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The Therapeutic Relationship and the Unconscious

Therapy is often referred to in terms of it being relational, or as a relationship, albeit a particular type of relationship, one that has very specific parameters, particularly around money, time, touch, and about whose inner life is there to be explored.

Despite this, in some ways, very one-way relationship, an awful lot of what goes on is a kind of relating. The therapist will encourage the client to speak as freely as possible and through a careful listening to the client’s words and to what is evoked in themselves, through this listening, they will try and relate as closely as possible to the clients experience and will feed this understanding back via their own comments, or interpretations.

What makes this different from other listening conversations, is that the therapists understanding and feedback will be influenced by the therapists training, specifically their own therapy and their learning of theories, which provide maps of mental structures and types of human experience and distress.

The therapist as well as listening to the stories, will also listen for patterns, for words, they will try and be attuned to what is going on emotionally for the client and also pay attention to the actions of therapy, to the how the client goes about relating to the therapist. When the therapist feels something useful has been understood, they will share this.

Sometimes this may not have been consciously known by the client, and this is why it can be useful. However, it can also be unnerving, as we like to believe we are the masters of our own houses, independent and not in need of the help of another.

Freud said there have been three great blows to man’s ego, the Copernican discovery that the solar system didn’t revolve around the earth, Darwin’s discovery that we are descended from animals, and share an essentially mammalian brain structure and Freuds own discovery that we have a dynamic unconscious, that the rational beings we like to believe ourselves to be is only one part of the story.

Part of this unconscious is the repressed unconscious, the place where we store the things we don’t want to know about ourselves, however these things are known at some level and we can expound a great deal of energy trying not to know them.

Getting to know and understand these parts of ourselves although often frightening to begin with, can actually be a huge relief as we come to know and accept these parts of ourselves, parts of ourselves that may seem like monsters under the bed and cast scary shadows but are usually essentially human characteristics.

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

A Nation Divided

Adolescence: the trials and tribulations

Does the male mid-life crisis exist?

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Psychotherapy can change your life – but you may not want it to

Anyone who is or has been in “psychotherapy proper” will tell you that it can be really hard work.

First, you begin by telling a total stranger about the most intimate things in your life. Things you never even said out loud because it was all too difficult to admit to yourself, let alone to another human being.

Then, you find out that most things you were taught about yourself growing up turn out to not be true. Well, that’s a relief in most cases, especially since many of us are taught to believe pretty horrible and untrue things about ourselves like: “you’re stupid”, or “you’ll amount to nothing”, or something a bit subtler like “your sister is the good one”.

Next, you are encouraged to feel things you haven’t or couldn’t feel before because no one cared or knew how to deal with it. So, once you start learning that the stuff you swallowed in your childhood was more about your parent’s inadequacy rather than anything to do with you, you begin to feel pretty angry about this, or sad, or disappointed, etc

All of this inevitably leads to the painful realisation that your early life wasn’t as rosy as you thought it was, and therefore you are now feeling very anxious or depressed about seemingly unrelated things like work or your relationship.  This then leads to more mourning of the loss of good experiences that you never had. And because you can’t go back in time and no one else can make up for these experiences, you then have to gradually come to terms with it.

Of course, this is all very uncomfortable and plus it turns your world completely upside down, which you weren’t expecting at all cause you just came here to talk to a lady (or man) with a nice face and (hopefully) a soothing voice.

But then, because you are feeling all this sad and angry stuff that you never felt before, you realize that you are also feeling other things, like relieved and happy. And that over time, you feel more and more alive and happy than sad and miserable.

This leads to you being more attractive to other people and them wanting to spend more time with you because you are a nicer and more interesting person.

You also get more secure in yourself and find better work, which in turn leads you to feeling even better about things and, oh gosh – a positive loop begins!

But of course, being sad and miserable has its advantages. People feel sorry for you and they try to rescue you. Plus, you don’t have to make any fundamental changes or feel very uncomfortable feelings and make some difficult realizations. It’s the devil you know, right?

Well, being in psychotherapy might change your life for good – it’s up to you whether you want to.

(P.S. The process of psychotherapy can take many different avenues, depending on what you are bringing and where you want to go. The above is only one general example).

Sam Jahara is UKCP Registered, CTA, PTSTA and is one of the Brighton & Hove Psychotherapy Co-founders.  She is a Transactional Analysis Psychotherapist with experience of working with individuals and couples in short and long-term therapy. Sam is available at our Lewes and Brighton & Hove Practices.

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Men, Sex and Aging in Relationships

I have previously written about women and the menopause, I am now turning my attention to men, sex and aging in a heterosexual context.

Research indicates sexual activity declines with age however as we see older people being portrayed as healthy, attractive and vigorous, we are more likely to acknowledge this age group as sexually attractive and therefore potentially sexually active.

