In this video interview, Paul Salvage demystifies psychoanalytic psychotherapy and explains what clients can expect from the process. Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.
In second of two video interviews, Paul Salvage discusses who may benefit from psychoanalytic psychotherapy and explains how it has evolved since the days of Freud. Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.
We have all heard the phrase. Often shouted at a moment of crisis on a television programme or film: “Don’t just sit there, do something!” As if ‘doing something’, anything at all, will make a difference. Of course, the reality is that doing something does make a difference, if not to the outcome of the crisis, then at least to how the protagonists in the crisis feel.
Doing something – anything – at a moment of crisis or even simply at a moment of inner discomfort, can be a common way of avoiding uncomfortable feelings. Doing something can convert those feelings into an external activity whereby they, at least for the duration of the ‘doing something’ do not need to be consciously experienced.
We call defences, such as these manic defences, as their purpose is to rigorously protect us from having to be in touch with uncomfortable feelings.
Is manic defence linked to depression?
Most people associate the term manic defence, or ‘mania’ with depression and in particular bipolar disorder. And whilst it is correct that some suffers of bipolar disorder experience acute manic episodes which may or may not include psychosis, all of us use manic defences as an unconscious way of protecting ourselves against psychic pain.
The clinical bit
Manic defences arise developmentally sometime between the age of six months and a year. This stage is when the infant is starting to come to terms with the fact that his/her primary carer (I shall use the term mother here for simplicity) is separate to them. In other words, that the mother is not a ‘part’ of the infant and that therefore she will frustrate and anger the infant in not being perfect in meeting their needs. Manic defences protect the infant against painful feelings of control, contempt and triumph, according to Melanie Klein. Manic defences therefore protect the infant against their own uncomfortable feelings and protect the mother, from the infant’s rage.
How do we use manic feelings?
Manic defences come into play to stave off a whole range of difficult feelings from boredom, through to rage and anger – often feelings where we feel impotent, helpless or fear our own strength of emotion.
An example could be to go shopping after a tough day at work. And, with the advent of the internet, ‘shopping’ is invariably always at our fingertips.
What’s the problem?
The developmental process of growing up is one in which we should all learn to be able to face our emotional and mental discomfort and then use it in a growth orientated manner to move forwards in our life.
Without this, we remain at the mercy of early, primitive defences that stop us engaging with who we are and how we feel and severely limit our capacity to become an integrated whole person.
How can psychotherapy help?
In order to grow up in a methodical way using our wisdom to make sense of our internal and external world, we must rely on others to teach us what is required. This is ideally the role of a parent, however, if we have a parent who has been unable to truly separate from their p[aren’t and relies on manic defences to navigate the world, then we cannot learn this from them.
Psychotherapy offers and represents a relationship in which our inner worlds can be understood and tolerated. This is not an easy process, but it is a fulfilling one: when the going gets tough, the tough go to therapy.
Returning to the title of this piece, perhaps the challenge for us all is in being able to resist doing anything, and to simply sit there and observe our internal process and acknowledge our feelings. This is the mature response, but does not make for dramatic television!
Mark Vahrmeyer is a UKCP registered integrative psychotherapist who draws strongly on existential thoughts and theory to help clients make sense on an increasingly senseless world. He sees clients in Hove and Lewes.
Further reading by Mark Vahrmeyer –
Can Psychotherapy or counselling be a business expense?
The difference between Counselling and Psychotherapy
How do I choose a Psychotherapist?
This blog follows on from my previous blog – Existential Therapy. This is how I have interpreted some vital notions connected to existential therapies.
Existential therapy is a diverse approach which is used to understand and clarify a client’s problems and possibilities for living their existence. Below are some more of the vital principles (as I see them) typically considered by existential therapists. I would like to make clear that what I have written is not exhaustive, conclusive or necessarily a general order of things.
1) A belief in the relational nature of being as a central aspect of existence [1].
This suggests two things to me. That we are always in relationship with the world, and how we relate to it is often fundamental in how we are and what we become. It is interesting to note that in therapy the relationship has been continually found to be the key to efficacy whatever the approach.
In contrast to the relational sense of existence some existential philosophers have asserted we are ultimately alone in our existence. For instance, Kierkegaard emphasised the individuality of being human, describing human existence as a solitary affair.
Wherever one falls on this spectrum the discussion of how one is relating to their world can be a fruitful enterprise in existential therapy.
2) Seeking to understand a client’s subjectively lived experience and how it is taking place within a framework of temporality (past, present and future), tensions and contradictions. [2]
For me this means the intention is to understand that human existence is full of paradoxes. The aim is to clarify a client’s life as they have lived it, support them to reflect on what has happened and allow them to determine how they would like to live in the future in line with their values.
For instance, if a client comes to see me I am not going to attempt to fit them into any theory or model. I am also not going to tell them what to do. I do hope to hold an openness to each client’s way of being-in-the-world and support them to get clarity on what is going well and what needs to be changed. I may employ an exploration of philosophy and other wisdoms as well as psychological theory to support a client’s inquiry, but I will always lean towards emphasising a client’s lived experience as key to the investigation rather than any theoretical understanding.
This leads me to another understanding that frames existential therapy.
3) A consideration and discovery of a client’s freedom and responsibility
For me this element is summed up nicely by Nietzsche’s words “Follow not me, but you”. [3]
When he said this I think he was responding to people’s attempts to pinpoint his ideas into an all-encompassing approach to life. For me, it feels like a relevant description of every individual’s existential responsibility.
An existential therapeutic perspective typically strives for the clients to take responsibility for their lives and see their very existence, their being-ness, as the source of their potential as well as an opportunity to confront their limitations.[4] This possibility of being also upholds a fluid sense that we are always becoming and not a static substance. It invites a platform from which clients might begin to take responsibility for their existence and what they value. In this movement we may begin to reveal, understand and clarify their choices and actions. This takes courage though. It takes courage to birth and live out one’s potential, especially in the face of adversity and limitation.
This links into another significant understanding or theme underpinning existential therapy: ‘being towards death’. Please also read my blog on Existential Therapy and Death Anxiety.
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 and Lewes Practice.
Further reading by Susanna Petitpierre –
Being embodied in Therapy: Feeling and listening to your body
Resources –
[1] Spinelli, E. (2007) Practising Existential Psychotherapy. The Relational world. London: Sage
[2] van Deurzen, E. (1998) Paradox and Passion in Psychotherapy: an Existential Approach to Therapy and Counselling. Chichester: Wiley.
[3] May, R., (1958) Origins of the existential movement. in Existence. (Eds: Rollo May, Ernest Angel & Henri, F Ellenberg) Rowman and Littlefield Publishers: USA. p. 31
[4] van Deurzen, E. (1998) Paradox and Passion in Psychotherapy: an Existential Approach to Therapy and Counselling. Chichester: Wiley.
We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?
There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.
There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?
Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.
Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.
A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.
Here are a few points you might want to consider if you want to access therapy online:
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 –
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
