mind and body Archives | Brighton and Hove Psychotherapy

February 24, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Living with Borderline Personality Disorder

Borderline Personality Disorder (BPD), also know as Emotionally Unstable Personality Disorder, is a thought to affect between 0.7 and 2% of the general population. While estimates vary, it is considered that the disorder is predominantly diagnosed in women (75%).

So what is BPD? On a generic level, BPD is characterised by having difficulties in how you feel and think about yourself and other people. This can manifest in feeling insecure in relationships and consistently worrying that people will abandon you. This can bring about intense feelings that are very painful and difficult to mange, and they can last anything from a few hours to many days. This can make it hard to make and maintain stable relationships as the intense emotions and abandonment fears can push other people away. People with BPD often don’t have a strong sense of self and will try to change who they are depending on the person they are relating to.

The difficult feelings that are associated with BPD can often lead people to act impulsively, have strong feelings of anger that are hard to control and often self-harming or suicidal feelings. At the most difficult times, they may also experience paranoia or dissociation.

The causes of BPD aren’t clear, but there are some factors that appear with most people that can lead to a diagnosis of BPD. These are environmental factors when growing up, such as feeling unsupported, afraid or upset, with little validation. Family difficulties such as addictions in the parents or any kind of neglect or abuse can also lead to BPD. In additions to these factors, having an inherent emotional sensitivity can also be a factor that can lead to BPD.

So what should you do if you have been diagnosed with BPD? The first thing to consider is whether or not the diagnosis is correct. BPD is a controversial diagnosis as in itself it is hard to diagnose. The disorder shares a lot of commonalities with other personality disorders, and also with other conditions such as depression, bipolar-disorder and PTSD. For some people the diagnosis is a relief as the difficult feelings they experience now start to make sense. For others, having the label of BPD is unhelpful and doesn’t seem to capture their experience. Whatever way you feel about your diagnosis, it is important to get help so you can learn to manage your difficult emotions.

While there are a few treatments available for BPD, the one that is recommended by the NICE guidelines is Dialectical Behaviour Therapy (DBT). In DBT therapy, you will focus on acceptance and change. Accepting yourself is a fundamental part of building a sense of self, and leads the way to making positive changes in how you experience life. You will also start to learn emotional regulation skills so you are not swamped by difficult emotions, but instead learn to accept them and let them go. One of the key tools for this is mindfulness, as this allows you to really see what you are thinking and feeling, and allows you to distance yourself from these thoughts and feelings and stay rooted in the present moment. DBT therapy does take commitment to change, but it can allow you experience life in a more positive and balanced way.

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

Further reading by Dr Simon Cassar –

Online Therapy

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

January 20, 2020 by Brighton & Hove Psychotherapy Leave a Comment

New Year’s Resolutions – why change might be so difficult

The start of a new year feels like a good time to make resolutions to change your life. Cut down on drinking, learn something new, be more efficient, be kinder, be more sociable or get fit.

Gym memberships regularly peak in January, increasing by 10%-20% but how many of those new memberships are used? According to research by Fridge Raiders, published in the Daily Mail in March 2019, 23% of Britons have gym memberships but only 12% use them often. They estimate that more than 4 billion pounds a year is wasted on unused gym memberships.

The reasons given for the 50 percent who did not attend regularly or at all, were to do with feeling self-conscious or intimidated, thinking that everyone was watching, finding repetitive activity boring and not knowing how to use the gym equipment. These could be valid reasons but Robert Kegan and Lisa Laskow Lahey think it goes deeper. They ask why do we stick with the status quo when we are unhappy or unwell and know that change will make us feel better or even make us live longer? Kegan and Lahey have been researching the resistance to change for many years. In their book Immunity to Change (2009) they discovered that strongly held values, often unconscious, prevented both collective and individual change.

The most quoted finding from their studies comes from interviews with patients with heart disease who were told they must change their habits around eating, drinking, smoking and exercise and take their medication otherwise they would die. Kegan and Lahey found that only one in seven was able to make the necessary changes. Making further enquiries they discovered that although patients recognised the imperative of their doctor’s advice there were deep seated beliefs that contradicted their desire to get well.