In psychosexual terms feeling healthy, feeling good about your body and being reasonably fit are factors in feeling sexually attractive and of course these are likely to make a partner more responsive. Whilst the recognition of desire, lust and libido in the later stages of life must be a positive shift it may hide some of the struggles that older men are facing in the bedroom.

There are inevitable physiological effects of age on erectile function. Age UK says that 40% of men over 60 experience erectile problems. Erectile tissue becomes less elastic over time, testosterone levels are reduced, blood flow to the penis decreases. Apart from achieving an erection, difficulties in maintaining it, ejaculating too quickly or not being able to climax at all are common problems.

Sexual problems are frequent amongst older adults. In one study about 25% of older adults with a sexual problem said they avoided sex as a consequence. There are links between poor health and lack of sexual activity. In the same study the most common reason cited for a lack of sexual activity was the man’s ill health. Examples included drinking alcohol to excess, smoking, stress and a lack of exercise and conditions like high blood pressure, type 2 diabetes and heart disease.

Sexual problems are infrequently discussed with doctors and communication about sexual problems can be poor. Apart from the fact that sexual problems may be symptoms of an underlying physical condition, undiagnosed and undiscussed sexual problems may lead to depression and social withdrawal.

The kinds of problems that do not get discussed include concerns about medication for other conditions that impair men’s sexual performance, as well as drugs to improve sexual performance that have unpleasant side effects such as headaches and indigestion. Men might choose to stop taking medication if they feel they will have better sex without it and they may give up taking medication to improve their sex lives if they cannot tolerate the side effects.

In 2015 prostate cancer accounted for 13% of all cancers in the UK. The survival rate has been improving over the last 40 years but survivors can be left with lasting changes to their sense of themselves as sexual beings. One of the treatments is hormone therapy, which effects the production of testosterone and reduces the desire to have sex. Men put on weight more easily and can develop man boobs and they may find themselves crying more often. It is no wonder that a man might ask himself, “Am I still a man?”

In a relationship the impact of an older man’s difficulties on achieving and sustaining an erection will depend on their partner’s own experience of sex and aging. A man with a younger partner may feel he is letting his partner down. A couple may feel safer distancing themselves from each other and avoiding even affectionate physical contact in case it leads to unsuccessful sex. Men with partners no longer interested in sex may feel shameful about masturbating using pornography or fantasising about other women.

We do not readily talk about sex, it makes us feel very vulnerable. Seeking support and sharing feelings in counselling and psychotherapy can be a step to rebuilding a sense of self and sexual confidence and the start to thinking about new ways of relating.

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

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A Couple State of Mind  

This is the first in a series of blog posts about couples therapy.  In this post I want to talk about what Mary Morgan from Tavistock Relationships calls a ‘couple state of mind’.

Why if our partner is ‘right’ for us don’t they understand us completely? There are limits to how much we can ever fully understand or know another person. As we move from away from the early stages of being in love or infatuation it can be disappointing when our partner doesn’t live up to our expectations, ‘You aren’t the person I married!” or “You’ve changed since we first met.”. What we mean is “You haven’t become the partner I imagined you would be.”

When we become a couple we are two separate people with our own ideas of what it means to be a couple and what each of us should be prepared to offer and can expect to receive. These ideas are likely to be based on how we experienced our parents’ or carers’ relating to each other, as well as the community and culture we grew up in. As a couple we will inevitably be sharing psychic space as well as physical space, the tension between wanting to be held and close and wanting our own space and freedom can be challenging.

At times we might find our sense of our self and our reality is threatened by our partner’s version of what is happening. For example, we might feel our frequent phone calls and texts show how attentive and caring we are but our partner may feel overwhelmed and claustrophobic. One of us may feel it is important to regularly spend time apart to not become tired of each other, but this might make our partner might feel rejected and isolated. These polarised positions highlight the difficulties of holding two perspectives on what it means to be in a couple relationship.

Couples coming to therapy often do not have a sense of themselves as a couple. Thinking about what your relationship needs is not the same as thinking about what you need. This may sound obvious but it is easy to lose sight of when you are finding life is a struggle. One role for the couples therapist is to help partners contain or tolerate their differences long enough to create a shared space to think, a couple state of mind. A couple state of mind can be understood as a third perspective, a position which gives a couple a chance to step back, look at their relationship and explore what they could hope for and create together.

Couples therapy also gives each of us the chance to see our partner relating to the therapist, showing ways that two people can think together in a close and trusting way. Seeing someone as familiar as your partner connecting with another person can be surprising, they can be revealed in a different light. The therapist offers a safe and supportive environment where a couple can think together and explore a couple state of mind, to see if they can continue to develop as individuals whilst enjoying the closeness and intimacy of being a couple.

Morgan, M. (2018) A Couple State of Mind: Psychoanalysis of Couples and the Tavistock Relationships Model. London. Routledge.

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

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The Pain of Decision-Making

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

Either/Or

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

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

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

Loss

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

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

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

Regret

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

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

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

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

Conclusion

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

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

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