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May 22, 2023 by BHP Leave a Comment

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.

Filed Under: Brighton and Hove Psychotherapy, Psychotherapy, Society, Thad Hickman Tagged With: childhood, Mental Health, Relationships

May 1, 2023 by BHP Leave a Comment

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

Enhancing the Positive Self 

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

Filed Under: Mental Health, Rebecca Mead, Sleep Tagged With: Diet, Food, Mental Health

April 24, 2023 by BHP Leave a Comment

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

Enhancing the Positive Self 

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

Filed Under: Brighton and Hove Psychotherapy, Mental Health, Rebecca Mead, Sleep Tagged With: Diet, Food, Mental Health

April 10, 2023 by BHP Leave a Comment

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)

Filed Under: Chris Horton, Loss, Mental Health Tagged With: Loss, Mental Health, Psychotherapy

March 27, 2023 by BHP Leave a Comment

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)

Filed Under: Mental Health, Psychotherapy, Susanna Petitpierre Tagged With: Love, Mental Health, Relationships

March 6, 2023 by BHP Leave a Comment

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?

Filed Under: Brighton and Hove Psychotherapy, Mental Health, Psychotherapy, Sam Jahara Tagged With: Mental Health, Online Counselling, Therapist

February 13, 2023 by BHP Leave a Comment

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

 

Filed Under: David Keighley, Mental Health, Society Tagged With: Mental Health, secure, Self-esteem

January 30, 2023 by BHP 2 Comments

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

Filed Under: Mark Vahrmeyer, Mental Health, Psychotherapy Tagged With: Mental Health, Psychotherapy, Relationships

September 19, 2022 by BHP Leave a Comment

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

Filed Under: Mental Health, Sam Jahara, Society Tagged With: Mental Health, Psychotherapy, wellbeing

September 5, 2022 by BHP Leave a Comment

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

Filed Under: Mark Vahrmeyer, Mental Health, Psychotherapy Tagged With: Counselling, Mental Health, Psychotherapy

August 29, 2022 by BHP 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?

Filed Under: Mark Vahrmeyer, Mental Health, Psychotherapy Tagged With: Mental Health, Psychotherapy, psychotherapy services

August 15, 2022 by BHP 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

Filed Under: Mark Vahrmeyer, Mental Health, Psychotherapy Tagged With: Mental Health, Psychotherapy, sleep

August 8, 2022 by BHP Leave a Comment

How do I find the right Psychotherapist?

Finding a psychotherapist can feel like a daunting task. For starters, the difference between a counsellor and psychotherapist may not immediately be apparent. Then there are the different modalities, or approaches to therapy. And lastly, there are the different professional bodies to make sense of.

The term ‘psychotherapist’, unlike ‘clinical psychologist’, is not a legally protected term in the UK. This means that there is very little to stop anyone claiming that they are a psychotherapist, without having undergone an accredited psychotherapy training (or indeed any training at all).

There is also, as of yet, no agreement across the different professional bodies as to what exactly constitutes a psychotherapist, which further muddies the water for anyone seeking psychotherapy.

If a client is wishing to go into therapy then my advice would be first and foremost to seek out a professional registered with either the UKCP or BACP and who can evidence significant clinical experience in the field.  Both of these professional bodies have helpful websites which enables users to search for clinicians based on location, as well as other criteria.

Once you have a list of accredited psychotherapists, you may wish to consider which approach, or modality, in which the clinicians in question have been trained. Whilst this may seem confusing, it is important to remember that research has shown that it is the quality of the therapeutic relationship combined with the approach, that leads to the most successful outcomes in therapy. Therefore, look for a clinician who is able to explain how they think and work in clear and understandable language – remember, it is their job to help you understand how they can assist you, rather than you needing to figure it out by wading through complex jargon yourself.

Many people make the decision to seek out a psychotherapist when in a crisis. Whilst this is common and the sense of urgency strong, it is important to take the time to find the right ‘fit’ and this may mean contacting various clinicians, as well as attending potentially more than one initial consultation. When new clients come for an initial consultation with me, I always set a goal with them at the start of the session in suggesting that it is their job to work out whether they feel comfortable enough (but not too comfortable) working with me, and my job to work out if I believe that clinically, I can help them. This often comes as a surprise to new clients in that they are there to make a judgement and choice in relation to working with me, however, therapy needs to be a co-created and collaborative process from the outset.

How do I know if my therapist is right for me?

