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Why there’s nothing as infuriating as Anger Management

Throughout my career as a Psychotherapist, particularly when working with statutory services, I have often been asked to provide, ‘Anger Management’. Now I do understand that some people desperately need help with their anger and that it often has destructive effects on them and their relationships. However, what was, (its much less heard of these days), called anger management often consisted of cognitive techniques to control anger, breathing exercises, counting backwards etc, and while these may help a few people they don’t really touch the surface for most. The appeal is in a simplistic idea of control, the idea that we can simply choose which emotions to feel.

Once a certain point of anger has been reached rational thought has gone and telling someone to just control their anger is a bit like saying to someone with depression, “hey bud, don’t be sad’.

The psychodynamic approach along with all exploratory therapeutic approaches, seeks to understand the hurt behind the anger, attempting to address the root rather than the surface ‘symptom’.

The root of anger is very individual, each person has their reason to be angry and an analytic approach seeks to understand the reasons, meaning and purpose of an individual’s anger, helping them feel understood.

Anger and Depression

Anger is often part of a complex set of internal feelings and conflicts and is felt to be a bad feeling and sought to be repressed, setting up feelings of guilt and self-criticism. The hurt behind the anger often relates to a personal sense of wounding, rejection and loss. Anger is sometimes directed inwardly towards the self and this is causal factor in depression.

This sense of internal rejection, which of course can come from very real experiences of feeling let down or rejected and while sometimes may be due to genuinely abusive experiences can also be due to a care givers unavoidable unavailability. For instance, if a caregiver themselves suffers a depression, the feeling of the child can be one of personal hurt and rejection, leading to a painful feeling of unwanted-ness, self-loathing and externalised or internalised anger.

However, it can be very hard to be angry at someone one needs or is dependent on, powerful guilt and/or anxiety can be stirred up about these aggressive feelings towards someone loved, with a feeling that these feelings may damage the loved person and therefore the anger has to be split off and directed elsewhere. Splitting is an age old defence mechanism, alive and well in todays world, whichever side of any given debate you can be sure that many on either side will be using that debate to project their bad feelings onto the others over theirs.

The ability to tolerate both angry and loving feelings (ambivalence) towards a loved person is hard and Psychotherapy aims to create a safe non-judgmental space where these feelings and conflicts can be expressed through words, easing the need to either split them off or act them out.

 

To enquire about psychotherapy sessions with Paul Savage, please contact him here, or to view our full clinical team, please click here.

 

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 –

What makes Psychotherapy Different?

What’s wrong with good advice?

Psychiatry, Psychology and Psychodynamic Psychotherapy 

Analytic Therapy for Addictions

Loss

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I Never Thought My Son Would Watch Pornography

It was a decade ago that was listening to the radio when I heard this line being spoken for the first time by a mother who was describing the time the police came to her house to enquire after certain pornographic material which had been downloaded using the family IP address. She described the early morning raid by the police, the taking away of the family computers, the suspicion hanging over her husband – until it was discovered that it was the couple’s 14-year-old son who had viewed the material in a curiosity-driven trawl through multiple pornographic internet sites.

That may have been the first time I came across that line, but I have heard it many times since in the intervening period as I have moved into work supporting young boys and men in their efforts to free themselves from their addiction to online pornography.

Pornography and the Adolescent Brain

There has been considerable research in recent years into the effects of consistent use of pornography on the adolescent brain and, indeed, on the brain in general. To summarise a complicated process briefly, the plasticity of the adolescent brain (with all brains, actually), combined with a leaning towards hyper-arousal when it comes to matters of sex, leaves the teenage child prone to a vulnerability of dependence, which can be frightening in its speed and grip. The reward centre of the brain is hard-wired to be stimulated and demanding when certain things connected to the propagation of the species are on offer. Food and drink come to mind – but sex is important, too. As a species, we need to have sex to survive.

For the young adolescent, perhaps still some years away from a sexual encounter with a real person, the online world offers instead a kaleidoscope of sexual experiences at the touch of a button. In the secrecy of their bedrooms they are free to explore material that would have been unimaginable (certainly illegal to print) just a few decades ago. The brain does not know the difference between a computer and a real person. It just knows that its owner is excited sexually. Its reward centre is activated, and it releases that precious drop of dopamine, which will prove to be both curse and blessing, the first step on the road to addiction. To put it bluntly, for the child, it feels good – and the brain will begin to lay out the neural pathways which will make it easier to access that feeling in the future. As in all things – from football to depression – the brain gets better at what it practices.

As the boy becomes more habituated to the use of the pornography, so it becomes more difficult to achieve the level of arousal that was easily done on first viewing. In essence, the brain is developing a level of tolerance. The user has to find newer forms of stimulation – generally much riskier, more challenging sites – in order to satisfy the brain’s demands and to receive that precious dopamine hit. It becomes more difficult to focus on one item. The user will begin to hop from site to site in an effort to find the ‘best bits’; the whole purpose will become about gratification, generally marked by masturbation, which once achieved, is the signal for the whole cycle to start again. It all feels so natural. There are no drugs involved – apart from the delicious ones supplied by the brain. The parts of the body that react are doing so naturally. What can be wrong with something that feels so right?

Boys and not girls

The research on girls’ use of pornography is scant, but what does exist points to their usage as being considerably lower, and less frequent, compared with that of boys, something supported by anecdotal dealings with young people. Although many young girls (estimates suggest as high as 40%) will have viewed pornography, this is more likely to be out of curiosity rather than habitual usage. This might be partly cultural, partly to do with the way arousal works and develops in adolescents, partly to do with the interest in internet activity shown by girls generally (interestingly, figures in gaming addiction, a process which ‘piggy-backs’ on to the reward system, has similar figures in favour of boys’ dependency), and significantly to do with the type of pornography available, which is overwhelmingly produced for the gratification of men, with women in the role of the passive provider. Even the dominatrix – which alludes to a degree of power for the female – is a male construction, designed to gratify male desires. Given this context, it is no surprise that even into adulthood, the vast majority of pornography is consumed by men.