A composite example would be a man who said that cutting down on food and drink and taking medication for ‘old people’ would make him feel he was old and weak. This challenged his idea of himself as a competent man in the midst of a productive life. Beneath this was his fear of becoming incapacitated and dying that brought back memories of his father’s illness and death. At a deep level the fears that prevented him taking care of himself were the very things that were likely to happen to him if did not change his habits.

There are many other examples in their book. Another composite example would be a manager who wanted to be more collaborative and involve his team in decision-making. Until he participated in the research he did not realise how much his fear of being a weak leader prevented him from being open to the ideas of others. This feeling stemmed from the unspoken culture of ‘you must be strong otherwise you won’t survive’ in the family he grew up in and was an integral belief about himself. When he could recognise this belief and its negative impact he was able to ask for support to change and eventually become a better and happier leader.

Kegan and Lahey’s research helps us understand why it might be so hard to change our habits to improve our lives. They offer an alternative to castigating ourselves for our indiscipline and lack of commitment and, I think, suggest that we begin by being kind to ourselves and curious.

References –

https://www.dailymail.co.uk/news/article-6765171/Britons-spend-4-billion-year-unused-gym-memberships-new-survey-reveals.html

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

Further reading by Angela Rogers –

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

December 23, 2019 by Brighton & Hove Psychotherapy Leave a Comment

Why do I do that? A Dramatherapist looks beneath the surface

I am a dramatherapist and I am talking today about one of my favourite subjects. I am going to explain the benefits of working with creativity in the therapy room.

When we are being creative we are using a part of our brain which does not relate to logic or linear time. This part of the brain thinks in pictures, metaphor and symbols. It is representational rather than objective. It endows personal subjectivity to our experience. It is what makes us human and unique. It records and remembers everything that has ever happened to us, every thought, every sensation, every feeling, every hope, every dream. What a storehouse of information waiting to be revealed!

But here’s the thing. Whereas we can easily access the logical part of our brain, so we know to carry an umbrella when it’s raining. We have learned this, it’s logical. Our creative brain thinks in pictures, sensations and emotions. Experiences and memories are recorded and stored in a different way which means they’re not always readily available for us as information because they reside outside of our awareness.

So for example: you’re normally a reasonably polite friendly person, but behind the wheel of your car you rage at other drivers and you don’t know why you do this. This behaviour stems from something in your psyche that is ‘out of your awareness’. So you can’t stop yourself doing it by simply noticing it and trying to change your behaviour. The interesting thing about this type of ‘out of awareness’ behaviour is that we can’t seem to learn from it no matter how hard we try.

This is where the dramatherapist armed with a creative toolkit can help. We know from research that when the mind is engaged in a creative task, the logical mind takes a back seat. It goes off-line and allows us to tap in to the resources that are held ‘out of awareness ‘ and hidden beneath the surface of our everyday experience.

Here we can see why we behave the way we do and where/ how it originated. We can explore the triggers. In doing this we can actually heal our past experience and recover form it. And that’s what we want from therapy, right?

One way I get my clients to tap in to their ‘out of awareness’ experience, is to use a method called hot-penning. First of all I prepare my client using relaxation techniques to enable a clear focus on the issue at hand. The client then takes pen and paper and writes whatever comes to mind. The rule book is thrown out and the pen is given free reign. The writing need not be logical or sequential, it may be a stream of words, you’re allowed to swear, it does not have to make sense. After a couple of minutes of loosening up the client will generally begin to write meaningful narrative which can be very revealing. Clients are so frequently surprised by their own articulacy and the wisdom that they express. Quite often there will be the ‘a-ha’ moment.

In my experience when the client has insights unprompted by the therapist they are more motivated towards lasting change.

Dramatherapy as a creative therapy can help the client to begin to live more fully ‘in awareness’ and be less affected by ‘out of awareness’ behaviours which formerly tripped them up.

Magdalena Whitehouse is an experienced HCPC Registered Drama Therapist, working with individuals, couples and groups. Magdalena is available at our Brighton and Hove Practice.

