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

I don’t know about you, but I have been riding the Covid-19 emotional roller coaster since March 2020 with very little roadmap, whilst trying to guide those who I work with like “the blind leading the blind”.

I also see my own psychotherapist and supervisers in the exact same boat. They are supposed to know more than me, but actually I get the sense that we are all struggling together.

Nonetheless, as a mental health professional, business owner and with all my family living in different countries, I have been dealing with my own set of challenges as a result of Covid-19, as well as trying to be the best support I can for my clients. I have also felt grateful for the support of a therapist throughout this period and couldn’t imagine a better time to be in therapy other than now.

All helping professionals are going through their own predicaments throughout this crisis whilst trying to help others as well. This can be both rewarding and also incredibly taxing. I noticed feeling more tired than ever at the end of last year – an exhaustion which felt both familiar and entirely new. Self-care has become more important than ever.

We all had to adapt to new working practices and navigate the unknown over past months. This has been both unsettling and reassuring in that most of us have survived and gotten through in our own way. There have been losses for sure and they have taught us that we can survive them too.

Professionals in support roles have been working through the pandemic feeling mostly under-resourced themselves. Under such unusual set of circumstances this can only be expected. It has been humbling.

Having weekly psychotherapy sessions has helped and continues to help me enormously. Therapists need their own therapy now more than ever. If we are to continue to be of help to our clients, first we need to have the support ourselves.

 

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.

 

Sam Jahara is a UKCP Registered Psychotherapist and clinical Superviser. She works with individuals and couples in Hove and Lewes.

 

Further reading by Sam Jahara

What shapes us?

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Face to Face and Online Therapy Help Available Now

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Nietzsche and the body

Here I reflect, a little,  on a few of Nietzsche’s words on and as the body. These reflections are not conclusive or comprehensive. The only agenda is inspired by Nietzsche,  to perhaps stimulate the reader’s curiosity and desire to experiment and explore.  Please do read my previous article – ‘Why read Nietzsche?‘

“The body is a great intelligence, a multiplicity with one sense, a war and a peace, a herd and a shepherd.” (1)

Nietzsche felt many philosophers, including Plato and Descartes, failed to grasp the significance of the corporeal nature of human beings and the pivotal role of affect.

In much of his writing he explored the impossibility of pure thinking, reminding us that we are embodied thinkers, and our senses and emotions are as much a part of this reasoning as thought, if not more so.

Nietzsche treasured being and walking in nature. In fact, Nietzsche (1967) seemingly suggests physical movement was necessary for a thought to be accepted as plausible when he said –

“Give no credence to a thought that was not born outdoors while one moved about freely”. (2)

He depicted how the air we breathe, the food we eat, the place we live and what we ingest through reading, writing and talking all have an impact on our physiology and philosophy and vice versa. Nietzsche (1974) even advised:

“Our first questions about the value of a book, of a human being, or a musical composition are: Can they walk? Even more, can they dance?” (3)

Nietzsche wrote a poem called ‘Writing with one’s feet’. It emphasised the principle of embodiment through metaphor and description of the anatomy of his writing.

“Not with my hand alone I write: 
My foot wants to participate.
Firm and free and bold, 
my feet Run across the field – and sheet”(4)

I understand Nietzsche as a passionate defender of the embodied lived experience. His philosophy is one that elevates both known and unknown instincts and drives that interplay with our bodily lived experiences. In fact, Nietzsche seems to suggest the self is the body.

“Behind your thoughts and feelings… there stands a mighty rule, an unknown sage – whose name is self. In your body he dwells; he is your body”(5)

Nietzsche was not defining the body in a conventional way, such as a physical body or a single unit. He viewed it more metaphorically as a collection of corporeal and psychic forces, including emotions and instincts which are in a continual and often conflictual interplay. He saw the self as a plurality of forces, or more precisely a plurality of (relational) affects. These relational affects each express a viewpoint and seek domination.  Affects, for Nietzsche, are dynamically and continually interpreting and creating perspective. (6)

This multiplicity can sometimes create confusion and conflict, especially if one gets stuck in thinking there is  a such a thing as supremacy, or the right way, or the truth. Perhaps the key is to recognise that they all say many things at once. Rather than seeing this multiplicity of meaning and often unknown elements as something to fear, one could be curious and trust there is something to be listened to in all aspects. This exploration and experimentation is something that therapy can be helpful for.  A potential space to sit in the unknown for a while, exploring, experimenting and experiencing,  and see what might emerge.

Perhaps as Nietzsche suggests this very experience of conflicting affect can dislodge the notion that there is one way to be and create an opportunity for us to be guided into new, more fluid and creative ways of becoming. It can show us there are no limits to novel forms and there is always potential for transformation even within the limitations, obstacles and challenges that we may face. It also tells me that the idea of a rational pure thought that can somehow ignore or overcome the influence of emotions, physical sensations and those forces that reside in the unknown or unreflected, is unlikely. For Nietzsche it seems, nothing is, or needs to be, left behind in this often enigmatic embodied endeavour we might call lived experience.

As I conclude I feel a pressure to tie this short piece up into a nice and neat bow, so that it feels complete and reassuring somehow. However, I also feel the desire to swim. Perhaps the former would be missing the entire point of Nietzsche and the latter highlights his case in point.

 

To enquire about psychotherapy sessions with Susanna Petitpierre, 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

Why read Nietzsche?