Meanwhile, in the real world

At the young man develops, they will want to practise their sexuality in the world around them. The difficulty for them is that their brains, accustomed now to being aroused by digital sexual-stimulus, will already have an idea of what sex looks and feels like, how their partner should behave and, significantly, they will already have internalised an idea that sex is something that involves their gratification. The notion that giving pleasure to others might be a fulfilling part of sexual engagement is something that is beyond their experience – even though their experience in some respects is a considerable distance ahead of where it might be in a non-digitalised world. For the habituated user of online pornography, it can be very difficult to come to terms with the fact that the person within their arms has feelings and desires which are unlikely to conform to those who have aroused their senses online. The online world will often present an exaggerated view of sexuality: breasts and penises are larger; bodies are firmer; all imperfections (and hair) are removed. For the habituated user, it can be very difficult to achieve any kind of arousal, and desire is lost – only to be found again back in the online world, where the brain, comfortable, primed and ready, can once again be gratified.

There is another difficulty that habitual users have to face. Their online experience will have normalised certain aspects of sexual behaviour that in the real world would be considered shocking or taboo. Even on the blandest pornographic sites freely available to all, one will find countless ‘sex with my stepmother/ sister/ etc’ as titles. It is as though it is the most normal, routine practice in the world. There really are no boundaries.

Disadvantaged Parents

It would be easy to be judgemental with parents whose children become habituated to online pornography. But there are a number of reasons for their ignorance and then denial regarding the habits of their sons. Firstly, unless they have used pornography themselves, they will have no idea how much is available – unfiltered, free and without the requirement of age verification – at a simple click of a button. It is hardly their fault that they just don’t know what they don’t know. Secondly, as pornography and issues more widely to do with sex are practised in areas of secrecy, there is often a barrier of shame which makes any non-judgemental discussion of the subject impossible for parents and children. Thirdly, and linked to the former point, the image of their children that many parents carry in heads often allows no room for an activity they themselves would find abhorrent. It is why so often when parents come to see me with their sons, they are in a state of shock. It is not unusual for them to apologise for the fact that their son is in this position, claiming plaintively that they ‘never thought their son would be using pornography.’

As youngsters become men

Unfortunately, many adult men who have to deal with addiction to pornography fail to do so until they are much older. Many of the clients I have worked with on the issue have endured many years of habitual use before being forced to seek help by circumstance rather than because they see it as a problem. It might be to with failed relationships; it might be because of worries to do with their increasingly poor sexual performance in real relationships – often manifested in low mood, anxiety or depression; or it might be that their sexualised treatment of a partner or friend is not appropriate for one reason or another and they feel a strong sense of shame. This last is perhaps worth highlighting as it has been the topic of national debate recently.

One of the dangers facing habitual users of online pornography is that they must deal with a blurring of the lines between what is real and what is imagined. Of course, we all do this to some extent when we watch a television show: we are adept at sorting what lies either side of that line between the real and the imaginary. But these television shows are not tapping into the reward centre in our brains; they are not linked to our areas of desire, gratification and reward as is the sexual instinct. On top of this, for many young people, they will have no experience outside of their online practices to guide them as to what is appropriate or not. They haven’t yet learned what is normal. If they make a mistake in this area, they could be left with a legacy of shame and regret – or much worse if their actions pass into illegality.

What can parents do?

My advice to parents is always very clear on this. Before you do anything else, contact your internet provider to make sure your controls are locked down – and never share your passwords with your children, or even enter a code when the child is in the same room. It is another story, but never underestimate the ingenuity of young people for discovering their parents’ passwords! Then talk to your child. Be curious. Take a parental interest in their internet history – not in a judgmental way, but one which seeks to understand what is going on for that young person. If your son is using pornography habitually, seek support for yourself and for them. Do not ignore it, for in any number of cases it will not go away. Research indicates that those who become addicted to online pornography are likely to be prone to low mood and depression, not surprising given that they may well be living a kind of double life, a part of which exists in a place of secrecy and shame. Those last two bedfellows are hardly the harbingers of happy, fulfilled lives.

 

Kevin Collins is a UKCP registered Psychotherapeutic Counsellor with an academic background in the field of literature and linguistics. He worked for many years in education – in schools and university. Kevin is available at our Lewes Practice.

 

To enquire about psychotherapy sessions with Kevin, please contact him here, or to view our full clinical team, please click here.

 

Further reading by Kevin Collins –

Why is it hard to make decisions?

Communication, communication, communication

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Name That Tune

How can an old parlour game help us reflect on the way we communicate? Quite a lot it would seem.

Many of us will have played the game where we tap out the rhythm of a tune or song and ask our partner to guess the name of the piece. The challenge for the person doing the listening is that they have to use only limited information (the rhythm) to piece together something much more complicated in its whole. It is a different story for the person tapping out the rhythm. For them, the whole tune is in their head and it seems obvious that what they are hearing (in their head), is also what is being heard by the recipient.

In a study using the game to explore expectations in communication, over 90% of the people tapping the tune expected the recipient to guess correctly – some admitting to be dumbfounded that their recipients could not understand them. Sadly, this expectation was not matched by the results, where only 14% of recipients managed to guess the tune correctly. Imagine the frustration on both sides!

The fact that the large majority (over 9 in 10) of the tappers (as we will call them), felt they had supplied all the information required for their message to be understood, makes a useful reminder of the difference between the message we think we are communicating and the meaning that is created by the recipient. It is interesting that in the study of the exercise referred to above, the recipients did not just say they didn’t know the answer – over 8 in 10 of them named a tune they were sure was correct even though it was often some distance from the one in the head of the tapper. In other words, they created a meaning from the message which was quite different from the one being communicated by the tapper – which, of course, led to even more frustration: ‘How could you possibly misunderstand that? It’s so obvious!’ Worryingly, when it comes to communication, what seems just so obvious to us, can lead to confusion or misunderstanding for those on the receiving end.