If you find that you are working with a therapist and it does not feel like you are getting what you hoped for or are feeling uncomfortable then raise this. As I stated earlier, psychotherapy is ‘work’ that two people undertake and a big part of the work is in establishing a particular kind of relationship – a therapeutic relationship – or alliance.

If your psychotherapist is unwilling to hear your concerns and to discuss these with you, then that is a strong warning sign that the person you are working with is not a good fit (and arguably not a very good clinician).

I suggested earlier that psychotherapy should be a process that feels supportive and comfortable, but not too comfortable – you have sought out a psychotherapist because you have a problem and want support. Your psychotherapist is not there to be your friend.

They are equally not there to collude with you, but to appropriately and mindfully challenge you.

I previously referenced the different approaches to psychotherapy – the methods. These can seem confusing – and even cause a fair bit of infighting amongst the therapeutic community! One way of thinking about these approaches is to consider them as ways of conceptualising, of thinking, about your inner world. It may be that after a period of time you discover the way your psychotherapist thinks simply does not ‘fit’ with the way you think. Remember, psychotherapy is about understanding the human mind and nobody has veer seen or touched a mind – it is a concept, a construct, and as such is shaped and brought to life by language.

What is ‘good’ psychotherapy?

There are many answers to the question – ‘what is psychotherapy?’ – which is another way of asking the question ‘what is good therapy?’. As there are so many ways of helping people make sense of their inner world, there are an equal number of answers as to the goals of therapy, however, there is commonality.

Rather than ‘good therapy’ being one thing, it can be better expressed as a formula: A solid frame combined with a containing relationship. Let me explain: Us psychotherapists frequently reference ; ‘the frame’ in psychotherapy and this refers to all the elements that enable a solid ‘containing’ relationship to form between the client and their therapist. The frame consists of a regular meeting day and time, a stable and unchanging consulting room, sessions that start and end on time, a therapist who is ready and attentive – these are some examples.

By ‘containing relationship’ we are talking about the very unique role that we, as psychotherapists, must play for our clients. We are there to think about the client every second of the encounter and must not make the relationship or sessions about us.

Therefore, when in psychotherapy, if you ask your psychotherapist a question – something such as ‘how was your weekend?’ – they will likely explore with you what lies behind the question before answering.

A containing psychotherapist is also one who can ‘survive’ their client – in other words, the client is free to express themselves how they wish and the job of the therapist is to be able to hold the boundary no matter what. When the frame and container are solid, that is a good starting point for successful therapy.

Can it be dangerous to see the wrong psychotherapist?

Let us assume that by ‘wrong’ therapist we are assuming a poor fit rather than any kind of abusive relationship, as clearly the latter presents significant risks to the client and would constitute a breach of the psychotherapist’s (BACP or UKCP) code of conduct.

Psychotherapy is, amongst other things, about helping client to understand their wants and needs and to help them put appropriate boundaries in place in relationships. If a client is continuing to see a psychotherapist where they are getting little to nothing from the sessions and feel that they cannot raise this, then this is only going to further undermine their self esteem and confidence which is utterly counter-productive to the process. This would be an example of the client’s experience in their relational world repeating in the therapy.

How important is it that my therapist is accredited and what should I look for?

As I have previously highlighted, psychotherapy remains largely formally unregulated in the UK. Membership of the various professional bodies is voluntary and for clients, it can be hard to distinguish between them.

As a UKCP registered psychotherapist I am acutely aware of the rigorous training standards of my professional body and understand the level of training that other psychotherapists, irrespective of their modality, have received who are fellow members.

Anyone crossing the threshold of a psychotherapist’s consulting room has been on the receiving end of some degree of neglect or abuse in their childhood. This makes them susceptible to further relational injury from working with someone who either is misrepresenting themselves, or has received inadequate training to understand their
limitations.

Mark Vahrmeyer is available at our Brighton and Hove practice and the Lewes Practice.

 

Further reading by Mark Vahrmeyer

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

The limitations of online therapy

Filed Under: Brighton and Hove Psychotherapy, Mark Vahrmeyer, Mental Health Tagged With: Mental Health, Psychotherapy, psychotherapy services

July 25, 2022 by BHP Leave a Comment

Making Sense of our Multiple Selves

How many people are you? Personally, I know I’m quite a few and always will be.

Some years ago at a conference on ways of treating trauma a speaker was challenged from the audience to define what ‘mental health’ was. She paused for a moment and then replied that a mentally healthy person was ‘comfortable with self, comfortable with others’.