Magnificent Monsters

Death Anxiety

A consideration of some vital notions connected to Existential Therapies

 

References – 

1) Nietzsche, F. (1883/2010) Thus Spoke Zarathustra (Ed. B Chapko),Ebook.

2) Nietzsche, F. (1967) Ecce Homo, in On the Genealogy of Morals and Ecce Homo, trans. and ed. by Walter Kaufmann. New York: Vintage Books, 1967

3) Nietzsche, F. (1882/1974), The Gay science. With a Prelude in Rhymes and an Appendix of Songs, trans. W Kaufmann, New York: Random House

4) Nietzsche, F. (1882/1974), The Gay science. With a Prelude in Rhymes and an Appendix of Songs, trans. W Kaufmann, New York: Random House

5) Nietzsche, F. (1883/2010) Thus Spoke Zarathustra (Ed. B Chapko), Ebook.

6) Bazzano, M., (2019) Niezsche and Psychotherapy. London: Routeledge.

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What shapes us?

We all have key figures in our lives, people who either held or hold great importance because of their positive impact on our professional and personal lives. They may have been people who we are either personally or professionally connected to, such as parents, siblings, friends, family members, or teachers, bosses, coaches, therapists and work colleagues, to name a few.

These people become so important to us because we internalise their qualities and also their positive messages to us, whether they were implicit or explicit, verbal or non-verbal.

Therapists are keenly aware that some key elements need to be present in our work in order for a positive relationship to form. We know that many who come to therapy do so because of breakdown or absence of relationship early on, which we can also understand as a scarcity or total absence of some key elements listed below:

Interest and Curiosity

To feel seen, heard and to perceive sense of curiosity towards oneself from another, which is engaged, honest and encourages mutual trust. Delight, enjoyment and even surprise in the exchanges that take place.

Attunement

Usually used in the context of a parent-child relationship, but the word is also used in other contexts. Attunement is a quality where the other person ‘tunes in’ to another, almost as if trying to absorb and understand what the other is communicating on a deeper level. Attuning entails putting oneself aside to hear how the other views and experiences the world.

Consistency

Consistent love and care is something children need in order to feel emotionally and psychologically safe. This continues to be the case for adults, albeit in a different way. The consistency in the care of others is what gives us a sense of belonging and therefore a sense of safety in the world.

Commitment

To feel the commitment of another to a relationship is another form of consistency, but also one that affirms that “I am here for you” or “You can count on me”. This doesn’t not mean that the other won’t disappoint at times or will always be available. But they let you know that you can rely on their commitment to you as a friend, partner or in an ongoing professional relationship, such as the regular long-term commitment of psychotherapy, for instance.

Time

Related to the two above in that there needs to be a consistent time commitment in order for any relationship to work. The gift of time cannot be underestimated, especially in today’s world. With time, important conversations take place, people get to know one another and things are allowed to unfold. We feel valued and important when others make time to be with us.

Connection

Of course this can’t be forced. We either feel connected or we don’t. However, all of the qualities above are conducive to developing a connection with another. Some people are better than others at connecting, both to themselves and therefore to other people. But there are times when the chemistry between individuals exists in a way in which can’t be explained. Some of these formed connections stay with us for a very long time, if not forever.

What are other qualities that you see as essential to forming a positive bond with someone? I look forward to your thoughts.

 

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

Sam Jahara is a UKCP Registered Psychotherapist with a special interest in working with issues linked to cultural identity and a sense of belonging. She works with individuals and couples in Hove and Lewes.

 

Further reading by Sam Jahara

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Leaving the Family

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Making Changes

As well as working privately, I work within an NHS IAPT Service providing psychological therapy for depression and anxiety disorders and when a client comes into therapy, one of the first things we discuss is goals for treatment.

What is it the client is hoping to change by the end of treatment? Is there anything that the client is not able do now, because of their difficulties, that they would like to be doing in the next couple of months?

Goals help to focus the therapy. It’s quite common that the client will say they would like to increase their confidence or to improve their self esteem, to be less anxious or to be happy. These are very broad goals, would be difficult to measure and don’t tell us what the client would actually be doing differently if they were to be confident, have better self esteem, be less anxious or be happier. So we work together to work out what this might look like.

One way to help determine goals for change is to think of our values. When considering values we need to think about what is really important to us, what gives our life meaning and purpose. Values are what we care about and are different for everybody. They can change over time depending on where we are in our life. Meaningful activity is value driven. Values are fluid and don’t have an end point, they are how we want to live our lives, they help us to be the person we want to be.

We hold values in different areas of our life: intimate relationships / marriage / being a couple; family relations; friendships & social relationships; parenting; career / employment; physical wellbeing / healthy living; connecting with the community; spirituality; education / training / personal growth; mental wellbeing.

It can be useful to consider what values you hold in each of these areas and rate how important each domain is to you and where you are in achieving that domain. For example what kind of values do you hold in physical wellbeing? How do you want to look after yourself physically? Is it to take regular exercise, eat healthily, get enough sleep and rest? Are you achieving this as much as you would like to be? What sort of friend do you want to be and how would you like to act towards your friends? For example, loyal, trustworthy, to spend time with friends, to share, to listen, to have fun together. What kind of values might you want to model as a parent? For example, to be curios, have courage, be adventurous, have determination, gratitude kindness and have fun (to name but a few). Values can be described as compass directions in which we live our life.

