seeds.

Specific evidence looking at nutrients directly linked to mental health include B vitamins (including folate) and zinc with research suggesting that these nutrients are important in managing depression. Vitamin D has also received attention as to whether vitamin D deficiency causes depression. There is no evidence that this is the case, however there is a correlation between people who have depression and low levels of vitamin D. This is likely to be a causal effect from the social withdrawal and isolation from feeling depressed. There is evidence that not having enough vitamin D leads to depression symptoms. Eating a colourful variety of fruit and vegetables at least 5 portions per day (1portion = 80g), consuming foods fortified with vitamin D and getting safe sun exposure helps provides a wide range of vitamins and minerals sufficient for health and well-being. In addition, some researchers think that omega-3 oils, found in oily fish, may also help with depression. Oily fish twice per week such as salmon, sardines, mackerel, and trout is recommended.

A healthy brain contains up to 78 per cent water, therefore dehydration may also affect mood. Caffeine can lead to dehydration, withdrawal headaches and to low or irritable mood when the effects wear off. Drinking too much alcohol causes dehydration and can lead to B vitamin deficiencies, which increases depressive feelings or anxiety. Alcohol should be limited to within safe limits of units per week along with at least two alcohol free days per week.

Eating and drinking pattern is also important. Regular eating ensures optimal blood sugar control and as described above, links to our body’s functions, including brain health.

Avoiding over-eating and eating a main meal by 7.30pm encourages better sleep quality, which in turn supports our body’s natural circadian rhythm or body clock. Lack of good sleep also affects how much we eat. Research at King’s College, London, found that even partial sleep deprivation increased daily calorie intake of the equivalent of four slices of bread.

A recent area of interest is the link between our gut microbiome and mental health. As well as supporting our gut health, the microbiome is linked to stress and sleep quality and conversely sleep deprivation is known to negatively affect the gut microbiome after only two days of reduced sleep quantity and quality.

Such preventative measures to help with optimising mental health, gut health and overall well-being is key to maintaining a long-term positive lifestyle and will pay dividends in your overall health and happiness.

For further food examples, please refer to my blog called ‘Practical Examples for Food and Mood‘.

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.

 

Further reading by Rebecca Mead –

Online vs in-person therapy

Loneliness and CBT

Is that a fact or an opinion? 

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

 

Resources:
• https://www.bda.uk.com/resource/fat.html
• https://www.bda.uk.com/resource/omega-3.html
• https://www.bda.uk.com/resource/fruit-and-vegetables-how-to-get-five-a-day.html
• https://www.bda.uk.com/resource/vitamin-d.html
• https://www.bda.uk.com/resource/probiotics.html
• https://www.bda.uk.com/resource/the-importance-of-hydration.html
• https://www.bda.uk.com/resource/depression-diet.html
• https://www.bda.uk.com/news-campaigns/campaigns/one-blue-dot/sustainable-
september/nutritional-considerations-for-dietitians.html
• https://www.nhs.uk/live-well/alcohol-advice/the-risks-of-drinking-too-much/

References

Al Khatib HK, Harding SV, Darzi J, Pot GK (2017) The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr;71(5):614-624. DOI: https://doi.org/10.1038/ejcn.2016.201

Appleton KM, Rogers PJ, Ness AR (2010) Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. American Journal of Clinical Nutrition. 91(3):757-70.

Arens U (2018) Authorised EU health claims for carbohydrates and maintenance of normal brain function. In: Foods, Nutrients and food Ingredients with Authorised EU Health Claims – volume 3. Woodhead Publishing.

Cuomo A et al (2017) Depression and Vitamin D Deficiency: Causality, Assessment, and Clinical Practice Implications. Neuropsychiatry. 7(5) 606-614.

Firth J, et al (2020). Food and mood: how do diet and nutrition affect mental wellbeing? BMJ; 369;m2382 doi:10.1136/bmj.m2382.

Gomez-Pinilla, F (2008) Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci 9 (7) 568-578.

Kraguljac NV, et al (2009) Efficacy of omega3 Fatty acids in mood disorders – a systematic review and meta analysis. Psychopharmacology Bulletin. 42(3):39-54.

Lespérance F, et al (2011). The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry. 2011 Aug;72(8):1054-62. doi: https://doi.org/10.4088/jcp.10m05966blu

Letchumanan V, Thye AY, Tan LT, et al (2021) Gut feelings in depression: microbiota dysbiosis in response to antidepressants. Gut;70:A49-A50.

Lin PY, Huang SY, Su KP (2010) A meta-analytic review of polyunsaturated fatty acid compositions inpatients with depression. Biological Psychiatry. (68(2):140-7.

Lindseth G, Helland B, Caspers J (2015) The effects of dietary tryptophan on affective disorders. Arch Psychiatr Nurs. 29(2):102-7. doi: https://doi.org/10.1016%2Fj.apnu.2014.11.008

Martins JG. (2009) EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. Journal of the American College of Nutrition. 28(5):525-42.

