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September 30, 2016 by Brighton & Hove Psychotherapy 1 Comment

How to grow a mind?

The word ‘mind’ is one that most folks use quite regularly and comfortably. Us psychotherapists use it more often than most. However, to the best of my knowledge, nobody has actually seen a mind. So, what is a mind, and why should we grow one?

Those of you who follow us know that at Brighton and Hove Psychotherapy we believe in mind-body integration and espouse a range of approaches in order to facilitate this. Furthermore, our approach is also in keeping with the latest neuroscience findings on why therapy works So, back to the mind. While there are differing definitions, we believe that a mind is that part of a person that enables them to make sense of their world (inner and outer) and can navigate and mediate between feelings and intellect. If the brain is in the head (no disputing this fact) and emotions originate in the body as sensations, then the mind is what enables us to connect the two up (counter-intuitively, neuroscientists are now suggesting that rather than residing in the brain, the mind is in the body – just like the unconscious).

In psychotherapy, the mind is very different to intellect. We can all probably bring to mind folks who have academically brilliant intellects, but struggle to apply a rational, wise mind to how they relate to themselves and the world around them. It could be argued that some of these people even hold quite powerful positions in government and business, so sometimes having a limited mind does not hinder performance, at least in certain parts of our lives.

We grow our minds from the moment we are born, perhaps even in utero. A mind is grown from the mind of our parents (or caregivers) and thus, the quality of our mind is generally directly correlated to that of our parents. They are the ones who use their auxiliary mind to build ours, hour after hour, day after day, and throughout our young lives.

They begin by helping us make sense of the turmoil of the sensations we feel in our bodies as tiny infants and give shape and form to our emotions through naming them and normalising them. With time, they help us understand that we are not alone in the world, and so, while our own emotional experience really matters, so does that of those around us. Finally, they guide us in developing wisdom in using our minds to navigate a complex arbitrary world. That’s if it all goes to plan, anyway, and often it doesn’t.

If our parents’ minds are limited because their parents didn’t enable them to grow their minds, they won’t have so much input to give us. This is one example of inter-generational trauma. Or, if our mother was depressed after we were born, she won’t have the capacity to attune – to be fully present – to us. In fact, any form of abuse or neglect will have a detrimental impact on our minds.

To emphasise the difference between the intellect and the mind, consider the impact of boarding school, particularly where children are young. This is traditionally an environment where the development of the mind is forsaken in lieu of intellectual prowess.

Why does all this matter? Well, because psychotherapy is about helping clients grow and develop their minds where, for whatever reason, this did not fully happen when they were young. It is precisely why therapy cannot be rushed and needs to be consistent and regular. One cannot fast-track the growing of a mind.

Let’s move on to another word we use a lot and consider how this all fits together – trauma. Again, this is a word with many definitions, and it is very much the zeitgeist at present. Essentially, trauma in an emotional sense is shock that has not been processed. There are broadly two types of psychological trauma: single-incident trauma, known as PTSD, or Post-Traumatic Shock Syndrome, and complex trauma, also known as Childhood Developmental Trauma. They are fundamentally different and require different approaches. We can treat PTSD with a range of approaches including counselling, brief psychotherapy, Cognitive Analytic Therapy (CAT), EMDR and energy psychotherapy, to name a few. All of these can be very effective. None of them grow a mind.

Childhood developmental trauma, or, as I prefer to think about it in most cases, a lack of parental attunement, requires a slow consistent methodical relational approach to enable the development of the client’s mind. This is what depth psychotherapy offers and the research – back to neuroscience – evidences that the relational approach does this best.

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.

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Filed Under: Attachment, Mark Vahrmeyer, Neuroscience, Psychotherapy Tagged With: attachment, Parenting, Psychotherapy, PTSD

May 23, 2016 by Brighton & Hove Psychotherapy 3 Comments

On Affect Regulation

The term ‘affect regulation’ is one that I have written about previously and one that is increasingly used in the world of applied psychology and neuroscience. It can be a very useful term for bringing together psychology, biology and in explaining why good psychotherapy works, so read on!

What is regulation?

We all regulate (manage) the environment around us moment to moment. A good example of this is how we may regulate the temperature in a room by either opening a window or turning up the thermostat.