If you feel that you are not where you would like to be within a particular domain, how can you bring this value further into your life? This is where goal setting comes in. Values are a direction we want to progress in. Goals can be set to help us achieve that direction. For example, if we place value upon exercise and physical health we might have the goal of going for a swim twice a week or we might have a goal of completing a qualification, which sits within the value of education and personal growth. Goals can be achieved and have an end point. You maybe familiar with the acronym SMART goals. This means goals are specific, measurable, achievable, realistic and time limited. So if we wanted to make the goal of ‘going for a swim twice a week’ into a really SMART goal we could add a set time period, i.e. ‘going for a swim twice a week for half an hour’. By setting SMART goals we break down the areas of change into manageable chunks.

Change is difficult and if we are feeling low or stressed and anxious we can often feel overwhelmed. It is likely that areas of our life that are important to us have become affected and we don’t know where to start to change this.

Setting ourselves small goals for change in line with our values is a useful starting place. It’s important to remember that there is no such thing as a failed goal. If we don’t achieve our goal it still give us useful information. Perhaps we set ourselves an unrealistic goal, in which case we might consider how we can break this down further into smaller, more manageable chunks. We can explore the process along the way whilst trying to achieve our goals and moving towards our values. In this way change takes place and has a positive impact on our mental wellbeing.

 

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

 

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 –

Social Connections

Back to ‘Bace’ics

Interpersonal Therapy (IPT) explained

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Online Depression Psychotherapy

Depression is like a whole-body illness that a?ects not just your mood and thoughts but also your physical self, such as your appetite and sleep patterns, and how you view yourself, your capabilities and your emotions.

The symptoms of this condition vary from person to person, as well as in severity, but they can range from a feeling of helplessness and sadness to anxiety, insomnia, a loss of appetite, irritability and even suicidal thoughts.

How Can Psychotherapy Help?

There are several types of treatment available for depression, but the most effective is talking therapy in the shape of counselling or psychotherapy. Depression can be thought of as a ‘stickiness’ related to unexpressed emotion. A clinician trained in working with depression will listen to you without judgement, in a confidential and safe space to offer you the support you need to work through the problems that are troubling you. They can offer suggestions of strategies to deal with your depression and techniques to help you during the darker times.

Online depression counselling and psychotherapy makes it easier to speak with a trained professional, with sessions held remotely to make them more convenient and accessible. Depression can often make tasks feel insurmountable, so being able to speak to someone from your own home can also make therapy more approachable for many people.

Self-acceptance is fundamental in overcoming the destructive thoughts and beliefs one holds about themselves when they are depressed. Psychotherapy can help you recover trust in yourself and develop a better relationship with yourself through being in a relationship with your therapist.

Seeing a counsellor or psychotherapist work through depression enables you to learn a new approach in expressing your thoughts and feelings in the presence of another. Our clinical team are skilled in helping people deal with negative thoughts and feelings, as well as in providing objective advice and guidance to help you overcome the challenges related to this condition.

If you’re feeling depressed or want to talk to someone about how you’re feeling, get in touch with our team today and talk to someone.

All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.


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The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

What is ‘Manifesting’ and The Law of Attraction?

Recently a client, somewhat younger than me, described a phenomenon they called “Manifesting”. They felt excited and disappointed in themselves in equal measure that they seemed to be failing in using this ‘secret’ method of working with ‘the universe’ to bring them whatever their heart desired.

Curious, I investigated.

Manifesting is a verb used to describe the active process of using positive thoughts, and a degree of self-hypnosis, to draw ‘good things’ to oneself. Based on the many Youtube videos on this topic, these good things seem to be consumer products or monetary wealth, rather than contentment and tolerance, but then the latter two are really not as enticing as ones own private island.

Manifesting is not new and nor is the concept original. It seems to have been re-hashed in a 2006 ‘documentary’ and book entitled ‘The Secret’ which explains the mystical process of using the ‘Law of Attraction’ to get what you want in life. What a great concept – if only it were true.

Fate and Destiny
I have previously written about the concepts of fate and destiny and how I do not believe that any idea of fate has a place in psychotherapy – or indeed in the outcome of psychotherapy, which is in essentially becoming an adult who can tolerate reality.

To recap, the concept of fate posits that there is some sort of external force, entity or deity that decides what happens to us. This can be very unhelpful in the therapeutic process as clients can often use the idea of fate to reinforce that what is happening (or not) to them is simply how things are supposed to be.

Destiny, though not a word I personally favour, can be translated to being thought of as taking some degree of ownership of one’s life whilst remaining firmly rooted in reality. Therefore it is possible for most free people to experience a change in their lives, or perception of their lives, whist acknowledging their reality.

Destiny and death
Some years back I spent four years working on the front lines of death – as a psychotherapist in the field of palliative care. Whilst the usual issues around meaning, relationships and mental health problems presented themselves, they were all within the context of death and dying: I worked with patients who had terminal illnesses, were actively dying or with their bereaved relatives. It certainly redefines the concept of ‘psychotherapy’ when sitting beside the bedside of a patient who has hours to live and is engaging with you through a cocktail of opiates!

Despite the confronting nature of death and dying – the patients’ ‘fate’ was sealed – nonetheless, many of the people I worked with were able to find purpose and meaning in their predicament and to mourn losses not previously addressed. They were engaged in changing their destiny.

