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A Dramatherapist at work in the sand tray

 

Dramatherapy is one of a group of therapies which are called Creative Arts Therapies, along with Music therapy and Art therapy. Today I am going to explore one aspect of Dramatherapy.

We usually come to therapy to talk.  Dramatherapy, has the capacity to go beyond the talking because it is creative.

Dramatherapy becomes useful in the therapy space when it is used as a way of illustrating  the talking which takes place between the client and therapist. This illustration provides another way (a container) for the client to find meaning in their experiences and in their sense of self.

How is this?

Mostly when we seek therapy we expect to be talking. As a dramatherapist I am always alert to opportunities within the talking,  opportunities to explore  those things for which there are no words-maybe those things that happened to us before we spoke,  or those painful experiences, things that we want to actively or unconsciously deny, or perhaps a dream, or an illness.  In other words those things that are not part of our everyday cognitive knowing.

And this is where creativity comes in. When we are creative we are tapping into the right side of our brain which is very different from the left side.  Simply speaking the right brain does not have the same rules of logical thought and sequential time. It receives and processes information and experience very differently. For us to be able to connect and communicate with the rich wisdom of the right brain we need to use a medium which represents (re-presents) our experience to us in a different way.

Sand tray is such a medium which can re-present a situation or experience. The placing of objects in the sandtray is intuitive, there is no right or wrong, only personal and individual interpretation.

In my work with a particular client who suffered from chronic anxiety, we explored her early pre-verbal experience as a way of understanding the roots of the anxiety.  She made sandtrays of her early years showing scenes of confinement, of heaviness, weight and pressure. Over the weeks she interpreted her created scenes to me, her witness. Through this witnessed process she was able to articulate her pain for the first time. As her feelings emerged and as she became more emotionally open her anxiety lessened.

In my experience this precious work continues outside of the therapy room, bringing a richness of new experience and self -understanding.  Through this work I see clients growing in self-confidence which I think is born from coming to know the self more fully and  profoundly.

If you are interested to know more about dramatherapy and how it may be of help to you, do contact me.

 

Magdalena Whitehouse is an experienced HCPC Registered Drama Therapist, working with individuals, couples and groups.

 

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Emotional Well-being

When most people hear the words ‘mental health’ perhaps what they are most likely to think of is mental difficulties, or mental ill-health.  I always think it’s such a shame that ‘mental health’ has these negative connotations, whereas just the word ‘health’ doesn’t seem to. 

I am a big believer in being proactive about mental health and wellbeing, and in the importance of doing things to stay mentally and emotionally well – just as you might keep active, eat a healthy diet and clean your teeth to keep your body well and healthy.  There is, perhaps unsurprisingly, a huge overlap between a person’s emotional and physical wellbeing. The negative impact of stress on health and wellbeing has been well researched. 

Positive Psychology is a branch of psychology founded by Martin Seligman, which is concerned with the positive aspects of life; it focuses on potential and thriving, or as one book puts it ‘positive psychology is concerned not with how to transform, for example, -8 to -2 but with how to bring +2 to +8’.[1]

So, what might be the emotional equivalents of cleaning your teeth or keeping active be?  There are lots of ideas that can be helpful, and some will suit certain people more than others.  It is worth trying out a few different ideas to see what works well for you.  Using a planner can help, to ensure that you are regularly and frequently doing something specifically to have a positive impact on your emotional wellbeing.  It’s good to have a mixture of things across a week, including things that bring you pleasure and things that bring a sense of satisfaction or accomplishment. 

The list below includes different ideas and strategies drawn from Positive Psychology, and other areas of psychology:

  • Engaging in physical activity
  • Noticing your strengths
  • Actively relaxing – this could be using imagery, or a progressive muscle relaxation
  • Random acts of kindness
  • Spending time engaging in hobbies
  • Spending time with, and investing in close relationships
  • Completing the ‘Three good things’ exercise; every night for a week spend some time to identify and write down three things that were good about the day and notice your role in them
  • Thinking about someone you are grateful to or for, and telling them about it
  • Spending some time paying attention to the present moment (Mindfulness)

Later this year I will be running a series of workshops along with a physiotherapist, looking at tips for having a healthy body and healthy mind which will go further into the topics discussed in this blog.

Dr Emma Stevens, HCPC Registered, is an experienced Clinical Psychologist. She has an integrative approach drawing on Cognitive Behavioural, Systemic and Psychodynamic models, as well as Attachment Theory. Emma sees individuals primarily for sort-term work. Emma is available at our Lewes Practice.

[1] Positive Psychology in a Nutshell, 2nd edition.  Boniwell, I. (2008).

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A few questions to ask if you are having relationship difficulties

When do you think these difficulties started?

It is important to recognise when things began to change. On the other hand you might realise that to some extent it has always been like this but it is only now that you recognise that.