When we feel overwhelmed by our emotions, we become dysregulated. It is interesting that the language we use often reflects our experience of how we experience nature or bodies when we witness this dysregulation taking place. “She blew her top.” “He became hot and bothered.” “She went weak at the knees.” “She exploded with anger.”

Imagine a sunny warm afternoon, and you are relaxing in a nice safe place. If you don’t like the sun, imagine an environment where you feel contented and calm. There are no worries or stressors and life is good. In this state, you are likely to be regulated and in a state of ‘rest and digest’. However, as we all know, calmness is transitory, and soon a stressor will appear on the horizon. An irate relative calls, we realise we have lost our keys somewhere on our walk, our partner says something we experience as hurtful – the list is endless.

In this moment, our arousal levels increase. Arousal simply refers to the wide range of physiological, emotional and psychological changes that happen when our attention is drawn to a stressor that we perceive as something that needs dealing with. In this moment, we have moved from ‘rest and digest’ into a state of alertness.

Just as a room temperature on a micro level is never static, so our arousal levels are also never static. Whatever we think about, see, hear, smell, taste or imagine creates a change to our physiology on a moment by moment basis.

If our arousal starts to become too heightened, we can shift into a ‘fight or flight state’ (or freeze/fold state) where our thinking brain quite simply goes offline and we feel overwhelmed.

Being in a fight or flight state is useful if we are about to be attacked by a sabre-toothed tiger. However, in most day to day situations and interactions, it is simply unhelpful and can be damaging to ourselves and others.

Affect regulation is therefore the understanding and practical implementation of how we manage our emotions in the face of an ever-changing inner and outer environment.

How do we learn it?

In simplistic terms, we learn to regulate our emotions by our primary caregiver teaching us to do this. They literally help us make sense of our emotions by using their own nervous system to tune into ours and give form, shape and language to our experience. This is often our mother, as she will generally have the strongest and most frequent physical bond with us when we are very young, such as when we are breast-feeding. However, fathers have an equally important role to play in this process.

Time after time, our sense are flooded as infants by strong physiological responses which we have no capacity to make sense of. Time after time, our primary caregiver will soothe us, name the motion, witness our experience and normalise our response. Ideally, anyway.

Why does it matter?

Nobody enjoys living under the feeling of ‘being on edge’ all the time, or the opposite, of feeling bored, apathetic and ‘switched off.’

Both of the above states of being, although seemingly opposite, are in fact highly stressful states of being that put our minds, hormone systems, bodies and immune systems under enormous stress, just like we cannot ‘rest and digest’ when overly aroused.

Ongoing dysregulation does not only occur through poor attunement as a child (emotional neglect). It can also be the result of trauma characterised by PTSD.  However, research has shown that those people who lack the ability to healthily regulate their emotions are more prone to PTSD in later life (van de Kolk)

Types of regulation

Broadly speaking, there are two ways we regulate ourselves: we auto-regulate, and we regulate our emotional state interpersonally.

Auto-regulation is the ability to self-soothe; the ability to hold onto a thinking mind as arousal levels start to increase, to ‘think things through’ and then take action, rather than being at the mercy of our reactions. Examples of self-soothing techniques in the moment include mentalisation (holding onto that all important thinking mind) taking a deep breath, walking away from situations that are not in our best interest, through to engaging with external behaviours and activities such as yoga, going to the gym, meditation and lifestyle choices such as diet and good sleep hygiene.

Auto-regulation can also include a whole host of dysfunctional behaviours which, rather than stemming from taking action as a result of using our thinking minds, fall into the categories of reactions – a flight from emotions – such as addictions or narcolepsy (falling asleep when under emotional stress).

Interpersonal regulation is the most sophisticated forms of regulation and it involves using our thinking mind (from auto-regulation) to seek out other human beings with whom to share our emotions. All humans are wired for connection and while we can, and must, learn to auto-regulate in healthy ways, the fact of the matter is that our nervous system needs the nervous system of others in order to down-regulate our emotional state. Put simply, human beings are hard-wired for relationships and need these relationships in order to feel calm and content. This is arguably the fundamental principle as to why we pair-bond.