Magical thinking
We can all, at times, make use of magical thinking. It can be a way of assuaging anxiety and giving us the illusion of being in control. The practice is as old as human beings and embedded in a language such as in the saying ‘touch wood’ or in the belief that walking under ladders brings bad luck. Human beings are symbolic creatures who make the unreal real. This is perhaps how we cope with our knowledge of finitude – death. However, we also confuse the symbolic with the real.

Whilst touching wood and avoiding ladders is relatively harmless, subscribing wholeheartedly to fantasies that there is some ‘secret’ method or means of ‘manifesting’ objects into ones life is dangerous and deluded. In psychological terms, it is a way of avoiding growing up and being born. A way of believing that the world can be just how we want it if only we imagine it hard enough – a sort of womb, in essence.

The power of magic
The reality of being in weekly or more frequent psychotherapy is that it is not very magical at all.  In fact, it is the opposite. Psychotherapy generally takes place in a fairly ordinary consulting room (or online), you see the same face week after week and often find yourself going over the same ground. Clearly, promises of Ferraris and private islands are far more enticing. However, the consistency and regularity, along with having someone there who holds us in mind and helps us think can be life-changing. If we are thought about, just perhaps we can learn to think our own
thoughts about ourselves rather than follow a script on who we are. If we are not alone then we can learn to bear reality, however hard that may seem.

Psychotherapy does not promise magic. It is, in fact, the opposite in that often our job as psychotherapists is to help clients and patients lift the veils of illusion and see life and their history for what it was – only then can the mourning begin. And it is only through mourning that eventually, desire can emerge – a sense of self and a sense of what that self wants.

Desire
When desire emerges it is rarely if ever about Ferraris or private islands. It is not about consumer products period. It is about a deeper recognition of what will bring contentment and peace in the context of the realities in which that person lives. And that can be achieved even on a death-bed.

Of course, as a final blow, unlike manifesting, psychotherapy also has science on its side. And a long studied evidence base. It may not get the Youtube hits but then real life was never to be found in movies.

 

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

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

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We are recruiting

Thanks to ever increasing demand for our services, we are now recruiting new associates to join our vibrant and busy practice.

Established in 2008, Brighton and Hove Psychotherapy is a practice offering high-quality face-to-face psychology and psychotherapy across the Brighton & Hove area, as well as online therapy to clients nationally.

We are interested in hearing from experienced Psychotherapists (UKCP or BPC registered) and Clinical Psychologists, who are looking to be part of a cohesive practice and who are hungry to grow their private practice as part of our brand.

We offer a broad range of psychological specialities to individuals, couples, families and groups, across all age groups from infant to adult. We are offering you the opportunity to take your private practice to the next level through our service and brand. With a full page profile on our website, referrals made through our administrative team, high-quality consulting rooms with online bookings as well as all the benefits of being a part of a clinical team with regular practice and reflective meetings, and cross-referrals.

If you are a clinician who has been practising for at least 5 years post-qualification and can work with a variety of client groups, we would like to hear from you.

For further information or an informal chat, please contact us on admin@bh-psych.com.

For more information about Brighton and Hove Psychotherapy, visit our website:
www.brightonandhovepsychotherapy.com

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Why read Nietzsche?

Nietzsche reflected on and wrote much about the lived experience of human beings. He discussed many things that were seemingly in conflict with the last thing he wrote. I have sometimes heard this used as a reason not to read Nietzsche. This apparent paradoxical nature might sometimes leave you confused and resistant to look again.  However, I feel he is always worth returning to, especially if we are curious about life.

According to Kaufman (2004) Nietzsche depicted himself in Ecce Homo as “a psychologist without equal and many consider his philosophical work to have a deeply psychological understanding of the human experience.”  [1]

Freud apparently discussed the level of introspection Nietzsche reached as being greater than anyone else past or potentially in the future. [2]

When I began to read Nietzsche, I was actually surprised at how engaged I became, despite how little I seemed to understand. He inspired me then and continues to each time I return to his texts, often seeing it from a different perspective each time.  I feel his rhythmical and metaphorical offerings were made to stimulate exploration and awaken emotional responses rather than offer conclusive truths. He was purposely ambiguous and contradictory. For me, Nietzsche was on the side of experiencing and embracing the significance of creativity, music and dance. He
welcomed understandings about fluidity, multiplicity, becomings and going beyond. I feel he invited us to see that we are so much more than we have dreamed of thus far, and there are many dimensions to be explored.

My understanding of Nietzsche is that he was not one to be dogmatic, and he challenged scientific reductionism. Bazzano (2019) discusses how Nietzsche did not see science as able to explain life, only describe it. He challenged people to see how structures and systems were filled with our attempts to the bring natural dynamic and conflicting forces (both internal and external) into order and control [3] .