Further reading by Magdalena Whitehouse –

Couples Therapy in Practice

A Dramatherapist at work in the sand tray

April 16, 2018 by Brighton & Hove Psychotherapy Leave a Comment

Can Mindfulness Replace Psychotherapy?

There is a lot of hype surrounding mindfulness at present. The NHS now sees it as a psychological intervention, and large corporations recognise that calm, happy employees are more productive. But how realistic is mindfulness, a secularised and stripped-down version of the Buddhist practice of meditation, as a long-term psychological intervention?

What is Mindfulness?

Mindfulness is essentially ‘awareness’; being able to remain aware of what we are experiencing without becoming attached to the thoughts, feelings and sensations that come and go.

What are Some of the Touted Psychological Benefits?

Few in-depth academic studies have been carried out into the effects of mindfulness on psychological health. Even fewer have approached the question critically with a willingness to consider adverse effects. However, early indications from pilot studies are that mindfulness can be beneficial (more on this word shortly) for alleviating the symptoms of mild depression and anxiety.

And the Drawbacks?

Dr Bessel Van Der Kolk is one of the world’s leading authorities on PTSD (Post-Traumatic Stress Disorder) and CPTSD (Complex Post-Traumatic Stress Disorder, also known as Childhood Developmental Trauma.) He states that mindfulness does not work for these patients, as they cannot feel.

What he means with this statement is that for traumatised people, the capacity to feel emotions has become compromised. This could be because their childhood experiences prohibited them developing a healthy relationship with their emotional world. Alternatively, this inability to feel emotions derives from massive emotional trauma in adulthood that the person has not been able to process. Traumatised people, in lieu of feeling, become overwhelmed and then dissociate. They split off their emotions from their experience in the ‘here-and-now’.

Clinically, early studies have shown that mindfulness, when not integrated into psychotherapy, can exacerbate symptoms in psychological illnesses such as Bipolar Disorder and in people with (C)PTSD. Further research strongly indicates that engaging in any practice of mindfulness can lead to a psychotic breakdown in patients with a history of psychotic episodes. Furthermore, particularly for children living under abusive conditions, mindfulness can strip them of their coping strategies and leave them more traumatised. This is a consideration that schools using this technique would do well to hold in mind.

Impermanence, Suffering and Not Self

These three experiences are what mindfulness can bring us into contact with. Located away from any spiritual context (Buddhism) and without adequate psychological holding, the silence and emptiness that so many crave through mindfulness can cause a psychological break in others.

What is Change?

In the world of psychotherapy, we look at two levels or orders of change – first and second order change.

First level change is about clients and patients accessing behaviours that enable them to stabilise emotionally. However, this level of change does nothing to resolve the underlying conflict and trauma that drives the lack of stability. First order change is a critical step to assisting clients and patients in stopping or managing damaging behaviour. This is an important step and can literally be life-changing for people. It is not, however, the goal of psychotherapy, as it does not address the problem. Managing symptoms is useful but it negates the critical fact that symptoms are already a way of the client/patient managing the problem. They are a form of self-coping, however malign they may seem.

Mindfulness works to bring about first order change but cannot address the underlying problem. Additionally, as traumatised people cannot feel, they may in fact be dissociated during their ‘practice.’ While they may appear calmer, they are unable to use their emotions and ego to make clear informed decisions for themselves.

Early studies have shown that first order change is only sustained as long as the practice is maintained. This kind of change is not structural on a psychological and emotional level.

Why do some Meditators Die Young?

This is a question (riddle) I was posed a few years ago when attending a conference snappily entitled ‘Neuroendocrinology for Psychotherapists’. What was lacking in the title was made up for in the content. A significant number of meditators with a traumatic past think they are meditating when they are, in fact, dissociating. Their emotional and endocrine systems are under immense stress. Long-term, this impacts on their immune system, leading to chronic illness and death.

Second Order Change, or Dealing with the Problem

Psychotherapy is about mind-body integration. It is about providing a therapeutic relationship with the traumatised, split-off, vacant parts of the client/patient which can be seen and related to by the psychotherapist.