Mischoulon D et al. (2009) A double-blind, randomized controlled trial of ethyl-eicosapentaenoate for major depressive disorder. Journal of Clinical Psychiatry 70(12):1636-44.

Murakami K, Sasaki S. (2010) Dietary intake and depressive symptoms: a systematic review of observational studies. Molecular Nutrition & Food Research 54(4):471-88.

Penckofer S, et al. (2010) Vitamin D and depression: where is all the sunshine? Issues Ment Health Nurs. 31(6):385-93. doi: https://doi.org/10.3109%2F01612840903437657

Pouwer F, et al (2005) Fat food for a bad mood. Could we treat and prevent depression in Type 2 diabetes by means of omega-3 polyunsaturated fatty acids? A review of the evidence. Diabet Med. 2005 Nov;22(11):1465-75. doi: 10.1111/j.1464-5491.2005.01661.x

Rocha Araujo DM, Vilarim MM, Nardi A (2010) What is the effectiveness of the use of polyunsaturated fatty acid omega-3 in the treatment of depression? Expert Review of Neurotherapeutics 10(7):1117-29.

Rogers, PJ. (2007) Review: Caffeine, mood and mental performance in everyday life. Nutrition Bulletin 32, pp.84-89

Rondanelli M, et al. (2010) Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr 29(1):55-64.

Royal College of Psychiatrists (2019) Alcohol and depression. [online] Available at: https://www.rcpsych.ac.uk/mental-health/problems-disorders/alcohol-and-depression [Accessed 27 March 2023]

Somer E (2000). Food & Mood: The Complete Guide to Eating Well and Feeling Your Best, Second Edition

Walker JG, et al (2010) Mental health literacy, folic acid and vitamin B12, and physical activity for the prevention of depression in older adults: randomised controlled trial. Br J Psychiatry Jul;197(1):45-54

Wurtman, RJ., et al (2003) Effects of normal meals rich in carbohydrate or protein on plasma tryptophan and tyrosine ratios. American Journal of Clinical Nutrition 77 (1) pp.128-32

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The End

Just as what goes up must come down, so whatever begins must end.

Each of us comes to deal with this existential reality imposed on our own lives and all the living beings that we care for. As truly relational creatures we humans encounter the inescapable fact of death in those who die before us and we experience the pain of loss and bereavement.

And grief work itself is a common reason for people to seek therapeutic support. But whether it is through debilitating loss, or one of the many other reasons that spur people to commit to regular therapy, it is a fact that once therapy has begun, an ending of some sort will surely follow in the fullness of time.

Indeed the business of deciding when and how to end therapy is not straightforward.

Aspects that might make it easier to recognise when work is coming to an end can sit within the very beginnings of the work. Sometimes we go to therapy with a higher level of self knowledge about where our difficulties lie. With the help of our chosen therapist we can identify a working goal that will help us to recognise desirable change and a means of measuring how we will know when this has been achieved.

Through this means an ending may well present itself. In some senses this work might be likened to sailing whilst keeping the shoreline always in view.

Perhaps more often than not though, we can approach therapy with a less clear picture of who we are in our lives at that particular point in time, maybe even feeling unsure about quite what is ailing us or why.

In this case the beginnings of therapy can require a willingness to tolerate uncertainty. To deepen our self awareness, we might contract with our therapist to explore more deeply how we are in the world and this might come with a commitment to developing skills for new ways of being. We might compare this approach with setting sail beyond coastal waters to the open sea in search of new horizons.

When client and therapist first meet one question swirls for each of them: how is this for me to meet in relationship with this new person? And when the time comes to end therapy the question’s twin will arrive: how is this for me to end my relationship with this person I have known? An attuning therapist will process both these questions in the service of her client. For the client these valuable questions offer a way to better understand themselves and to evaluate any differences they experience in who they were back then at the beginning and who they feel they are now, at ‘the end’.

Much has been written about endings in therapy in terms of how this might relate to the ways in which both client and therapist have processed loss and bereavement in their own lives. Some family systems therapists have proposed that we can conceive other contexts to finishing therapeutic work than (1) ‘ending as loss’. Their framings suggest to me some useful additional questions for both client and therapist to consider:

• Ending as cure: does the client feel ‘better’ in relation to the way they originally felt ‘bad’?
• Ending as transition: how has this therapy supported the client to grow developmentally?
• Ending as release: does either client or therapist feel relief in this ending and if so, what might this mean?
• Ending as metamorphosis: how have both client and therapist changed through this relationship?

Reviewing these questions here reminds me of the vital importance of beginnings and endings in shaping the content of therapy and the emerging relationship between practitioner and client. Thus therapeutic beginnings and endings always invite our special attention.

As it is ultimately the client who decides to finish in therapy one final question becomes theirs alone: having begun, how much time and space will I allow myself to end?

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

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

 

Further reading by Chris Horton –

I’m the problem – It’s me!

Making sense of our multiple selves

Let’s not go round again – how we repeat ourselves!

How are you?