I admired the way she met this challenging question with a clear definition that describes a state of true wellbeing. At the same time I wondered, which ‘self’ are we referring to here?

Being in Relationship

Underlying that speaker’s definition of mental health is the notion of relationship and the recognition that to be a person is to always be in relationship with others and, most especially, with ourselves. In fact this learning how to be with ourselves is a process intricately linked to how we come to be ‘our selves’ in early development through relationships with our primary caregivers and other family members.

This notion that each of us appears to have multiple selves – or at least multiple parts of our ‘self’ – chimes with the reported experience of most people. This sense can be most acute when we face a life situation where we cannot decide on something, as though different parts of us are conflicting with each other to determine what is best for us as a ‘whole’ self.

The Parent, Adult & Child Model of the Self

A radical and deceptively simple idea for accounting for our different selves first emerged in the 1960s in the modality of Transactional Analysis (TA) (1) . This proposed that we naturally relate to ourselves and to others through a constant interplay between three different ways of thinking, feeling and behaving.

We first learn how to be from our close observation of the all-powerful others we meet in infancy.

We borrow aspects of how they behave towards us and incorporate these into our own way of being. This has been termed our ‘Parent’ ego state, of which we can have many different ‘borrowings’ from the authoritative figures of our early years. Borrowing these parental ways of being is useful when it allows us to provide ourselves with parental comfort and structure to safely navigate the world, such as soothing ourselves by rubbing a bruised knee or remembering to stop and hold hands at the kerb. This becomes unhelpful when any borrowed forms of the parenting we received prevent us fully accepting and loving ourselves.

We also learn by actively storing as separate ‘Child’ ego states within us our earliest intense aspects of previous emotional experiences and imaginings about the world. By replaying these old experiences in different situations, they give us guiding models for expressing our innermost impulses or adapting in order to successfully maintain relationships with others. This is less helpful to us when previous fears overwhelm us in the present or we over adapt to the demands of others at the expense of our own needs.

Our third and probably most common way of being is to operate in the here and now – or our ‘Adult’ ego state – where we use our accumulated knowledge of the world to solve daily challenges and get our needs met. Problems can arise when our ability to function in the moment is compromised by us bringing our more unhelpful Parent or Child ways of being into our present.

Making sense of our multiple selves

So when we face times in our lives when we do become ‘uncomfortable’ or worse, it can be instructive to use this powerfully simplified model to explore how aspects of our Parent, Adult or Child ego states might now be limiting our capacity to live well.

TA Psychotherapy

Part of the process of TA Psychotherapy is to focus with compassion on how our borrowed and previous selves continue to serve us and to explore with care and curiosity those aspects of ourselves that are now no longer helping us to change or grow. For example, we might identify the origins of self-critical voices and practise liberating new nurturing parts of ourselves. Or we might explore those moments in our lives when we seem to be suddenly incapacitated by childhood vulnerabilities and work to resolve why this is so.

To return to our speaker, if the definition of mental health is indeed to be ‘comfortable with self, comfortable with others’, then I would like to suggest that the vitally important process towards this healthy state is of one of ‘compassion for self, compassion for others’, a process that TA and many other forms of psychotherapy can very effectively support.

 

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 –

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

How are you?

Out of Sight, Out of Mind

 

Resources – 

(1) Berne, E. (1961). Transactional analysis in psychotherapy: A systematic individual and social psychiatry. New
York: Grove Press. 

 

Filed Under: Chris Horton, Mental Health, Relationships Tagged With: Mental Health, Relationships, transactional analysis

June 20, 2022 by BHP Leave a Comment

Are People with Mental Health Problems Violent?

The stigmatisation of mental health and mental illness is nothing new and can be traced back through the centuries and across cultures.

Despite much improvement in the treatment of mental illness and an increasingly open dialogue about the effects of mental illness from sufferers and professionals, the evidence shows that paradoxically increasing numbers of the general public fear violence from those who are mentally ill.

What is mental illness?

Whilst the term mental illness is ubiquitous, it is a ‘catch all’ term which fails to differentiate between people struggling with their general mental health, people who struggle to regulate their emotions and the tiny minority who have an actual illness as defined in psychiatric terms.

In its most extreme form, mental illness is an inability to ‘hold’ onto reality and is a terrifying experience for the sufferer – this would be the definition of psychosis. However, as terrifying as this is, there is simply no correlation between violence and mental illness.

Where does this fear come from?