Emotions are our compass. They tell us, moment by moment, whether we want more or less of something; whether we feel safe or a situation is dangerous. Where clients lack the ability to navigate using their emotional compass, they first need to learn to reside in their body – to become embodied. This is achieved through an ongoing stable and in-depth relationship with a psychotherapist who can give shape and form to our trauma through words. Language development is a social process, and so is becoming embodied.

Second order change impacts on our emotions, structure and personality and assists in resolving the problem. Our traumas have happened to us in relationship (with our caregivers or ourselves) and can therefore only be resolved in relationship.

Some Final Thoughts

I work extensively with trauma and actively integrate the body into my work. This, however, means first and foremost to teach a client to remain in the ‘here-and-now’ so that they do not become overwhelmed and dissociated. The first step in this is that any trauma work is processed with our eyes open, unlike most mindfulness practice. After all, we cannot be in relationship if we cannot see the other person.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Further reading

How psychotherapy works

How to grow a mind

Remembering in order to forget

April 9, 2018 by Brighton & Hove Psychotherapy Leave a Comment

How body stability creates psychic stability

There is No Such Thing as a Baby

I frequently blog about the importance about including the body in the process of psychotherapy and how the unconscious resides in the body. However, unlike many ‘body psychotherapists,’ I believe that the involvement of the body is more profound than identifying the presence of the body in the process. Let me explain using one of Donald Winnicott’s most famous quotes, “There is no such thing as a baby.”

Winnicott famously made this statement in 1947. On face value, it may seem somewhat absurd. After all, we have all seen babies and know they exist. However, the reality is far more complicated, because every baby that any one of us has ever seen is only visible because it is in a relationship with its primary carer (which for simplicity, I shall refer to as its mother).

A baby cannot exist alone but is essentially part of a relationship. Babies exist in an absolute state of dependence, such that the infant (the word is taken from the Latin – ‘infans’ – not able to speak) has no knowledge of maternal care, as this would require the knowledge of ‘an other’ providing the care. The baby therefore is essentially indivisible from its mother and thus cannot exist in its own right. The infant’s experience relies on the mother’s ability to merge with, and adapt to, her baby. Therefore, whenever we see a baby, we actually see a baby, its mother, the relationship between the two and also the wider social context within which that baby lives and has come to be.

There is No Such Thing as a Body

The same principle can be applied to a body. There is no such thing as a body in its own right. A body is created, shaped, moulded and exists within the relationship that the mother of the owner of the body has had with it. In other words, the body and how it is experienced by the person in the body is contingent on the relationship that the baby has with the mother and the wider environment. This then dictates the relationship that the owner of said body, has with him or herself (if any.)

Why Does the Body Matter?

Psychotherapy is about many things, but one of the primary tenets is that it is a relationship within which the client/patient can, through relating to the therapist, establish a relationship with themselves. Having a relationship with ourselves includes having a relationship with our body. However, I believe that too many psychotherapists assume that such a relationship is necessarily experienced as helpful by the client at the outset of therapy, or even possible.

The Body as an Enemy

If we come to inhabit, or embody, our bodies through the relationship with our mothers and the wider social context, and our mothers were abusive to us, then the experience of our body can be one of ambivalence (‘I don’t really care about my body”) through to experiencing the body as dangerous, attacking or not our own.

Examples of where internalised abuse/hatred is expressed towards the body include cutting and burning the skin through to anorexia and bulimia, to name a few.

Risk of Trauma

Assuming a pre-existing, or even conceptually possible positive relationship between a client and their body on the part of the psychotherapist is naive. At worst, it risks re-traumatising the client.

If, for the client, all that is bad resides in their body, then they need to slowly find a way to ‘meet’ their body in a different context and to tentatively form a different relationship with their body – to reclaim it from the ‘bad’ parent. The therapeutic process involves creating a different relationship with ourselves, one in which we are able to leave the echoes of past formative relationships behind. At the very least, we need to learn to think about ourselves as players in those stories in a different way. In the same way, we need to learn to relate to our body as our own and as our friend, guide and an integral part of us.