Out of Sight, Out of Mind

 

Resources –

Fredman G. & Dalal C. (1998) Ending discourses: implications for relationships and action in therapy. 1
Human Systems: The Journal of Systemic Consultation & Management. Vol 9 (Issue 1)

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Some Existential Musings on Love, Generosity, and the Relation Between Self and Other

(Adapted from a presentation given at the SEA conference November 2022) – (Part one)

Anne Carson (1998) wrote,

“‘Now’ is a gift from the gods and an access onto reality. To address yourself to the moment when Eros glances into your life and to grasp what is happening in your soul at that moment is to begin to understand how to live.” (p.153).

Was it Merleau-Ponty (2012) who showed us that, without you, I do not know who I am. I cannot see the back of my head. I need you, the other, to tell me so I can build a picture of it. Yes, it seems we are made in the social.  But that means there will be ruptures too. Losses and suffering will prevail without our control. Can we transform in them? Do I need your help for that too?

Sal Renshaw (2009) describes the relation between self and other as a continual movement intrinsic to our becoming. Not only does the relation between self and other reveal the movement of becoming. It also signifies the impossibility and impermanence of the unified subject or absolute being. Encountering self and other reveals difference, perceived “somewhere in the space between that which returns to us that which we recognize as the same, and that which escapes us” (Ibid, p. 2).

Sometimes difference is felt as a conflict, sometimes as a threat, sometimes as an interest and an opportunity. But difference can be, and is, an opening into our becoming.

It may entail a complex exploration: maintaining positive regard for the other without being implicated in a kind of sacrificial logic rooted in Christian morality and its derivatives and without being caught in the web of patriarchal narratives. As Renshaw states (2009) writers such as Helene Cixous inform us of the extent to which “women have traditionally borne the brunt of sacrificial logic in a patriarchal structure” (p. 7).

How can we hold a space for a version of selflessness that is generous, alive, affirmative and does not fall into self-abnegation? A difficult task, no doubt. But an important one: “loving the other as other, allowing them and oneself to be born into the present in love” (Renshaw, 2009, p. 176). Perhaps they have forgotten or never knew that difference is the astonishing source of their love.

Isn’t there always more to the story, yes, more to come, more to become?

Is not life itself a movement of becoming …

Part two of this blog can be found here.

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

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

 

Further reading by Susanna Petitpierre –

On living as becoming (part two)

On living as becoming (part one)

Some thoughts on becoming (part two)

Some thoughts on becoming (part one)

What is the Menopause? (part one)

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Online Therapy: Good for Some, but not Everyone

Therapy over the phone and in more recent years on video has been around for a long time, but since the recent pandemic it has become normalised with lots of online therapy platforms emerging and an abundance of “mental health” apps.

At Brighton and Hove Psychotherapy we offer both face-to-face and online therapy, and whilst many people can benefit from the latter, this option is certainly not advisable for everyone. I would like to share some of what I have observed about psychotherapy conducted online from my own clinical experience, from supervising clinicians who work with clients online and from many exchanges with colleagues in the field, especially since the beginning of the Covid-19 pandemic. Here are some considerations:

Doing therapy from the comfort of your own home x travelling to see your therapist

The journey to a therapist’s office is a part of the work itself, as long as it isn’t so arduous and exhausting that it becomes unsustainable. The intention and commitment to make the journey each week, the space to reflect, the checking in with self before entering the therapist’s office, arriving at a physical room and being greeted in, or waiting for your appointment, all are rituals that are a part of the process itself. There is also the journey after the appointment, which hopefully is long enough to allow some space to be with yourself before engaging in any other activity. Time poor people will argue that they can fit therapy into their day more easily if it’s done online, however one of the goals of therapy for some individuals could be to look at difficulties in prioritising personal needs, including making time for therapy appointments.

Choosing from a larger pool of therapists x choosing someone locally

Depending on where you live it may be easy or difficult to choose someone to work with. However, the very process of choosing is an important one. I compare some online directories or platforms to fast food. We live in a consumer-led culture where convenience is highly sought after. We want quick results because many of us are time poor, but consider that this is probably on of the most important choices you will make. Therefore, it is worth spending some time and effort choosing a therapist as it might determine the future state of your mental health and even your life.

People who are socially anxious can access help at home

Unless someone has a debilitating condition that keeps them housebound, in which case psychiatric care would be advised, colluding with or perpetuating the existing issue might be counter productive. Encouraging someone with social anxiety to venture out and travel to see a clinician face to face is a small step towards creating a relationship that is safe and manageable for the client, before they risk other forms of social engagements that go beyond the therapy room.

“ The therapist’s office is intimidating ”

Here is another great reason to explore why it is more difficult or intimidating to talk about yourself when faced with a therapist – a real person in the real world. Psychotherapy should enable and encourage people to have better relationships that are real. If the ease of talking more about yourself when you’re meeting someone online could be linked to difficulties forming and sustaining real relationships. Just as we see brilliant poets and writers who can barely utter a word when faced with a social situation, someone who is seemingly confident and capable of relating on the screen, can be very different in person.