The fear of mental illness seems to be profoundly primal. Human beings pride themselves on the rationality and intellect and to be exposed to someone who has ‘lost their mind’ triggers fear – if it can happen to them, can it happen to me? Losing ones mind can feel like losing the connection with what makes us human.

Periodically these fears are brought back to the surface, often as a direct result of some unfathomable act such as the recent school shooting in Texas where 19 children and two adults were murdered by an 18 year old gunman. How can something like this happen? Who would do such a thing?

Human beings seek to ‘fit in’. We all to a greater or lesser extent abide by the rules and laws laid down by our culture and society. Where we abide by the rules and perform well, society tends to reward us. The rewards are multiple, but are generally related to social standing and financial payment which propels us to continue to do well: fitting into culture affords us self esteem.

Many people who suffer from mental health problems have experienced trauma during their lives – it can be argued all of them. We now know, in no small part thanks for the 1998 ACE study (Adverse Childhood Experiences) conducted by the CDC-Kaiser Permanente, that the more adverse childhood experiences a child is exposed to, the higher the likelihood that they will suffer from mental illness.

However, whilst striking, it was not only their mental health that was likely to be affected, the higher the number of ACE’s, the higher the risk of emotional and cognitive impairment, physical disease, poverty, criminality, social problems and substance abuse problems, all culminating in a higher likelihood of an early death. Trauma therefore impacts on a person in every facet of their future life. Trauma is not caused by poor mental health – poor mental health comes about through trauma, accompanied with the long list of symptoms above.

All human beings harbour thoughts and feelings that we consider to be in conflict to how we see ourselves and how we wish to be seen. Psychoanalysis was the first discipline to start to talk about how we all have sadistic drives, harbour murderous thoughts and take glee in the suffering of others. Psychotherapy seeks, amongst other things, to help people know themselves and to integrate these parts of their character.

However, where this integration has not happened people can ‘split’ these parts of themselves off – as if it simply is not a part of themselves – and ‘project’ them into others: I am ‘good’, you are ‘bad’, or in this case, I am ‘sane’ you are ‘mad’.

I would therefore suggest that much of what drives the stigma around mental illness and the association between the latter and violence is driven by fear leading to the psychological defence called projection. ‘Mental illness’ or ‘mental health’ is a convenient scapegoat for the parts of ourselves that we disavoy.

What can be done to challenge the misconceptions around mental health and violence?

In order to challenge the misconception that people with mental health problems are violent, we need to be able to have a mature and complex conversation about society, trauma and how we are all collectively responsible for ‘othering’: scapegoating and ostracising certain groups of people who are vulnerable. There is correlation between childhood trauma and violence, but violence is not caused by mental illness.

Alongside this we need to use factual statistic to show that simply having a psychiatric diagnosis or ‘suffering from depression’ makes a person no more likely to be violent or to commit a crime than anyone else. What does significantly increase the possibility is childhood trauma, contributing to feelings of low self esteem, a lack of belonging in society, poverty and feelings of disempowerment.

The effects of stigmatising those with mental health problems

Through engaging in an open and honest debate around mental health and mental illness, we can not only support those who are suffering to talk about their experiences and seek help, but also acknowledge to ourselves that we are all in no small part likely to be affected by a mental health issue at some point in our lives. This makes it ‘our’ problem rather than ‘theirs’.

Where people with mental health problems are stigmatised it further alienates them from mainstream society and the opportunity to ‘contribute’ to that society and feel a sense of belonging, purpose all leading to greater
self-esteem.

Stigma and scapegoating leads to shame and shame makes it even harder for people to access help. People with mental health issues need support, compassion (not sympathy) and a pathway to belonging in society. It is no more helpful to pretend that they have no problems than it is to demonise them.

Mental illness is a social problem

As discussed earlier, trauma – particularly childhood developmental trauma – impacts on every aspect of a persons ability to lead a fulfilling, healthy life. And trauma begets trauma, meaning that it is passed from generation to generation. Therefore, rather that scapegoating those with mental health problems, perhaps we need to collectively pause, reflect and look in the mirror to see what sort society we are all contributing to.

 

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

The limitations of online therapy

Pornography and the Online Safety Bill

Does the sex of my counsellor or psychotherapist matter?

How much time should I devote to self care?

Why is Netflix’s Squid Game so popular?

Filed Under: Mark Vahrmeyer, Mental Health, Society Tagged With: childhood developmental trauma, Mental Health, Mental Illness

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