The tapping game might also make us reflect on just how limited words can be when it comes to communicating the thoughts and feelings we carry. Like the complex melody, much of the nuance may be lost without access to the pitch, timbre and colours which make up the detail. As humans, we are meaning-seeking creatures. If there are gaps in our understanding, we will fill them in an effort to make sense. But in those fillers, we often go awry – gloriously so in many cases, which is why metaphor and symbolism can be such fun – but awry, nonetheless.

It takes a lot of work to be really understood and a great deal more to understand fully. But when we feel anger or frustration at others for not getting our message, or when we deal with similar feelings when our friends or partners never seem to appreciate our understanding, we would do well to remember that the gap between what is being communicated and what is being understood is considerably wider than what might at first appear.

 

Kevin Collins is a UKCP registered Psychotherapeutic Counsellor with an academic background in the field of literature and linguistics. He worked for many years in education – in schools and university. Kevin is available at our Lewes Practice.

 

To enquire about psychotherapy sessions with Kevin, please contact him here, or to view our full clinical team, please click here.

 

Further reading by Kevin Collins –

I never thought my son would be addicted to pornography

Why is it hard to make decisions?

Communication, communication, communication

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Avoidance in therapy as the axe for the frozen seas between us

In this blog I will briefly discuss avoidant attachment strategies and how what can look like independence is actually a sort of suit of armour designed to protect and hide a locked box of vulnerability and need, preventing mutual dependency and intimacy.

The person who has developed the avoidant strategy has done so in order to cope with a lack of understanding and attunement to their needs from their caregivers, and have therefore had to deny their needs to themselves and make the decision (unconsciously) to repress or bury these needs and create an equilibrium for themselves where the pain, disappointments and griefs of these unmet needs are locked away. They can often find alternative ways to feel good about themselves and compensate for the shame of the disappointments and low self-esteem that they feel as a result of this lack of attunement. These alternative strategies can lead them to developing their intelligence as a way to circumvent their feelings and they are often very successful in their field of work. The problem of course is in their relationships, sometimes their relationship with themselves or parts of themselves.

The strategy seeks to enable them to have self-worth while keeping painful feelings of rejection at bay, they have found others unreliable and can therefore only trust themselves. They create an image of themselves that appears independent and strong but comes at the cost of denigrating others, especially those that are more comfortable with the parts of themselves that seek mutual reliance and inter-dependence on others. In extreme forms these others can stir up painful feelings of envy and hatred although these feelings too are disavowed. A calm state of coolness is sought that numbs any sort of emotional aliveness. However, this defence is often a fragile one and when a crisis occurs as it always does at some time or other in life then these defences can shatter, leaving the person distraught and desperate, unable to manage or deal with the emotions that now can’t be neutralized. Suicide can be one tragic outcome.

Brett Kahr, a British Psychoanalytic Psychotherapist, discusses the pain of this strategy which can be handed down generationally: – “Although many people inflict horrific cruelty upon their partners, the vast majority cause pain as a result of emotional unavailability, fuelled by avoidant attachment structures.”

Therapy takes time and requires an enormous amount of patience and keeping the patient in therapy is no easy task. However if they stay then perhaps the patient can slowly start to develop a more trusting relationship with the therapist, who can attune to them, who doesn’t need them to be other than who they are, who can accept their need for distance and who can digest their sometimes overt, but often covert denigrations, understanding them without retaliating or shaming them but not colluding either, calmly without judgment bringing to awareness what the patient is doing and the fear and pain behind these defences against relatedness.

The Author, Colum McCann, describes the work of literature, and I think his description also describes the therapeutic process.

“The job of literature is to acknowledge the heartbreak of the world and then to share that heartbreak in the hope that somehow you can find a little light, just a little, no matter how damaged and bruised. This light, then, must necessarily acknowledge the darkness. At the same time, it might just lift a portion of the dark, past the curtains, awaken us.”

He goes on to quote Kafka, “A book must be the axe for the frozen sea within us.”

So too must therapy.

 

To enquire about psychotherapy sessions with Paul Savage, please contact him here, or to view our full clinical team, please click here.

 

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 –

What’s wrong with good advice?

Psychiatry, Psychology and Psychodynamic Psychotherapy 

Analytic Therapy for Addictions

Loss

Post Natal Depression in Mothers & Fathers

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Some existential musings from the sea

“Why do we like the frantic, the unmastered?” Asks Virginia Woolf,  in her diaries. This is a question I also return to time and time again as I look out to sea. Feeling the disquiet holds an edge of excitement for me, there is a thrill to its wild and unknown nature.
For me there is something quite awesome about being made to feel small, insignificant, vulnerable.
Something playfully cherishing about being sprayed by the sea and even more so when seeing the other’s surprise as they are splashed by the sea spray as they walk along the promenade.
Even more touching is when I am in the sea, bobbing around, apparently trusting its capacity to hold me, softly caressing my form, knowing its strength could take me over, its sometimes silent, sometimes roaring power could take away any sense of control I may feel I have, at any time.
For me that makes me feel free. For others I am aware that feels like the opposite of freedom. Perhaps it is the sense of disquiet that is not thrilling for the other. Of course that is completely understandable and perhaps very sensible.
The sea, our relationship, has taught me a lot.  Not just what was said above. Many other beautiful things too, some known, some still unknown.
It has deepened my capacity to feel, to reach into sensations, when to let go and when to push forwards. It has taught me how not to take things personally,  how to play and take risks, how to feel and experience joy, it has taught me, or at least invited me to be open even in the unknown and when I think I might be unsafe; not to judge or believe every thought that emerges from the reckless mind. It has taught me there is much I don’t know and that it is ok not to know. It has taught me lessons about connection,  intimacy and friendship.
It has inspired me, filled me with awe. It has provided beautiful gifts, delightful and magnificent gifts.   Whether seeing elusive pods of dolphins in the early dawn, as I witness the wonder of the full moon and the rising sun in unison.  Or the simple drama of playful young seagulls dipping and diving into the waters. It has yielded me a space to dive deeply into the unknown, into pleasure, and held me patiently on its voluptuous and flowing surface as I come up for air, breathing, resting and trusting.
And when its roaring form prevents me from entering its embrace it still teaches me much. It teaches me about patience, power, movement and change,  and it quietly, continually gives me permission to become. It invites me once more to come into contact with and enjoy the unmastered within me.
Even if one only feels a slight desire to see the sea, and not even consider entering it, there are many gifts to receive, lessons to learn. But if that desire increases I recommend dipping a humble toe into that vastness, you never know what might happen.