Having said all the above, I remain an advocate of virtual sessions depending on the person and type of work. For instance, more cognitive and solution-focused approaches can work well online. Whereas in-depth psychotherapy which draws on unconscious processes is undoubtedly much better done in person. I would not recommend online therapy to those who struggle to maintain clear boundaries, feel easily emotionally overwhelmed, or are dealing with a range of complex psychological issues. People leading chaotic lives usually find it more containing to have the predictability of their therapist’s office environment. I also would not advise anyone training to become a psychotherapist to have their therapy online, and couples work can be difficult virtually, especially if the couple is in the middle of a lot of conflict.

This is not to say that good work can’t take place virtually, but we have to accept that there will always be a missing component and that the therapy will probably not achieve it’s full potential.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading –

The Psychology of Mindful Eating

Defining Happiness

What are the benefits of counselling and psychotherapy?

Why is mental health important?

What makes us choose our career paths?

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Why we need a ‘Secure Base’

At the heart of the process of psychotherapy is trying to see more clearly what our basic needs as human beings are and how they can be met. Most clients seeking treatment are feeling uncomfortable because of difficulties in this domain.

The sense of discomfort is often compounded because, without help, it can be hard to unravel what our core needs actually are. There is no simple users’ manual telling us how our brains and emotions work. This article is an attempt to shed light in this important arena, based on recent pioneering research work.

Our understanding of this subject has undergone a major revolution since, Sigmund Freud – in the 1890s until his death in 1939 – led the way in creating a theoretical framework of the workings of our brain. He postulated that if libidinal needs – such as for food and sex – are not met, the result was neurosis, repression, unhappiness and anti-social behaviour.

In the 1940s, a British psychoanalyst originally trained in Freudian theory called John Bowlby developed a revolutionary alternative framework.

He came up with the idea that, above all, during our growing up period, we need what subsequently came to be called ‘a secure base’. He concluded that more important than Freud’s libidinal desires was the requirement to be looked after, to be connected with others, to be loved and accepted and to be made to feel safe.

Bowlby’s pioneering research was conducted during the Second World War among children orphaned during the Blitz. He believed they were distraught to the point of inconsolability and felt totally disconnected because they were missing their parents’ love and care.

A seminal piece of research which further supported Bowlby’s main ideas was conducted in 1958 using rhesus monkeys. It was found that a distressed monkey infant did not go first to a mother model dispensing food, but rather to one covered in fleecy material which felt warm and comforting (1).

Parallel research also showed that those who did not have a secure base became less likely to explore the world, less sociable and more prone to mental and physical problems.

In an ideal world, our individual needs are met during our childhood by our parents or principal care-givers. But of course, parents often can’t manage. In the vast majority of cases, that’s not because they want to upset or harm us, but rather because their own needs have not been met and their ability to be emotionally available has been compromised. They can struggle to be able to express the right level of ‘good enough’ care.

Bowlby’s ideas have been hugely refined and expanded since his first research papers were published during the Second World War. A distillation of latest thinking in relation to our core needs and the ‘secure base’ is contained in a paper published Stanford University psychologist Carol S. Dweck in 2017 (2).

She states: ‘. . . basic needs are present from very early in life and their criteria for inclusion include: irreducibility to other needs, universal high value from very early in life and importance for well-being and optimal development from very early in life’.

On the basis of her very wide research and reading, she postulates that three ‘basic needs’ – for predictability, acceptance and competence – are the primary components of the secure base:

competence acceptance predictability

To spell that out further, if we grow up feeling that the world is reasonably and broadly predictable – that we are looked after and loved, have food, that there is routine – then we feel fundamentally safe and secure; if we develop so that we believe we can do the tasks required of us, we feel able and equipped to deal with life’s challenges; and if it is communicated to us that we are accepted broadly for what we are in ourselves and in the family and in social settings, we feel comfortable in our interactions with the world and other people.

In turn, feeling ‘safe’ gives us the basis to be able to regulate our primary negative emotions – fear, anger, sadness and disgust – to a comfortable level.

Dweck further says that having such a ‘secure base’ generates further benefits.

  • We feel can control events in our lives as a result of experiencing at sufficient levels predictability and acceptance;
  • We develop self-esteem as a by-product of feeling that we are competent and broadly accepted for what we are;
  • We feel we can trust ourselves and others more easily if we have experienced predictability and the feeling that we are accepted.

Finally if all these pieces of the jigsaw are broadly in place, then we also develop a sense of self-coherence.

In future blogs, I will explain on the basis of latest research how emotional regulation can be achieved through the therapy process.

 

David Keighley is a BACP Accredited counsellor/psychotherapist offering short and long term therapy to individuals and couples using a variety of techniques such as EMDR, CBT and Schema Therapy. He is also a trained clinical supervisor.  He is available at our Brighton & Hove Practice.

 

Resources –

(1) https://positivepsychology.com/harlow-experiment/

(2) https://moodle2.units.it/pluginfile.php/358466/mod_resource/content/1/2017%20Dweck%20PR.pdf

 

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Client or Patient; Patient or Client – Does it Matter?