Why do some people find mindful auto-regulation and inter-personal regulation hard? Perhaps it is because it becomes very hard to hold ourselves in mind when the one person who should have helped us to learn to regulate our emotions could not do that. This makes auto-regulation hard to do. If that primary carer could not do it for us, why would we trust that anybody else can?

 How does psychotherapy help regulation?

Good psychotherapy starts with helping clients to make healthier choices in auto-regulation. This all helps to bring down chronic stress levels and forms the foundation of bringing that thinking mind online – the beginnings of the process of mentalisation.

However, the real goal of therapy is to help clients to grow their minds and find – perhaps for the first time – safety in a relationship where they can entrust their precious mind and nervous system to be seen, witnessed, validated and ultimately regulated by the mind and nervous system of their psychotherapist.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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Filed Under: Mark Vahrmeyer, Mental Health, Neuroscience Tagged With: affect regulation, Psychotherapy, PTSD, Trauma

May 16, 2016 by Brighton & Hove Psychotherapy Leave a Comment

Remembering in order to forget

It is not unusual for prospective or current clients in psychotherapy to ask, “What is the point of me remembering that and feeling sad, upset, angry (insert whichever uncomfortable emotion comes to mind)?” And even when not posed directly, the question plays in the unconscious through resistance in the therapy and a quick shift of content or a dissociation from emotions that are coming up.

Remembering to forget lies at the heart of psychotherapy, and it is no coincidence that, like so much in the world of therapy, it is a statement with more than a hint of the paradoxical to it. After all, how can remembering possibly lead to us forgetting? Perhaps the answer, or one of the answers, to how this paradox unfolds lies in why we often seem destined to repeat the past in our lives – a key factor in what often brings clients to therapy.

The past repeats – particularly in our relationship to ourselves and others – until we become conscious of our past; our unconscious drives us until it is brought into consciousness. One way of thinking about this is that as we travel through life, we all collect trauma (with a small ‘t’.) Trauma is shapeless and formless, yet, once again paradoxically, it takes a substantial hold and can exert significant influence over our lives. Trauma, or the effects of it, also reside in the unconscious – the body.

Therapy is about giving shape, form and language to trauma – whether that is trauma with a small ‘t’, or more substantial trauma in the shape of single incident PTSD or Complex Childhood Developmental Trauma. We give shape, form and language to our trauma by listening to the communication of our unconscious which uses symbolism, repetitive behaviour and the body to communicate to us.

This is why we need to remember.  We remember so that we can bring our emotional being back into contact with the sensations, emotions and feelings that were evoked when the event we are remembering occurred.  Our emotional system is not linear or logical: when we remember, we feel what we felt at the time.

What good is it to feel what we once felt?

It is only though the remembering of the felt sense – the somatic memory – that we can allow our emotions to express themselves in the way they could not at the time of the original event or experience. And unexpressed emotions do not go away, they simply find other ways of telling us that we are hurting.

Psychotherapy is about feeling those unexpressed emotions – giving shape, form and language to them – and allowing ourselves to feel without becoming overwhelmed.

How do we know the outcome will be different this time around?

We may find we are defended against remembering as, after all, it did not make us feel better when we felt the pain the first time around. The art of feeling, whilst staying present with the here and now as well as being attuned to and witnessed by a psychotherapist is where the potential for change resides.

And so it is through a grounded and gentle approach to being witnessed and validated in our process of remembering that we can process our trauma and finally allow ourselves to forget the need for unconscious reminders that dominate our lives. Remembering to forget thus ceases to simply be a paradox and instead becomes a road to freedom.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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Filed Under: Mark Vahrmeyer, Psychotherapy Tagged With: memory, PTSD, somatic memory, Trauma

January 29, 2016 by Brighton & Hove Psychotherapy 1 Comment

Trauma and Recovery

Judith Herman (1992), writes:

“Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning”

Although Herman’s book was written more than twenty years ago, and findings in neuroscience have given psychotherapists a rich body of information to work with since, I summarize here three of the core symptoms of Post-traumatic Stress Disorder (PTSD), followed by three stages of recovery from trauma explored in her book “Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror”.

1. Hyperarousal/ Hypervigilance

This is a state of permanent alert after a traumatic event as if danger is constantly around the corner. Common factors include: startle reactions, psychosomatic symptoms, irritability, aggressive behaviour, nightmares and poor sleep, arising from the chronic arousal of the autonomic nervous system (ANS).