To enquire about psychotherapy sessions with Susanna Petitpierre, 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.

 

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Intimacy: pillars and obstacles

Our capacity for intimacy as adults is widely understood to be shaped by our early relational experiences. Theorists from diverse orientations emphasise the link between early attachment patterns and subsequent adult love relationships. When our formative experience is one of loving reciprocity with our caregivers, our abilities to give and receive love freely and fully later in life are enhanced. Children who experience themselves as loved and valued in the context of a harmonious parent/child dyad are more likely to develop a secure sense of self and will have a more robust relationship to (their own and others) autonomy and dependence.

We all struggle to find a balance between a need to be a part of something greater than ourselves and a need to be apart from – to be separate. Some of us will navigate the continuum between proximity and distance with fluidity and ease. Others will experience greater comfort at one end of the continuum or another. For all of us our capacity to experience intimacy will reflect in some measure our abilities to risk closeness and separateness. 

Separateness

The growing infant internalises their primary care giver(s) through the process of separation-individuation. A parent’s recognition and validation of the baby’s unique self will initially be expressed in the child’s specific preferences for being held, soothed and fed. The feedback loop between child and caregiver as the child seeks to explore the world beyond (m)other is critical. When attuned, the child will learn that separation is both pleasurable and manageable  and that it will not entail the loss of the love object. The process of separation-individuation is repeated throughout the life cycle, in adolescence, in marriage and in parenthood. At each stage there is an  opportunity to rework or repeat old patterns and to adopt either old or new solutions. 

Mutuality

To give, to receive and to share in the spirit of joint reciprocal endeavour is the cornerstone of mutuality, another pillar of successful intimacy. Once again it is understood that the capacity for mutuality is rooted in our early experiences with a “good enough” caregiver. The infant develops trust and confidence through interactive engagement with an attentive other. Through this exchange expectations of safety, effectiveness and pleasure are cultivated or impaired. 

Successful intimacy requires the capacity to regress and be dependent, and in an adult partnership, for each individual to be able to tolerate these states in both themselves and the other. This requires a secure sense of individuation on both sides so that closeness is not experienced as an engulfing fusion and a threat to a cohesive sense of self, and separation is not experienced as a catastrophic rejection or abandonment. 

Empathy

Feeling what another person feels whilst maintaining psychological separateness is the essence of empathy. It involves the capacity to immerse oneself in the emotional life of another, temporarily leaving one’s own world without experiencing a loss of self. As such it is fraught with difficulty and risk for the individual who is not securely individuated. Empathy is a two way process in which each partner must have an investment in both understanding and being understood. Early developmental deficits or excesses will inevitably interfere with our capacity for empathy and mature intimacy in our adult pairings.

Viable Intimacy

Intimacy can evoke fear ( conscious or unconscious) in any relationship. Fear of loss or merger, fear of shame, fear of attack or of one’s own aggressive impulse, fear of disappointment and fear of needing. The path to intimacy is complicated and fraught with risk, never more so when we bring our unattended psychic wounds to our adult partnerships in hope of healing. For intimacy to be viable  it will probably help to have an idea of our appetites for closeness and distance. Armed with this self understanding and willing to understand the appetites of our partners we will be better positioned to navigate and negotiate this most foundational relational terrain.

 

To enquire about psychotherapy sessions with Gerry Gilmartin, please contact her here, or to view our full clinical team, please click here.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin – 

Love and Family

Understanding sexual fantasy

Fear and hope in the time of Covid

Relationships, networks and connections

Paying attention to stress

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Fear and hope in the time of Covid – part 2

I am writing a follow on from the wonderful blog written by Gerry Gilmartin back in August. 6 months on and here we are again, facing new Covid-related challenges with more restrictive measures in place, more infections and more deaths.

The theme of Gerry’s blog revolves around fear and hope, and how to work with these polarities which coexist in most of us. Psychotherapy is very much about learning to live with polarities within ourselves as well as acknowledge them in others. In psychotherapy we gradually increase our capacity to understand and be with complex human emotions, and to reduce polarised black-and-white thinking. Gerry writes:

“The uncontrollability of the corona virus may reflect something of the uncontrollability of a globalised world. Both highlight our mutual dependence and by implication our mutual vulnerability. At a time when a sense of universal unity might be prescient it is also a time at which it seems extremely unlikely. In a state of fear the instinct is to contract mentally and physically, to batten down the hatches against a real or imagined enemy. In a state of fear we may abandon our capacities for hope and for trust…. On a global as well as an individual level”.

Talking about what we are afraid of can be enlightening. It helps us separate fantasy from reality and to stay connected to ourselves and others. It can be difficult to ‘stay sane’ when we are constantly being bombarded with news items which are designed to retain our attention as much as possible by scaring us into remaining watchful and alert to yet more bad news, just in case we weren’t already frightened enough.

This process actives our fight or flight systems, sending us into survival mode which is never conducive to reflective states of mind required for conscious thought and creativity. In fact, the very type of thinking that is required for effective leadership and decision-making.