A topic of certain difference, and at times discussion in the field of psychotherapy, is whether we refer to those we treat as ‘clients’ or ‘patients’.

Why might this matter?

On the face of it, it should arguably matter little to someone attending psychotherapy, as to what the therapist calls them on paper; in the room they will be referred to by name and thus, to some extent, the nomenclature used is academic.

However, psychotherapy is about how the psychotherapist thinks about the person who engages their services and this thinking will inevitably influence how the psychotherapist refers to those who come to see them and vice versa.

Why such different terms?

Psychotherapy was born out of psycho-analysis. And in both classical and modern psychoanalysis, as well as in the language of many psychoanalytical psychotherapists, the term patient is commonly used.

Historically, this is derived from Freud’s use of the term, whereby he situated psycho-analysis firmly in the medical field.

There is an additional term that is used in analysis which is ‘analysand’ – the person who goes for analysis. Whilst it bridges the gap between client and patient, I find it somewhat clunky and it is not a valid term to use in psychotherapy.

Who is the expert?

Much progress has been made in the field of psychotherapy to shift from a ‘blank-screen’ model on the part of the psychotherapist, to a relational approach – meaning broadly that the psychotherapist plays an active role in co-constructing the relationship and works within the context of the relationship to bring about change.

Many in the more humanistic field argue that one of the goals should be to bring about as much equality between the therapists and ‘client’, so as to eliminate the power imbalance.

Whilst a noble endeavour, I think this is naïve, as firstly, we are are there in an expert capacity and those of us who are trained and work at depth, understand that we carry an enormous burden of responsibility to those who engage our services. We are therefore, not equals.

Secondly, depth psychotherapy, using a psychoanalytic model, works with what the client or patient ‘projects’ onto us – something we refer to as transference. In the transference, we inevitably represent one of the parents for the client and it is arguable that the treatment process in psychotherapy is one of re-parenting.

Parents and children are never equal

I believe that roles come with firm boundaries – many of which are frustrating. For example, it is a parent’s role to always be a parent to their child. This role will evolve and change over time and eventually there will be two adults in the relationship, however, this does not imply that there are two equals. Part of the frustration of being a parent (and the child of a parent) is in acknowledging the firm boundary, meaning that a parent should not become a friend to their child, no mater the age of that child. This does not mean that this does not happen in some families, however, I view this as unhelpful.

The therapeutic relationship between a psychotherapist and their client or patient is sacrosanct – as should be the relationship between parent and child. We are there in an important, and at times, critical capacity and co-create with those who come to see us a deep intimate relationship that must be alive, messy, creative, conflictual, loving and hateful – but always and forever boundaried.

Boundaries frustrate but facilitate grieving

Over the past decade of being a UKCP registered psychotherapist, I have seen a fair few people come and go from my practice. Most have stayed for years and, I believe, done some very good and important work.

As in life, the relationships we form with those whom we see week after week matter to us and I have grieved with the end of the work and having to say ‘good-bye’ when treatment ended.

The grieving is necessary as, irrespective of how much we have come to matter to each other, I shall always be in the role of psychotherapist for all of my former patients. Most will never cross my threshold again, however, it is vital that they can hold me in mind in the role they assigned me and that I don’t deviate from that position and ‘befriend’ them. Whilst this may feel seductive to both sides (as it does for a parent and child), the boundary enables the relationship to work and continue working in the capacity it must for the patient.

On why I use the term ‘patient’

I have shown my hand in the previous paragraphs in using the nomenclature of ‘patient’ and shall now explain why I have, over time, shifted in my way of thinking.

Patients come to me because they are in distress. I am there as an expert, not to tell them how to live their lives, but to help them understand how and why they live their lives they way they do and offer them a stable and secure relationship through which to bring about change.

Psychotherapy is about change – it is not about enabling existing behaviour and this needs to be agreed between therapist and patient.

I view the term ‘client’ as representing a grey area when it comes to boundaries – with clients we can ‘have a chat’ and maybe take the relationship outside of the context in which it began. It also seems to me to be very transactional. This is a personal view and not an accusation of anyone who has a preference for this term.

My work as a psychotherapist is to ‘treat’ my patients. I am accountable for understanding their minds and helping them find a way through their distress. If they knew how to do this, they would not need me.

Lastly, rather than being a distancing term, I view ‘patient’ in this context of one towards which I can show the upmost respect. It does not imply, to me, that I am better than them, but it does show that I am willing to take on the responsibility for my part in their treatment and that the boundary will always hold. For me it is ultimately a term of ‘love’, in the way Freud meant it.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer

How to minimise Christmas stress if you are hosting

Can couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

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Why is Mental Health Important?

Mental Health has become a hot topic in the last few years. We often hear about it in the media, and because of more public awareness about mental health issues, more employers are adopting mental health policies and offering employees more support. Whilst mental health used to be seen as something related to mental illness, nowadays people are talking more about the importance of mental health as a part of their overall wellbeing, such as exercise and healthy eating.