For instance, in case of soldiers returning from war, when they are eventually removed from the stressful and threatening environment the anxiety initially recedes. However, after a while the psychological symptoms persists and cannot be integrated into a life of safety and security.

2. Intrusion

This entails reliving the traumatic event as if it was happening in the present. “It is as if time stops at the moment of trauma” (1992, p. 37). This manifests in the form of flashbacks, recurring dreams and vivid emotional memories triggered by reminders of the event (s).

“Traumatic memories lack verbal narrative and context; rather, they are encoded in the form of vivid sensations and images.” (1992, p.38)

3. Constriction

Also called numbing or a state of hyperarousal. “Perception may be numbed or distorted, with partial anaesthesia or the loss of particular sensations. […] The person may feel as though the event is not happening to her, as though she is observing from outside her body […]” (1992, p.43).

Numbness happens either through a psychological dissociative state or is also chemically induced with the help of drugs and alcohol.
Although dissociation can be a useful survival mechanism during a traumatic event, it becomes a barrier to relating with self and others after the event has passed.

Steps to Recovery

 

A Healing Relationship

Disempowerment and disconnection from others is central to traumatic experiences. Therefore, it is vital that healing occurs within a trusting and empowering therapeutic relationship, and with the support of significant others wherever possible.

“Recovery can take place only within the context of relationships; it cannot occur in isolation” (p.134).

Herman (1992) describes three main stages of recovery from trauma, which I list below. However, as therapists, we bear in mind that recovery isn’t necessarily a linear process, and treatment plans are used more as a helpful guide rather than something to strictly adhere to. In addition, every therapeutic work is tailored to the individual’s unique circumstances. Each stage may take days, weeks or months and be revisited again and again over the course not only of therapy but of one’s life.

1. Safety

The first stage of recovery entails naming the problem and normalizing common symptoms. Once the issue is identified, treatment can begin.

In the therapeutic work it is important to begin restoring control by establishing safety: “Survivors feel unsafe in their bodies. Their emotions and their thinking feel out of control. They also feel unsafe in relation to other people” (p.160).

Establishing safety begins through learning to regain control of the body by focusing on restoration of the natural biological rhythms (attending to health needs, medication, diet, exercise, sleep, relaxation, etc.), and gradually moves toward gaining control of the environment (engaging caring others, living situation, finances, self-protection, etc.).

2. Remembrance and Mourning

“In the second stage of recovery, the survivor tells the story of the trauma” (p.175). In therapeutic terms it is called ‘trauma debriefing’. It is a work of reconstruction and reintegration of memories into the person’s life. The therapist acts as a witness and ally in whose presence the unspeakable can be spoken.

Trauma debriefing needs to be carefully and sensitively negotiated between therapist and client, making sure the client remains within a ‘window of tolerance’ (Ogden, Minton & Pain 2006) between hyper- (agitation) and hypo-arousal (numbness).

Trauma inevitably involves loss. The mourning of those losses is both vital and one of the most challenging steps of recovery. This is because grieving is a complex process, varying in degree depending on circumstances. However, without mourning healing is unlikely to take place.

3. Reconnection

“Having come to terms with the traumatic past, the survivor faces the task of creating a future” (p.196).

Whereas in the first stage of recovery survivors focus mainly on establishing safety by creating an environment which is protective, the third stage may entail engaging with the world and facing their circumstances head on. In some cases this will involve accusing or confronting others who were either directly involved with the abuse or stood by.

This stage also involves reconciling with (and forgiving) oneself by means of developing desire and initiative. Survivors slowly recognize and begin to let go of negative aspects in themselves that were formed as a result of the trauma.

This process involves self-compassion, self-respect, and working toward renewing trust in others.

This isn’t to say that there is ever a final resolution to traumatic experiences. Life circumstances and events may bring back familiar feelings experienced before the start of treatment. As previously said, the course of recovery is not linear. The various stages are revisited, each time with renewed integration and strength.

Sam Jahara is a UKCP Registered Psychotherapist and Certified Transactional Analyst.

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Filed Under: Psychotherapy, Sam Jahara Tagged With: Psychotherapy, PTSD, Trauma

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