Part of our job is to help people to think when they have stopped thinking and are living in fear or in a state of hyperarousal. Of course, this isn’t always possible. However, it is possible in most cases and an outcome which is see in psychotherapy time and time again. People arrive contracted and fearful and leave feeling hopeful and with a more expansive and different mindset – each week, each month, each year this process deepens until it becomes second nature.

Through the establishment of a trusting relationship with another, we begin to create a microcosm of safety where difficult feelings can exist without the urgency to get rid of them. We learn to tolerate the intolerable, which may also result in setting limits, taking action, or even doing nothing. Whatever the choice, it will be one which emerges from a place of more awareness and hopefully lead to a more fulfilling life.

 

To enquire about psychotherapy sessions with Sam Jahara, please contact her here, or to view our full clinical team, please click here.

Sam Jahara is a UKCP Registered Psychotherapist with a special interest in working with issues linked to cultural identity and a sense of belonging. She works with individuals and couples in Hove and Lewes.

 

Further reading by Sam Jahara

What shapes us?

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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The Pandemic and the Emerging Mental Health Epidemic

There is a lot of talk about how Covid-19 and the resulting lockdown cycles are causing a mental health crisis in the UK. This blog aims to unpack and list some of the reasons why the response to the pandemic is also causing a mental health epidemic amongst us.

This year has been very hard on most of us, personally and professionally. I don’t think I have come across anyone who has not been negatively impacted by the pandemic and resulting lockdown cycles since last March. The pandemic and deaths resulting from Covid-19 are only one aspect of this crisis. The efforts to avoid death and transmission, not overwhelm the health service, and its resulting policies, in conjunction with how the Covid narrative is portrayed in the media, is what is driving the mental health crisis.

Before the pandemic hit, we were already living and dealing with normal day to day challenges linked with work, relationships, raising children, making decisions, caring for relatives, ageing and death, etc, etc. As psychotherapists, we listen to and work with these challenges everyday. The pandemic has added another layer to pre-existing issues in society, exacerbating them for everyone through the fear of death, loss, survival and health anxieties, to name a few issues which are both specifically linked to the pandemic but also issues to do with being human.

It has even become difficult to distinguish whether some of the difficulties experienced are linked to Covid or not. For instance, relationship issues which were pre-existing became exacerbated during lockdown and having to work together to home school children. Or someone with an already high level of health anxiety becomes even more anxious about becoming infected with Covid and isolates themselves even further from others.

There was a big drive to bring more awareness to mental health issues in UK society before any of us even heard of Covid-19. A large number of people were already experiencing pressures on their mental health through a variety of factors, which have now become more exacerbated through the fear of death and transmission, confinement at home, business closures, lack of outlet with entertainment venues, cafes, leisure and restaurants closed.

We have lost a large proportion of our social connections due to not being able to meet socially and professionally as we used to. Even small daily exchanges which used to make us feel more socially connected have been taken away, such as a visit to a local shop or the hairdresser.

The list is endless: Professionals who derive their identity and social contacts through work and running their businesses and had to close them, the elderly who were already lonely and have now become even more isolated, workers in the gig economy who were already struggling to survive and are now out of work, parents who were already under pressure and now have to home school as well. The list goes on…

It is vital that enough mental health support is available. In my work as a therapist, I acknowledge the collective impact in society yet focus on how it affects people on an individual level. We are all fighting our own battles at the moment, each one is dealing with a separate set of challenges pertinent to their life circumstances. It is vital for us to acknowledge and talk about what is troubling us and not just “get through”.

To enquire about psychotherapy sessions with Sam Jahara, please contact her here, or to view our full clinical team, please click here.

Sam Jahara is a UKCP Registered Psychotherapist, Transactional Analyst and Supervisor with a special interest in working with issues linked to cultural identity and a sense of belonging. She works with individuals and couples in Hove and Lewes.

 

Further reading by Sam Jahara

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Leaving the Family

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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What is Schema Therapy?

Schema Therapy (ST) is a flexible and comprehensive approach to therapy that focuses on understanding you as a person. It provides a helpful framework for us to make sense of some of the difficulties you might be experiencing. These might be difficulties with how you feel, your thought patterns, relationships, unhelpful behaviours, or a general dissatisfaction with your life.

ST was developed in the 1980s by psychologist Jeffrey Young and can be understood as an integrative model that draws on a number of therapeutic approaches, including cognitive behavioural (CBT), psychodynamic, gestalt, and person-centred.

CBT has a strong evidence base and because of this tends to be the treatment of choice for many common difficulties such as anxiety and depression; when delivering ST, I would be able to work with you to incorporate many of the effective components of CBT to support with the changes you make. In addition, ST goes deeper and puts more of an emphasis on understanding the links between childhood experiences and the development of patterns in thinking, feeling and behaving.

ST asserts that it is our schemas that link our past to our present. In ST, a schema can be understood as a deeply held belief which is often out of our conscious awareness. Schemas affect how we think, feel, and behave, and are sometimes described as our blueprints or software. They help us to make sense of the world, and are the patterns that run throughout our life. A goal of schema therapy is to help you to become more aware of your schemas and then to provide you with tools to change on an intellectual, emotional and behavioural level.

Another important part of ST is the focus on emotional needs. ST believes that schemas develop from experiences when our emotional needs were not met. One of the overarching goals of ST is to help you to develop an awareness of these needs and, over the course of therapy, develop a variety of ways of meeting them.

What happens in schema therapy?
In the early sessions of ST, we would work together to build an understanding of your current problems and how they developed. A crucial element of this is making links between your early life experiences and your current problems. The process of therapy is active, and, right from the start we would use different therapeutic techniques. These can be divided into: (i) emotion focussed strategies that aim to connect you with the emotional level of your experience, and include imagery and chair work; (ii) cognitive techniques that aim to promote flexible and compassionate thinking; and (iii) behavioural techniques that help you to challenge fears and break behavioural patterns.