Or sometimes, perhaps, as a way to avoid taking responsibility.  In fact, Nietzsche was often suspicious of the systematisation of life, “I mistrust all systematizers and I avoid them. The will to a system is a lack of integrity.” [4]   (Part 2, sec 26)

Nietzsche welcomed the dance of life. His writings pointed to the multiple dynamic perspectives and interpretations that direct human experience, and the oscillating movements between chaos and structure that we all seemingly exist within on a macro and micro level. He championed understandings and explorations that focused on active over reactive forces. He centred the ‘need to know’ that can monopolise human thought and perhaps gave consciousness and intellectual knowledge its origins and apparent semblance of supremacy as, in fact, secondary
to the primacy of the body. The latter being a direct experience of active forces experienced through feeling the body’s affects. [5]

Nietzsche has both inspired and disturbed me. He manages to shake the ground beneath you, leaving you adrift at times. Equally he evokes a desire to live this opportunity to exist and experience more fully, within all facets presented. I feel he provokes a desire to feel, listen and move. To take responsibility for this existence we are living in all its uncertainty, intensity and affect and utilise creatively their influence in our transformations. [6]

Sadly, his thinking can be overlooked and dismissed due to his fall into apparent madness. I feel that is a fruitful encounter missed. He is worth reading if only to find out if any gems touch and inspire something within you.

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 –

Magnificent Monsters

A consideration of some vital notions connected to Existential Therapies

Existential Therapy

Being embodied in Therapy: Feeling and listening to your body

 

References –

1 Kaufman (2004). Nietzsche, Heidegger and Buber- discovering the mind vol 2. New York: transaction publishers.

2 ibid

3 Bazzano, M, (2019) Nietzsche and Psychotherapy. London: Routledge

4 Nietzsche, F. (1888/1969) Twilight of the Idols, trans, R. J. Hollingdale, Harmonsworth: penguin.

5  Bazzano, M, (2019) Nietzsche and Psychotherapy. London: Routledge

6 ibid

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Taking therapy ‘online’

When Covid-19 started spreading, I didn’t instantly move away from working with people directly in the room.  Up until that point I had only provided limited online sessions, usually when people moved away from the area or travelled for work.  I was slightly apprehensive about that as an option.  However, as things continued and lockdown measures were looming, I decided to only offer online sessions, and of course it got to a point where this was all we were able to do.

As lockdown measures have eased there has been lots of discussion (and concern) amongst Clinical Psychologists regarding at what point is it ‘safe’ to return to working with people in the same room again.  As I write this, in early July, I do not feel that it is quite time yet, which is to do with a variety of factors.  One factor that is informing this decision is that I am actually (surprisingly) finding online working ok.  In fact more than ok.  There are of course some disadvantages, and it has taken some getting used to.  However, in terms of the feedback from my clients and the reflections I have made myself, I feel that online working is a very viable option.

Over this lockdown period, I have completed work with clients who I have solely worked online with and therefore will never meet in person.  If online working weren’t an option, these clients, instead of having completed a course of therapy, would still be waiting.  I reflected today on how online working doesn’t necessarily have to impact negatively on the therapeutic relationship, as perhaps I had previously anticipated that it would.  The therapeutic relationship is of utmost importance to me:  it is essential that people are able to foster a good therapeutic relationship with their therapist, and this has been proved to be essential in determining whether work is effective.  I have learnt that it has been possible to foster some really strong therapeutic relationships with clients through online working.

In some instances, online therapy might actually be easier for some people, as clients may feel more comfortable and relaxed in their own surroundings rather than in a clinic space.  This may mean that people feel more able to open up and allow themselves to be more vulnerable than they previously might have done.  It may even be about practical factors; people may find it easier to engage in therapy when there are competing demands on time as it can take just an hour out of the day when no travel time is required.

Of course, online options are not going to suit everyone.  For some people accessing therapy via an online platform will not be comfortable or even possible.  However, I am keen that once I am again in a position to offer ‘in room’ therapy again, that I will continue to offer online sessions to those who might want it, or indeed a combination of the both.  For anyone who is considering therapy, but unsure whether they feel online therapy is for them, I would encourage them to get in touch.  I offer a free 15 minute consultation, which can be conducted online in order to get a ‘feel’ for how online therapy might work.

 

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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“Should I stay, or should I go?” What does easing the lockdown mean to you?

I have found the Clash’s song of this title playing over in my mind when thinking about the current easing of the social lock down in the UK. It seems to me that we all, to some degree or another, now face a dilemma whether to stay or go.

Straight away, it is important to acknowledge the relationship of this dilemma to levels of freedom and privilege. It is true that some people have little or no choice about whether to go back into their workplace.  We all face very differing health concerns, with those in the ‘extremely vulnerable clinical group’ likely to feel greatest levels of concern and anxiety about going outside.  There has also been concerning, though unsurprising, expositions of inequalities in terms of health risks, with poorer and BAME people having greater chances of fatality.

However, in my experience these will not prevent them from experiencing similar kinds of conflicts at this time. It is a reality that a great many of us will, to some degree or another, be starting to wonder about how or when or whether we return to ‘normal’.

I have been wondering myself about this dilemma but I am also interested in how it might tap into broader questions about how we think about ourselves in relationship to our worlds – both outside and inside.

There is no doubt this has been a strange and disturbing time and of course we are no way through it. The sudden exponential growth of the virus and pandemic was frightening, and many felt traumatised by the level of crisis and what felt like an intense threat to our mortality. The war metaphors and imagery referenced by our government, while perhaps intended to help rally a ‘blitz spirit’, in all likelihood, simply added to the terror already felt by many.

The orders to lock down came as a relief for many people. We had permission to retreat and protect ourselves against what had suddenly become a hostile world. This was and is a necessary response but one that also exacerbated the fear of the outside world engendered by the virus and the rhetoric used about it.