But what is mental health?

Mental health is dependent on a certain degree of emotional, psychological, and social equilibrium. It impacts thinking, feeling and behaviour and therefore our capacity to handle stress, maintain good relationships and make decisions, amongst other things.

Good mental health is a vital aspect of us being able to function well in the world, hence it’s importance. There are environmental, social and psychological factors that can affect our mental state, such as:
– Ongoing real or perceived threat or danger to one’s life and livelihood
– Traumatic experiences/ events, recent or historical
– A physical or mental health diagnosis/ symptoms
– Bereavement and loss
– Breakdown in relationship(s)
– Major life change or life crisis
– Financial problems/ stressors
– Work stress
– Loneliness and isolation
– Discrimination and bullying
– Poor sleep and/ or diet
– Sedentary lifestyle/ lack of exercise
– Lack of light and/ or fresh air
– Noise and pollution

It is only human to have experienced one or several of the list above, therefore mental health is of relevance to everyone.

How to Look After your Mental Health?

Environmental and lifestyle factors:
Many people underestimate the impact of sleep, diet, exercise and sunlight on their mental wellbeing. With the increase in the use of screens and less time spent outdoors, especially in the case of children, these very basic factors are not being attended to, with often drastic impact on quality of life. Poor diet, poor sleep and lack of exercise and natural light are interacting factors. Lack of natural light and fresh air affects our sleep, as does the consumption of certain foods such as sugar and caffeine. Exercise can help improve sleep quality and lead us to want to eat better. Good sleep quality helps combat sugar cravings and when we feel rested need to consume less caffeine, etc. Good habits feed other good habits – it’s a cycle.

Social factors:
We all live in society and in communities within society. A sense of belonging paired with a sense of purpose and meaning are significant factors in our sense of mental wellbeing. We all need social connections and to feel a part of something. This became very apparent during the Covid pandemic when we saw many people’s mental health decline because of social isolation. Good relationships and good support systems make us feel safer and cared
about. Helping others, sharing interests, exchanging ideas and working towards common goals helps create a positive social loop where we feel that our life is meaningful and our contributions matter.

Psychological factors:
Most of us have gone through a crisis, a loss or even suffered significant traumatic event(s). Many of us have also experienced challenges growing up in dysfunctional families or under challenging circumstances. These issues when not attended to psychologically, can easily become cumulative and affect our lives in negative ways, often leading to depression or chronic anxiety. Feeling alone with our problems further exacerbates these issues, creating
a negative cycle that is self-perpetuating.

How Psychotherapy can Help

Psychotherapy can help you get and remain mentally healthy in several ways. A skilled therapist will help you address psychological issues such as the ones listed above. Therapy can be very effective in helping people deal with past traumas, life crisis, relationship issues and process loss, amongst many other things. In psychotherapy you can also explore how certain behaviours are affecting your mental health and how to change or improve them.

Sometimes bad habits tell us something about how we were looked after, and therefore how we end looking after ourselves. Finally, it can also help us get to a better place within ourselves and therefore make better decisions. Sometimes issues are multi-faceted, layered, and complex. Being able to distinguish, pick apart and navigate a seemingly hopeless situation is empowering and puts us back in control of our lives.

 

Sam Jahara is a UKCP Registered Psychotherapist, Superviser and Tavistock Certified Executive Coach.

 

Further reading by Sam Jahara

What makes us choose our career paths?

Antidotes to coercive, controlling and narcissistic behaviour

An in-depth approach to leadership coaching

Demystifying mental health

Women and Anger

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How to get a Mental Health Diagnosis

The term ‘mental health’ is pretty broad and encompasses emotional and psychological health.

When people talk about mental health they are often referring to symptoms such as depression or anxiety but rarely do they mean psychiatric disorders such as schizophrenia, for example. Therefore, the answer to how to go about getting a mental health diagnosis is – it depends.

It is possible to go to a GP in the UK and present with symptoms that fit the criteria for anxiety or depression and to receive a ‘diagnosis’ from this doctor. In turn they may ‘prescribe’ counselling or offer you medication such as anti-depressants.

However, receiving a mental health diagnosis is not the same as receiving a diagnosis for a physical disorder. Let me explain.

Nobody has seen a mind.

If you are unfortunate to break a bone due to a fall, it is safe to assume that unless you are encountering an incompetent doctor, you will receive the same diagnosis irrespective of which hospital you attend wherever in the world; a broken bone is exactly that.

When it comes to mental health, the criteria is different as we are really talking about the ‘health’ of the human mind (or in many cases the emotional system), and the problem is that nobody has ever seen a mind.

Most mental health diagnoses are therefore based on the presentation of ‘clusters’ or groups of symptoms that a patient experiences over time. A GP will consider your experiences and the duration over which you have experienced them and on that basis will offer you a ‘diagnosis’.

Whilst this may be helpful in order to access medication of brief counselling, it is unlikely to resolve matters. And bear in mind that most GP’s have had very little mental health training – generally only weeks, compared to the years of training around physical health.