What I like about schema therapy?
I really like the comprehensiveness and flexibility of ST. It provides a framework for understanding how we function on a deeper level and helps us to spot the common thinking and behavioural traps that we can all fall into. As a therapist I can be creative and draw on a number of proven techniques that aim to address problems on a variety of levels. ST also encourages therapists to play an active role in the therapy and to bring an authentic and open approach to the therapeutic relationship. This can help create a genuine connection, which is often the foundation for lasting change.

 

To enquire about psychotherapy sessions with Dr John Burns, please contact him here, or to view our full clinical team, please click here.

 

Dr John Burns  is an experienced Consultant Clinical Psychologist registered with the British Psychological Society, Health and Care Professions Council, and the British Association of Behavioural and Cognitive Psychotherapies.  He is available at our Brighton & Hove Practice.

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What shapes us?

We all have key figures in our lives, people who either held or hold great importance because of their positive impact on our professional and personal lives. They may have been people who we are either personally or professionally connected to, such as parents, siblings, friends, family members, or teachers, bosses, coaches, therapists and work colleagues, to name a few.

These people become so important to us because we internalise their qualities and also their positive messages to us, whether they were implicit or explicit, verbal or non-verbal.

Therapists are keenly aware that some key elements need to be present in our work in order for a positive relationship to form. We know that many who come to therapy do so because of breakdown or absence of relationship early on, which we can also understand as a scarcity or total absence of some key elements listed below:

Interest and Curiosity

To feel seen, heard and to perceive sense of curiosity towards oneself from another, which is engaged, honest and encourages mutual trust. Delight, enjoyment and even surprise in the exchanges that take place.

Attunement

Usually used in the context of a parent-child relationship, but the word is also used in other contexts. Attunement is a quality where the other person ‘tunes in’ to another, almost as if trying to absorb and understand what the other is communicating on a deeper level. Attuning entails putting oneself aside to hear how the other views and experiences the world.

Consistency

Consistent love and care is something children need in order to feel emotionally and psychologically safe. This continues to be the case for adults, albeit in a different way. The consistency in the care of others is what gives us a sense of belonging and therefore a sense of safety in the world.

Commitment

To feel the commitment of another to a relationship is another form of consistency, but also one that affirms that “I am here for you” or “You can count on me”. This doesn’t not mean that the other won’t disappoint at times or will always be available. But they let you know that you can rely on their commitment to you as a friend, partner or in an ongoing professional relationship, such as the regular long-term commitment of psychotherapy, for instance.

Time

Related to the two above in that there needs to be a consistent time commitment in order for any relationship to work. The gift of time cannot be underestimated, especially in today’s world. With time, important conversations take place, people get to know one another and things are allowed to unfold. We feel valued and important when others make time to be with us.

Connection

Of course this can’t be forced. We either feel connected or we don’t. However, all of the qualities above are conducive to developing a connection with another. Some people are better than others at connecting, both to themselves and therefore to other people. But there are times when the chemistry between individuals exists in a way in which can’t be explained. Some of these formed connections stay with us for a very long time, if not forever.

What are other qualities that you see as essential to forming a positive bond with someone? I look forward to your thoughts.

 

To enquire about psychotherapy sessions with Sam Jahara, please contact her here, or to view our full clinical team, please click here.

Sam Jahara is a UKCP Registered Psychotherapist with a special interest in working with issues linked to cultural identity and a sense of belonging. She works with individuals and couples in Hove and Lewes.

 

Further reading by Sam Jahara

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Leaving the Family

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Why do ex-boarders find intimate relationships difficult?

This is a question I often ask couples who come to see me for couples therapy. Most cannot answer the question beyond the superficial. However, it is an important question to ponder: relationships are not easy for the most well-adjusted of us and so there has to be a fundamental reason why we (generally) choose to pair bond (be in a committed intimate and romantic relationship with one other person).

I believe that we choose to pair bond as on an unconscious level it is the closest that we can come as adult humans to replicating the ideal) experience of childhood where we had a parent who was there for us, who would listen to us and who, most importantly, would help us make sense of our feelings so that we knew we were not alone. This is essentially what strong functional couples do – they listen to each other and try and work out what feeling their partner is trying to convey to them. The general term for this is empathy.

I therefore believe that this explains what we all want and why we all go into relationships. And also why so many of us keep on trying to find ‘the right person’ even after so many disappointments.

What happens to boarders?
Ex-boarders also harbour hope of a good relationship, however, may be at odds in identifying one. The attachment damage they have sustained and the abandonment (couched in privilege) that they have experienced, leaves them unconsciously yearning for that idealised mother who will be there unconditionally for them. Of course, what they eventually find in any relationship with another adult is that they are not in an unconditional relationship (no such thing exists) and then they withdraw to avoid being hurt or disappointed.

What does it look like?
We are all different and so are ex-boarders, however, many have some traits in common which I shall list:

Ex-boarders tend to-

  • Withdraw emotionally from relationships in order to keep themselves safe and default to their indolence survival strategy;
  • Struggle to make sense of what their emotions are telling them and lack the ability to navigate them without becoming overwhelmed: ex-boarders are good under pressure until they are not;
  • Have an over-reliance on logic and rationality to make sense of the world – this does not work when confronted with a partner who is trying to share their emotions;
  • Regulate (read manage) their emotions by controlling their external world – exercise, career success, sex, alcohol, drugs etc. Some may be less harmful than others but all show an inanity to be in contact with their inner world;
  • Live a pseudo-life where they can never really allow themselves to feel alive as that can only happen through bringing themselves fully into relationships and navigating their needs through communicating boundaries.

What can be done?
The effects that the abandonment a child suffers from being sent to boarding school can be enormously significant. Often ex-boarders will only resent for therapy when they have ‘hit a wall’ in some way.