We all responded differently to the retreat and this of course varied at different times. There are those who found and continue to find the lock down liberating, others who found and find it oppressive.  Of course, we are also living in different circumstances which add or detract from the benefits of the protection it offers. For example, it has been widely reported that incidents of domestic violence and abuse have increased during this period. Many were able to work easily from home, many were not and there was, and is still, differences between the level of risk for those going into work. And many have lost work or continue to face this as an increasing prospect.

External factors aside, our relationship to the pandemic and the lock down response will also key into aspects of our own internal worlds. A reluctance to move out of lock down could arise for those of us who tend to use retreat as a defence. It makes sense that the bubble offered by the lock down could tap into and heighten historical ways of managing difficult realities through strategies of self-seclusion. At the same time, those of us who have particularly found the lack of purpose and activity in the lock down difficult may have developed defences around keeping busy as a means of warding away difficult or painful feelings.  This could lead to a manic response to the easing of restrictions – perhaps a rushing quickly back into the world and ‘normality’.

Of course, both states may be at play in us at different times, but I am wondering about our overall tendencies that will shape how we are likely to interpret, and respond to, this shift in government advice.

Reflecting on my starting title, I wonder now about the aptness of the Clash song. It seems the transition from lock down to ‘normality’ (whatever that means) is not going to be as either/or as staying or leaving a relationship. It looks likely anyway that we are going to experience further Covid outbreaks with many expert views suggesting the current easing as premature and a second wave imminent.  We can therefore most probably anticipate more lock downs, perhaps even soon.

So, it feels more appropriate to think about a dialectic in/out situation we find ourselves facing requiring complex navigations. How we proceed and find our way through these difficult and disturbing times and those ahead, will be dictated by many external factors but also our own internal worlds and their responses, conscious and unconscious, to the different experiences of this pandemic.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2e

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A desire to change

One of my favourite papers is by Dr Sebastian Kraemer, called ‘Something Happens: Elements of Therapeutic Change’.  This blog helps break down what therapists and clients set out to do, as they sit together in a therapy room both hoping that change can be immobilised from a stuck situation.

This is first of eight short blogs exploring the eight elements of change identified as:

1. A desire to change

2. A primary task

3. A theory of mind and a method of treatment

4. Courage and honesty

5. A specific narrative

6. Neutrality and reflectiveness

7. A tradition

8. Something happens

A desire to change: As the client and therapist sit face to face in their first session progress has already begun  – the desire to change has been acknowledged and acted on.  The request for help to a therapist has been made and the therapist has accepted this. 

However long a therapist has been practicing – having collected skills, theories and techniques along the way – each new client brings a unique story and request for help.  They bring their stories of strength, courage and endurance alongside their stories of distress, confusion and pain.  Just turning up to the appointment is an act of bravery, it is our role as therapists to acknowledge and respect the clients vulnerability; walking alongside them as they take action to change.

On first meeting, many clients report that they have noticed shifts in their thinking, changes in behaviour and an increased sense of hopefulness that things can be different – this is before the first session.  This could possibly be a placebo effect or could be understood further in the context of the research around models of change.

In the early 1980’s Proschaska and DiClemete set out five stages of change. Upon arriving at their first session clients are already in transit between Stage Three and Stage Four 3 of this theory – monumental shifts in awareness and readiness have already taken place:

Stage One. Pre-contemplation – the ‘I’m not ready’ stage

I am unaware or under-aware of a problem and have not got plan to change – leave me alone.

Stage Two. Contemplation – the ‘I’m getting ready’ stage

I am aware I have a problem to address but do not have the motivation or commitment to change my behaviour as yet. – leave me alone but watch this space.

Stage Three. Preparation – the ‘I am ready’ stage  

I have researched and planned a way to change.and my initial goals are clear – no time to talk I’m busy!

Preparation is considered the most important stage of the model – relapse is considered to be 50 per more probable if the preparation stage is not undertaken

– ON YOUR FIRST SESSION YOU ARE HERE –

Stage Four. Action – the ‘I am implementing my plan’  

I am making changes to my behaviour, my environment and my choices. I have sought help in this process and am being encouraged to feel more hopeful about the future

Stage Five. Maintenance – ‘I have changed and I want to keep it that way’ stage.

Work and effort is still required to maintain positive changes and prevent relapse.

A desire for change is important to begin the work however sometimes it becomes clear change may bring difficulties and risks that had not been contemplated originally.  Resistance to the change may then come into play and the work takes a different turn as goals are reviewed.

 

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.

 

Further reading by Sharon Spindler –

Covid 19 – Talking with children in uncertain times

Family Therapy for Beginners

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CORONAVIRUS – How Psychotherapy can help you navigate your way through the crisis

I am writing this blog four days after the UK government imposed an effective ‘lockdown’ in response to the spread of the Covid-19 virus.  Inevitably this crisis will have a considerable impact on all of us be it emotionally, financially, physically, spiritually and psychologically. Depending on our character, disposition and ways of thinking we will experience the impact in specific and particular ways. We may be very aware of feeling lonely, anxious, frightened, overwhelmed, sick, vulnerable, frustrated, bored, angry and our unconscious fears almost certainly will be highlighted by this unprecedented situation.