A psychiatric diagnosis

If you have severe symptoms that quite possibly may include delusions, you may be referred to a psychiatrist. A psychiatrist is a medical doctor who has specialised in ‘diagnosing’ psychiatric disorders and on the basis of a diagnosis you will likely receive medication and/ or psychotherapy.

Counselling and Psychotherapy

The parallel but distinct professions of counselling and psychotherapy are both related to mental health and approach treatment of mental health conditions through what is known as ‘the talking cure’. In reality the cure comes about far more through listening, rather than talking on the part of the clinician.

Whilst there is disagreement about the fundamental differences between counselling and psychotherapy – which I have previously written about here – a reasonable differentiation is that counselling is used to as a shorter term treatment working on a more superficial level.

Psychotherapy, as defined by the UKCP _United Kingdom Council for Psychotherapy) involves a similar process to counselling but working with a clinician trained for a longer period of time who is crucially able to formulate, unlike counsellors.

Formulation is the word psychotherapists use to ‘diagnose’ but as we do not tend to work within the ‘medical model’ and recognise that mental health issues encompass both psychological as well as emotional issues, we use a different language and different models to the medical model in order to make sense of a person’s inner world.

Is psychotherapy about getting rid of symptoms?

Whilst most people presenting for psychotherapy simply wish to ‘feel better’, a large part of the process of therapy is to become curious about one’s symptoms in the context of the therapeutic relationship. Psychological or emotional symptoms, much like bodily symptoms, are often there to inform us of something important that needs attending to.

Psychotherapy is fundamentally about working to create a deeper relationship with oneself, through the relationship with the psychotherapist. And through this deeper relationship we can come to understand our symptoms better as signals that are telling us something about our life: often either about something in the past that has not been processed or worked through, or something about what we yearn for in the future.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer – 

How do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

Mental health problems in Brighton

by Leave a Comment

What is Psychotherapy?

Psychotherapy is a method of treating mental health issues through psychological, rather than medical means.

Known as ‘the talking cure’ a psychotherapist’s role is to work with patients or clients, generally on a minimum of a weekly basis, over a period of months or years.  The work takes place within what is called a ‘therapeutic relationship’, characterised by the psychotherapist listening and thinking carefully about the client’s experience and working with them to make sense of it.  Thus, whilst known as the talking cure, it could be more accurately described as the listening cure.

Psychotherapy developed from psycho-analysis, which is similar in nature, but involves multiple weekly sessions (up to five) and can often last for up to a decade.  Freud referred to (psycho) analysis as a ‘cure through love’ and this applies to psychotherapy in much the same way.  The relationship between psychotherapist and client is unique and one in which all the focus, attention and thought is about the client’s process.  The closest example to this type of relationship is between mother and child, or primary-caregiver and child, and it is often due to failings in this primary attachment relationship that clients seek out psychotherapy in later life.

Do I need to have a mental illness to go into therapy?

Whilst it is very common for people to seek out the assistance, support and expertise of a psychotherapy due to them feeling like they are in a crisis in their life, the crisis is often only the catalyst that brings a client into psychotherapy.  Indeed, it was once again Freud who said that psychotherapy (analysis) only begins once the patient’s crisis has passed.  What did he mean by this?

One of the goals of psychotherapy is to bring space and contemplation into a person’s life so that they feel less at the mercy of their emotions and more able to hold themselves in mind.  Once a crisis has passed, clients can often start to focus on using the therapeutic relationship and space to examine why they think and feel the way they do and to develop a construct or idea about who they would like to be.  Psychotherapy is thus about getting in touch with our appetite, or passions.

Whilst most people access psychotherapy due to an issue covered by the term ‘mental health’, most remain for months or years in order to learn to have a better relationship with themselves and others.

How does psychotherapy work?

Human beings are relational beings, meaning that we are, from the moment we are conceived, in relationship to another.  Relationships shape not only our worldview and our relationships to others in our life, but also shape our relationship to ourselves.

If we have learnt through early relationship(s) that others are unsafe and/or that we are not worthy of love then this shapes our worldview of all our relationships going forward.  If we have been wounded in relationship then it takes another (therapeutic) relationship to work through all the hurt and to discover a new way of relating through how we are related to.

What training do psychotherapists have?

In the UK, the terms of psychotherapist and counsellor are not legally protected meaning that virtually anybody can use these terms with impunity.

Whilst some clinicians use the terms of counsellor and psychotherapist interchangeably, the UKCP (United Kingdom Council for Psychotherapy) is the largest professional body for psychotherapy clinicians and lays out its training and membership expectations for clinical psychotherapist very clearly.

Psychotherapists in the UK (who are UKCP members) train for a minimum of four years at post-graduate level, undergoing their own psychotherapy throughout this period, obtain at least 450 clinical hours of experience and undertake a mental health placement.  Most UKCP psychotherapists will therefore have a minimum of a Masters degree in the field.

What’s the difference between psychotherapy and counselling?