Think back to the time when things began to change what else was happening around that time?

Life events make different demands on different people and individuals respond differently to the same events, often we don’t realise the impact this can have on how we feel as a couple. These events might include a new baby especially a first baby; changes at work, losing a job or being promoted; a house move to an unfamiliar area; children leaving home; serious illness, caring for elderly or sick relatives or the death of a parent.

How have these events changed how you and your partner spend time together and/or communicate with each other?

Most couples, consciously or not, have regular ways that they show their care for and communicate with each other. These may part of daily life, a cup of tea in bed in the morning, a lift to the station, a chat in the bathroom. These small rituals are important in keeping the relationship ‘oiled’ and for both partners to feel reassured and affirmed.

How did you meet and get together and what was it that first attracted you to each other?

Look back to what was happening for each of you when you met and think about your expectations of each other. You might have imagined each other would bring new opportunities or offer something that was missing in the other. Maybe one of you seemed warm, expressive and sociable when the other was feeling low or lonely or maybe one of you helped the other sort out practical problems or manage a difficulty at work; perhaps you saw each other as very funny, clever or sexy. One of you might have recently been left or left a relationship and have had high hopes that this one would be very different.

 

These questions begin to reveal the underlying hopes, dreams and expectations in a relationship. These may have been unrealistic at the start or they can become fixed and out of date. Thinking about disappointment is painful and it is easy to blame the other person for failing to live up to expectations or for changing, “You used to be thoughtful and sensitive!” “You used to care about me!” Life events make an impact and the picture keeps changing. Things that seemed important have drifted into the background, something new is brightly lit in the foreground and you can sense things emerging at the edges.

As a couple it is important to be responsive to life and what it brings for each of you, to give yourselves opportunities to reimagine what you want to create together as a couple.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

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

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

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

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

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

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

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

Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes practice.

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The Pain of Decision-Making

Our decisions navigate us through, and throughout, our lives. This blog is not intended to be a comprehensive explanation about decision making, neither is it a guide for how to make better decisions. I simply offer some thoughts about what I see as some of the reasons that decision-making can feel hard or even painful. And why some of us avoid or delay making decisions or get paralysed in the process.

Either/Or

There may be times when a decision is a stark choice between two different things. However, often what happens is we create an either/or split in our minds when making a decision, particularly when we’re anxious.

It is from Melanie Klein’s work that we get the concept of paranoid-schizoid position. This refers to a very early life stage when – as small infants – we were overwhelmed with intense anxiety and developed protective mechanisms, for e.g. splitting experiences into opposing good or bad. Klein thought that this stage never left us and in times of stress and high anxiety we tend to return to this paranoid-schizoid ‘position’. When we’re in this state of mind we return to defences such as polarising. Of course, far from helping our anxiety this kind of stark splitting generally makes decisions harder to make.

The referendum on Brexit is a good example of an either/or paranoid schizoid type of decision that was created possibly to manage, but more to avoid, complex and painful issues the UK and its government was (and of course still is) facing.

Loss

Some decisions are easier than others. Usually this is either because they don’t have a significant role in the shape of our future, or they are reversable, or repeatable. Generally, these decisions don’t put us in touch with profound feelings about loss.

Life decisions particularly stir intense feelings, and quite real experiences, of loss. Each step we take in one direction involves relinquishing those leading us in others. The older we get the more our lives narrow in direction and focus as we need to accept giving up ‘other’ options. This parallels a growing awareness of our own mortality.

How painful and paralysing the loss of ‘other’ life choices is will partly depend on our relationship with loss and whether or how we are able to tolerate the feelings stirred up by it.

Regret

Our decisions are our responsibility. We can all look back on certain choices we’ve made in our lives and wish we had taken a different option.

Bound up with our feelings about this is our relationship to regret. Regret can be a very frightening prospect for some people. This is because of the way they might punish themselves if they feel they’ve made a mistake or got something wrong.

Freud called the part of us that can be self-punishing, the Super-Ego. This is the rule-bound, conscientious part of us and is developed in the main from early experiences of authority figures, particularly parents. We will all normally experience our super-ego at times as restrictive – in a way this is its job. Ideas about

the super-ego have developed over the years to understand how persecutory it can be at certain times and for some people more than others. The degree and constancy to which we feel punished or even tormented by our super-ego will affect how frightening it can feel to us. This fear might generate such an anxiety about making mistakes that it can paralyse us from making even the smallest decisions.

Conclusion

We are making decisions all the time, often without thinking about it. Some decisions are obviously more significant than others and need to be considered carefully. This process can be painful as it means taking responsibility for our choices and sometimes accepting losses. We don’t help matters when we allow our anxiety about this to polarise our options with either/or thinking or attack ourselves with our regrets about past choices.

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

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