From what my clients have been telling me over the last couple of weeks it seems to me that the most difficult aspect of this situation for people is the uncertainty.  We don’t how long the threat of the virus will stop us from leading our ‘normal’ lives.  We don’t know what life will be like at the end, how it will end and what the longer lasting effects will be on us, our families, our communities and the world at large.

As human beings we struggle with uncertainties and ‘not knowing’. We may not always be aware of it but the lack of certainty the ‘not knowing’ makes us feel afraid, ill at ease, out of control and so in order to protect ourselves from these uncomfortable feelings we unconsciously replace them with the illusion that we are in control and therefore we know exactly what will happen. Being certain, knowing what will happen narrows the mind, reduces the questions and makes life feel easier.  We usually forget to focus on the present moment and instead we make plans for the future, focussing on what we are going to do, where we’ll go, what we’ll buy, who we’ll see etc, confirming our illusion that we know what will happen and that we are in control.

Focussing on the future works until we are faced with a crisis or we are under threat then we focus completely on the present moment, it takes up all our thinking.  The present moment right now is frightening and for many people this is overwhelming.  Many people are struggling to bear the awfulness of it and the feelings of uncertainty they are having to cope with.

The reality is we cannot change what is happening, we cannot control outside forces we can only change the way we think about them and therefore how we feel in response to them.  In essence this is the work of psychotherapy.

Having a therapist to talk to at this time can help you bear the uncertainties of life and what feels overwhelming.  As therapists we are trained to work with the ‘not knowing’ and are therefore uniquely placed to help you face uncertainty and anxiety – it is our medium and what we work with all the time in our consulting rooms. Having a space where you can verbalise your anxieties and reframe your life so it becomes more bearable is invaluable right now.

 

Please follow the links to find out more 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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How Psychotherapy will be vital in helping people through the Covid-19 crisis

Many self-employed psychotherapists, psychologists and counsellors have immediately felt the economic impact of the crisis brought by Covid-19. As our clients began to either lose their jobs or face increasing economic uncertainty, many had to either put their sessions on hold or stop coming altogether. Many of us have either dropped our fees or continued seeing people with the uncertainty of getting paid. Unfortunately, some people have lost their support system when they need it the most.

Private Psychotherapy has always been enjoyed by many in the UK and around the world, as most national health services cannot offer the same level of professional service due to cost.

Psychotherapy practices have always offered a vital service to the community, whether through charities, low-cost services or full paying clinics. Psychotherapy is a place where people’s deepest mental anguishes have a place to exist, to unfold and to be healed.

The health and consequent economic crisis brought by Covid-19 is already affecting people’s mental health in several ways, some of which have not yet come to light. This is being felt and will continue to be felt for a while to come at all levels of society.

An Existential Crisis

Covid-19 has highlighted our main vulnerabilities as human beings. It has hit many people at a very fundamental existential level as many have lost their jobs and their livelihoods overnight. In addition to this, as more people become infected and die of Coronavirus, we have become much more aware of our mortality and that of those we love.

Living in a globalised world, the spread of the virus had happened so rapidly that we have not had the time to process and digest the changes which we have been required to make as a result of the restrictions imposed to keep the virus from spreading. Never could we have imagined that something which started in China a few months ago could spread and reach our doorstep so rapidly and dramatically. This further highlighted our lack of immunity to world events.

Impacts of Lockdown

With people being asked to stay at home to protect the NHS, schools and businesses closing and people being asked to work from home (if they still have work), suddenly the home has become office, school, gym, social hub and place of relaxation. Whilst some families are feeling more crowded as a result of these changes, some people living on their own have become more lonely, isolated and vulnerable.

Some families trying to make life work under lockdown are finding that their relationships are being put under more strain, whilst children of unhappy and even abusive families are being made to stay at home more.

Of course, there are also positive stories emerging as a result of families spending more time together and solidarity between people. In times such as this, we are seeing the best and the worst of human nature.

Why is Psychotherapy vital during these times?

To put it simply, in times of crisis psychotherapy helps us to hold onto our thinking. When our survival is threatened, our ‘reptilian brain’ takes over and we can act impulsively (panic buying for instance) often resulting in harm to self or others. Thinking makes us slow down and consider options. In times of crisis, we sometimes need to think quickly and make decisions. However, buying time to think enables us to put things into perspective and to make wise rather than impulsive decisions.

Because this is both a health and economic crisis, it is hitting many of us at our very core. The British attitude to “keep calm and carry on” works to a degree. Of course, we need to keep calm, but we also need a place to acknowledge and talk about our fears, losses, despair, sadness, anger, etc if we are going to survive this crisis in good mental health.

 

Sam Jahara is a Psychotherapist and Supervisor in private practice working with individuals and couples. She is also the co-founder of Brighton and Hove Psychotherapy, a multi-approach clinic, offering Psychotherapy, Psychology and Counselling to all client groups, both face-to-face and online.

 

Further reading by Sam Jahara

Leaving the Family

Psychotherapy and the climate crisis

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

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Spirituality and Mental Health

Spirituality is an often-used term these days, and around 20% of the population in the UK define themselves as spiritual, but not in the religious sense. So what does it mean to be spiritual?

There are many definitions of spirituality but generally we could say that it involves having a sense of something bigger than ourselves – a transcendental view of life where we start to realise that there is more to life that we see around us. This can include a sense that there is a God or creator, an intelligence in the universe, or maybe a deeper wisdom that we all carry. However we conceptualise it, spirituality often leads to a greater sense of purpose and meaning as we start to step back from the everyday world and see a bigger picture playing out before us. Spirituality also includes a sense of connectedness, which might be with others, ourselves or with something more transcendental. This feeling of connectedness can bring us a great deal of peace as we start to realise that perhaps we are not alone in the world. 