Psychotherapy can help and indeed is the only way to remap the brain and help ex-boarders come to life. As the damage is relational, the only remedy is a therapeutic relationship where the cut-off feelings of loss, abandonment and emptiness can be retrieved and experienced in the safety of a psychotherapeutic frame.

 

The term ‘Boarding School Syndrome’ was coined by Jungian analyst Professor Joy Schaverian around a decade ago. Since then, it has gained significant traction as a model for explaining the experiences and symptoms of adults who were sent away to boarding school as children.  Please refer to Mark’s previous blog.

 

To enquire about psychotherapy sessions with Mark Vahrmeyer, please contact him here, or to view our full clinical team, please click 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 ready by Mark Vahrmeyer –

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

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Understanding Sexual Fantasy

The exploration of sexual preference and fantasy in therapy can be a portal to our inner psychological landscape. Unlocking the unconscious logic of sexual fantasy is one way of casting  a light on our internal world and of understanding the emotional and psychological difficulties that may have prompted us to seek therapy in the first instance.

Our sexual scripts are formed in infancy, long before the onset of mature sexual desire. Our early attachment experiences and the familial and cultural context into which we are born inform the psychological maps and templates for being (in the world) to which we both consciously and unconsciously refer as we develop and grow. We are evolutionarily wired and sensitively attuned to the moods and feeling states of our caregivers absorbing them all through a process of psychological osmosis.

The conflict of growing up

Whilst our lust and capacity for pleasure (according to the Freudian account) are instinctual, the road to pleasure is more often than not a complicated one. We are likely to experience myriad obstacles along the way (many that will later inform our sexual fantasies) guilt, shame, fear, rejection may all stand in the way of our experience of pleasure. We all (consciously or otherwise) feel guilty about something. Life is fraught with conflict – and from the get go. The conflict (for example) between our attachment to our families and to the developmental imperative to grow up, individuate and leave them is fraught with guilt and worry. We bring these unresolved and largely unconscious conflicts into our erotic lives.

The creativity of fantasy

The child of a depressed parent may grow up with a powerful sensitivity to and identification with the sadness of others. It may be hard for such an individual to fully connect to their own aliveness and vitality as sexual excitement is fundamentally incompatible with depression. In the imaginative realm of fantasy such an individual may be released from the burden of caring by populating their fantasies with dynamic carefree people, aroused, excited and turned on. It is not hard to understand, in this scenario, that when everyone is having a great time (and no one is depressed)  the fantasy serves as a creative permission to connect, without guilt or shame to one’s own desire.

An antidote to trauma

Many sexual fantasies can seem puzzling and hard to understand. One person’s turn on is another’s turn off after all. Arousal for some may come through being tied up and whipped, another’s from phone sex, group sex, sex with a stranger(s), etc, etc. All are plots of desire, many are attempts to draw on and transform past trauma. When someone is cruel or aggressive  in their sexual fantasy or practice it is not because they are inherently sadistic but rather that they are trying to solve a problem. It may be useful and illuminating to consider and understand why the normal pursuit of pleasure may require a particular imaginative scenario in order to be safely experienced.

Empathy and ruthlessness are important aspects of a healthy sexual relationship. Too much empathy (for the other) may be a dampener to our own desire and too much ruthlessness may render sex mechanical and devoid of emotion. Sexual fantasies can be attempts to counteract or transform beliefs and feelings that may interfere with sexual arousal and can provide an elegant ( if not always politically correct) solution to the problems of ruthlessness , guilt and shame.

When we  understand our sexuality we understand ourselves.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin

Fear and hope in the time of Covid

Relationships, networks and connections

Paying attention to stress

Why does empathy matter?

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Why ‘Cancel Culture’ is about the inability to tolerate difference

What is Cancel Culture?

This seemingly new trend is one of promoting the ‘cancellation’ of people, brands or television shows as a result of what some (the cancellers) perceive to be some form of offensive comment, remark, view or behaviour. It has surged on social media with various derogatory hashtags, notably #RIP.

A recent high profile ‘celebrity’ who has been on the receiving end of social media trends to have her cancelled is J.K. Rowling for her, views on transgender issues that some find offensive.

Is it that new?

The term may be new and the platforms used may serve to whip up a storm of support against those who some wish to have cancelled, however the concept is by no means new at all. Cancel culture is essentially a form of social banishment whereby in traditional tribal communities one of the most severe punishments would be the banishment from the tribe: to be cast out.

To be cast out of ones tribe would mean more than social death; if not literal death through being vulnerable to attack from predators and other tribes, banishment most certainly meant the death of the sense of belonging, which in psychological terms, could potentially instigate a psychic collapse (going mad).

However, whilst this may seem primitive, historical and anthropological evidence shows that it would be a punishment of last resort and would be handed down by the elders of the tribe – in other words, there would be some form of judicial process in place that sanctioned the banishment.

This is where cancel culture differs profoundly from tribal banishment or ‘being cast out’. It is not a decree from wise elders or some sort of judiciary; it is generally used as an attack against the views, opinions or behaviours of others that some disagree with.

Why does it matter?

Put simply, it matters because there seems to be an ever decreasing array of opinions and voices allowed and cancel culture is an immature way of trying to ‘kill off’ anybody holding views or opinions that may not be comfortable for others to hear.

Feeling offended and causing offence

There is a difference between a person feeling upset or even offended by another’s views and with another trying to purposely hurt a person or group of people. The former is what we may experience when we encounter others and are confronted by a different perspective. The latter is when we encounter sadism.

Sadism is unacceptable and should not be tolerated, however the mark of being an adult is the capacity to tolerate a different perspective and a different mind. Even if we may feel offended.