There is much disagreement about the differences between counselling and psychotherapy and this is something I have previously addressed here.  Fundamentally, psychotherapists are trained to work at a deeper level than counsellors and have been trained to formulate – our word for diagnose.

How do I find a psychotherapist?

Finding a psychotherapist can feel daunting.  Brighton and Hove Psychotherapy is a physical clinic comprised of a group of skilled clinicians offering psychotherapy across the greater Brighton and Hove area and Lewes.  You can use our search function to find a psychotherapist near you.

Alternatively, the UKCP holds a directory of all registered UK based psychotherapists which can be found here.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer – 

How to improve mental health

How do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

by Leave a Comment

How to Improve Mental Health

Mental health is constantly in the news and not a day goes by without an article, blog post or news piece on the topic.

The great contradiction is that whilst we know more about mental health now and how to manage it, the busy, chaotic and plugged-in world we live in does little to help our mental health. Nor is it often that clear what exactly is meant by the term ‘mental health’.

Mental health is a ‘catch-all’ phrase that encompasses our emotional, psychological and social wellbeing. It therefore includes our mind, our emotional system and our social world. It stands to reason that good mental health means attending to all three, but I would argue that there is a fourth – the body – which is intrinsically connected to good mental health.

When people refer to their mental health, what are they really saying?

As I write this article, the media will have us believe that mental health is currently under crisis in the UK. Waiting times to see a mental health practitioner are at an all time high, people are increasingly struggling to cope with high stress levels and many folks remain isolated or fearful for social contact following the numerous and lengthy Covid lockdowns.

Poor mental health can manifest in a range of symptoms from low level depression and anxiety through to diagnosable psychiatric illnesses. For most people concerned about their mental health, the latter is fortunately not very common and therefore we can think about how you can take responsibility for improving your mental health.

Steps you can take

Sleep is crucial to good mental health and it is no coincidence that many of us struggle with poor sleep which ever time can have a very detrimental impact on our mental health (as well as our physical health).

Establish a sleep routine and stick to it – going to bed at a set time and avoiding stimulants such as caffeine before bed can be very helpful. Another stimulant that you would do well to avoid is watching the news prior to bed – whilst informative, the news impacts significantly on our nervous system and can leave us feeling ‘activated’ exactly when we need to get to sleep.

Exercise is good for the body, but also the mind. Many folks are put off exercise as they see it as something that involves strenuous exercise in a gym, however, this need not be the case.

Exercise does not need to cost anything and can be a way of combining being in nature with moving the body. A brisk walk or sea swim (in the midst of this heatwave) are both good forms of exercise.

Eating sensibly is another activity associated with physical health but which can also have a significant impact on our mental wellbeing. Stimulants such as coffee and sugar impact on moods and with this can in turn impact on sleep patterns, so be aware of when you consume stimulants and avoid eating anything late into the evening.

Socialising is not only enjoyable but is also good for our mental health. Human beings are relational, meaning that we are born into relationship and require relationship(s) to develop. Even when we are alone, in a psychological sense we are in relationship to someone – we call this an internal object – and constitutes how we hold ourselves in mind and make the ‘best’ choices for ourselves.

The mind body connection

All of our emotions stem from the body. They start as sensations and we then notice them and group them into emotions; feelings are the words we use to describe emotions.

Each feeling, or set of emotions, has its own somatic (body) blueprint, which means to say that each feeling is made up of a unique set of sensations in the body. For example, anger, whilst ‘feeling’ different for everyone has the in-common body sensations of tight stomach, tight jaw, clenched or tightened fists and a narrowing of the eyes. Conversely, joy, is felt in the body as an openness and moving towards something or someone. Joy tends to bring a smile to our face and it is as if our whole body opens to receive more of what we are enjoying.

Everyone has a different shaped and sized body and everyone has a body that can perform different tasks depending on fitness, ability, age and (dis)ability. However, unless a person has a ‘good enough’ relationship with their body, it is simply not possible to have good mental health.

Hence why the body must be included in psychotherapy and feelings stemming from the body attended to.

Practicing gratitude towards your body for what it can do and how it looks after you, getting curious about what your body needs and wants and treating your body with respect, are all significant pathways to good mental health.

Talk to someone

When things get too much it can be good to talk and whilst a social and support network is important, some things need to be thought about with a mental health professional such as a psychotherapist.

A psychotherapist is someone who has trained at postgraduate level for a minimum of four years and undergone their own journey of analysis or psychotherapy throughout their training and ideally well beyond. In the UK, psychotherapists are registered with the UKCP who hold a directory of qualified clinicians or you can search for one using the search function on our own website.

People generally enter in psychotherapy because of a crisis of some sort in their life, however, they tend to stay because they find the therapeutic relationship so invaluable in not only improving their mental health but in developing an appetite for their lives. As Freud said, psychotherapy (analysis) begins after the crisis has passed.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer – 

How do I find the right psychotherapist?

Why do people get the birthday blues?

Is happiness the opposite of depression?

Are people with mental health problems violent?

Mental health problems in Brighton

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