Spirituality is different from religion, but is linked to it. Religion is about adhering to a set of doctrines that define each particular faith. Religion will often have a spiritual component – a worldview that has an idea of something greater than us (God, for example) and may also involve a spiritual connection as part of the religious practice. However, you do not need to be religious to be spiritual, and indeed being religious doesn’t need to be spiritual!

So how important is spirituality to our mental health and wellbeing? There has been a lot of research over the past decade that considers this question. The findings show that engaging in spiritual practices have a positive impact on our mental health. Lower levels of depression can be found in those who are actively involved in spiritual communities. Levels of stress and anxiety can be lowered by engaging in spiritual practices, and spirituality can be instrumental in the recovery from trauma. Also, there can be a greater sense of purpose and meaning from having a spiritual perspective, which can have a positive impact on our wellbeing. 

Having a committed spiritual practice – whether it is mediation, prayer, or whatever feels right for you – reading spiritual philosophy and engaging with a spiritual or religious community can be hugely beneficial in improving and maintaining positive mental health. Even if you don’t consider yourself to be spiritual, it is worth spending a few moments thinking about life and the wonders that we see around us. It is easy to see that there is more to life than our own limited worldview and when we step back and consider this, our problems and daily issues can be put into perspective as we gain a more holistic view of life.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

 

Further reading by Dr Simon Cassar –

Living with borderline personality disorder

Online Therapy

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

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How do I choose a psychotherapist?

Deciding that you want or need psychological help can be a difficult position to arrive at.  Choosing the right practitioner to work with can feel like a daunting task with so many different fields of talk therapy, types of therapy and professional bodies overseeing the field.  This blog is a guide to helping you find your way to the right psychotherapist for you.

Counselling, psychotherapy or psychology?

Counselling, psychotherapy and psychology all broadly fall under the category of ‘talking therapy’.  They have much in common, yet are also very different.  I have previously written a piece on the difference between counselling and psychotherapy; the former being largely for shorter-term work and the latter being appropriate for deeper and long-term work on the personality.  We also have an in-depth page on psychology here so I shall not go into more detail about that here.

Depth of work

In choosing a psychotherapist, it can be helpful to have a sense of what it is you are seeking to gain from therapy.  Generally, psychotherapy is longer term than counselling and rather than working with one specific issue, is instead a relationship through which the client can work through relational patterns (with themselves and others), formed in childhood that they wish to change. Depth relational psychotherapy takes time – months to years – to understand and process relational, or attachment, losses. It is a commitment to a process of therapy and to oneself with sessions being as a minimum weekly, at the same time and on the same day each week.

Professional Body

There are a few professional bodies who offer voluntary registration to counsellors and psychotherapists – the BACP and UKCP. Whilst the BACP includes the ‘P’ for ‘psychotherapist in its acronym, the minimum training requirements of the BACP for someone to call themselves a psychotherapist are quite low. The UKCP, on the other hand requires all registered psychotherapists to undertake a minimum of four years of post-graduate training at an accredited training institution alongside a mental health placement and four years of personal therapy, before permitting applicants to join.  At Brighton and Hove Psychotherapy, all of our psychotherapists have trained at least to this standard and many far beyond.

Training

Psychotherapy training is long, challenging and requires the candidate to be in their own personal therapy throughout the training period.  Most training institutions are located in London, or further afield, and so a great deal of commitment is required to reach the necessary training standards. One of the main aspects that sets UKCP registered psychotherapists apart from counsellors is that they have been trained to ‘formulate’, which is another work for diagnose, or understand, more complex trauma and mental health issues.

First Appointment

If you have never previously been in therapy, then the prospect of the first appointment can be daunting. It is the job of your psychotherapist to set clear boundaries and create an environment that ‘feels safe, but not too safe’.  What does this mean?  Psychotherapy is about learning to tolerate difficult feelings and your psychotherapist is there to facilitate this process through their relationship with you.  They are not there to be liked, or to be your friend, as this would not be beneficial to you or to your process. If all goes well at the initial consultation then you and your psychotherapist may ‘contract’, or agree, to work together.  This means that they have assessed what work is required to facilitate change for you and you have decided that you are going to enter into an intimate relationship unlike one you have perhaps ever had before.

Length of Contract

How long is a piece of string?  Most psychotherapy can last for months or years, however little can be inferred from the duration.  For example, someone attending a year of therapy is not necessarily ‘healthier’ or ‘saner’ than someone who attends weekly for many years.  It is entirely dependent on the work required, how the client wishes to ‘use’ therapy and the relationship formed. Freud famously believed that therapy only begins when the client is no longer in a crisis.

Final Thoughts

Finding a good psychotherapist begins on paper but ends with a feeling, or a set of feelings.  As it is in the relationship that the unravelling of the past takes place, it is critical that as a client, you feel you can build a therapeutic relationship with your psychotherapist. The capacity to do this will hinge on their degree of training, clinical experience and therapeutic boundaries, as well as on it being a relationship that feels ‘safe enough’ – not too safe to not be challenging – within which the therapeutic process can unfold.  

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

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