On mergers and separation

Although separate from its mother, an infant, when born, cannot differentiate between their mother and themselves. In essence they believe that their mother is an extension of them. Of course, in reality, the mother in question is very much as separate entity, at least physically, and thus will eventually fail to meet the needs of her infant. This is extremely frustrating for the infant in question and the mind of the infant concocts an ingenious defence against the pain of separation – a good and a bad mother is created: the infant imagines it is the good mother who meets all their needs and the bad mother who frustrates them. It is a primitive psychological defence called splitting.

Infants split off the bad until through ‘good enough’ parenting they eventually integrate the two mothers and tolerate reality: mother is not part of them and frustrates them as she has a different mind and a different set of needs. However, mostly, she seems to meet their needs so on life goes and importantly, on psychological maturation goes. The child is on the path from mergers to a world where they can be in separate relationships with others and tolerate a different mind.

Why cancel culture is simply splitting by another name

To be unable to contain ones feelings when confronted by a different perspective and thus a different mind shows a lack of psychological maturity. The world is split into ‘good and ‘bad’ like in a child’s fairy tale. Bad must be killed off so good can live happily ever after. This is not how the real world works; it is how cancel culture works.

How does cancel culture relate to psychotherapy?

In essence, psychotherapy is about outgrowing cancel culture. It is about learning to be in a relationship where difference can be tolerated and acknowledged, without this needing to be threatening. For some this means they must learn for the first time to bring their needs ‘into the mix’ – something that can feel really confronting and may bring on fears of rejection and abandonment. For others it may mean the opposite which is to be able to cope with the separateness of their psychotherapist and tolerate this without throwing away ‘all the good’ – without ‘cancelling’ them, if you like.

Being an adult means tolerating the frustrations of the real world and the frustrations of the others who make up the real world. However, if this can be tolerated then real relationships are possible and people can locate substance and meaning thus moving them out of a fear/threat pattern into adult relating patterns.

If you would like to work on your own intolerances and relationships, get in touch with us to discuss whether psychotherapy may be appropriate for you.

 

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

Why does the difference between counselling and psychotherapy matter?

Love in the time of Covid

Why am I feeling more anxious with Covid-19?

Coronavirus Lock-Down – Physical Health Vs Mental Health

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Online Relationship Therapy

There are many reasons why people seek out online relationship counselling and psychotherapy, from ongoing conflicts and communication challenges to infidelity, bereavement and grief, or family-related issues that are causing a rift. By working with a trained counsellor remotely from your own home, you’ll benefit from a confidential and safe space to discuss any issues, past or present, to help you improve your relationship.

What is Online Relationship Counselling and Psychotherapy?

While it may seem in the moment that your relationship is at breaking point, a trained psychotherapist can help you talk through your problems to help you find a solution and to see each other’s point of view. Many couples imagine that relationship counselling means sitting in a therapy room with a clinician, however, there is also the option to talk with a trained professional in the comfort of your own home with online sessions.

Our psychotherapists are trained to provide a supportive and non-judgemental environment to help you face any difficulty in your relationship. Though practically identical to face-to-face therapy, online therapy offers the option of receiving counselling or psychotherapy remotely through a secure platform for greater accessibility, convenience and approachability.

How Can Relationship Counselling or Psychotherapy Help My Relationship?

For some couples, just a few sessions of counselling can help them resolve their problems while for others, it’s the beginning of a long process of discovery in order to make a breakthrough. Your clinician will be able to help you in setting out expectations. Whether you’ve been struggling with the same argument for years or it’s a new issue that has arisen, a couple’s psychotherapist can help you work through the problem in a healthy way.

Communication is such a vital component of any relationship and finding new ways to talk through issues can help you move past rough patches and restore your relationship or amicably go your separate ways – an essential consideration where children are involved. Couple’s counselling or psychotherapy can be an incredibly rewarding experience that can make a marked di?erence to your partnership. Through choosing to work online, you can access to our highly skilled team from anywhere in the country.

Contact us today if you want to talk to an expert about your relationship or if you need any advice.

All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.


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Am I cracking up or is it my hormones? Pre-menstrual Dysphoric Disorder and the importance of tracking symptoms

It is not comfortable being told that you are feeling the way you do because of your hormones. This kind of biological reductionism is not helpful to any gender but the extremely severe symptoms of Pre-menstrual Dysphoric Disorder are completely aligned to the menstrual cycle. They manifest during the week before menstruation and end when or shortly after the start of menstruation. Like a switch going on and off.

There are a wide range of physical symptoms some not usually recognised as linked to pre-menstruation – changes in vision, heart palpitations, numbness and easy bruising – along with those that are familiar. In this post, I am concerned with the psychological symptoms.

The ones we might expect like irritability, confusion and weeping to excessive anxiety, deep depression and suicidal thoughts and feelings. It is the severity of these psychological symptoms, far more severe than normal pre-menstrual symptoms that make PMDD so disturbing and destructive.

Women suffering with PMDD can find themselves unable to cope with everyday life in the week or so leading up to their period. Ordinary tasks at home or at work can be insurmountable. Getting out of bed to dress and wash is impossible. The ‘personality changes’ put relationships under enormous duress. The sudden change in symptoms at the onset of a period is a relief but much of the next three weeks will be spent in repairing and picking up the pieces. It is not surprising that women can feel they are cracking up.

Unfortunately, many women are undiagnosed, incorrectly diagnosed and they can feel as if they are regularly in torment for a long time until their PMDD is recognised and treated. An example of misdiagnosis is a diagnosis of bipolar disorder. This is because the cyclical nature of mood swings is a feature of both conditions but it fails to recognise the correlation between emotional lability and the menstrual cycle. The predictability of the changes in thoughts and feelings is a key feature of PMDD and this raises the importance of tracking symptoms. Tracking symptoms provide information over time that may reveal a pattern, in this case, the menstrual cycle. Informed diagnosis leads to appropriate treatment, this means a woman will be treated for a severe problem with her endocrine system rather than a psychiatric illness. Sometimes it is your hormones.

 

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

 

Further reading by Angela Rogers –

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

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