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Brighton and Hove Psychotherapy

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Family Therapy for Beginners

Professor Richard Layard, one time ‘Happiness Tsar’, wrote, ‘in every study, family relationships, (and our close private life) are more important than any other single factor in affecting our happiness’.

It’s hard to grow and feel safe and content in the world if our family stories are causing us distress and discomfort. This is especially true for children, and young people when their family is their world. When they are struggling with emotional and behavioural problems or maybe unexplained physical ailments a ‘systemic’ approach can be revealing.

Systemic therapy is relational, that means looking at the spaces in between people and their relationships with others, as opposed to looking inside individuals. Systemic therapists are interested in the ‘systems’ that people belong to, such as our families, school, work places, peers and friendships. Exploring the context of tension, distress and unhappiness can help us illuminate the possible causes.

For example we may find stories of divorce and separation, estrangement, sibling rivalry, family illness and disability, bullying, academic struggles, financial problems, loss and bereavement, or drug and alcohol use Family therapy is about having conversations that can be difficult, exposing, controversial, and upsetting.

But also about reconnecting, understanding, sharing and being surprised. Feeling heard, understood, loved and believed. Explaining your side of a story, hearing family stories that help you understand current struggles and appreciating other people’s point of view. Feeling proud and united, relieved and supported and wondering together how you can move on.

Any therapy involves taking a risk; family therapy provides an invitation to be brave and accept that families may be worried, sad or confused about someone they love. Or maybe family relationships are feeling tense and strained, or they are missing someone who played an important role in your lives.

Established, repaired and revisited relationships give families a rich resource for healing.  Family Therapy sessions usually last 90 minutes, and as many family members who are available are welcome.  Work would begin by exploring why it had been decided now was the time for family talking and noting individual and family goals to help focus the work. Some family members may be initially reluctant to attend, its important for them to be aware that just be attending they are showing their support. They do not have to contribute verbally if they do not want to – this could be agreed at the beginning of the session. By just turning up they are able to listen to other expressing their views and will usually join in when they feel comfortable and safe within the process.

A genogram or family tree is usually constructed looking at the current family structure and remembering older generations. This provides a map of the family and a cultural context for the current problems. It generates stories, sometimes forgotten, about how positive and negative patterns and traits may have been inherited by the family in the room. This can be a revealing and emotional, with younger people hearing about relations that may have died before they were born and older ones remembering stories that help build to a clearer understanding of the family’s identity. A time-line constructing a chronology of family births and deaths and other family events is also useful. Again, this begins reveals its own narrative, which can help a family begin to plot the life story of a problem.

Family Therapy is always driven by the goals of the family and continual feedback allows the therapist to ensure that the family are having the conversations they want and need to have. Sometimes it may feel useful for family members to meet individually, in couples or sibling groups as part of the therapy.

It is not necessary to meet weekly; sometimes families find one or two sessions are enough to feel they are able to move forward. In my experience family therapy can be a powerful process with the family leaving more connected with and appreciative of each other.

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

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What is the difference between fate and destiny?

I have often heard these terms used interchangeably, however they are slightly different.  Both refer to predetermined events that lie outside of our control and imply some sort of higher, or external, power. 

It can be argued that destiny is more positive than fate and furthermore the implication is that we can exercise some degree of control over our destiny.  Fate feels particularly hopeless to me and I notice my resistance to the term both in life and in my clinical work.  Hollywood would have us believe that we are destined for good things, and fated to bad, however this negates free will and assumes pre-determined destiny.

Accepting reality

Much of the work of psychotherapy is around coming to terms with reality – past and present.  This means accepting what was in terms of our experience of childhood or past traumas and working through the complex emotions around them.  It means grieving.  Seeing something as fated or destiny can be protective in the short-term but can massively hinder how we approach life.

Accepting reality in the present also means accepting uncomfortable limitations which we may now not be able to change.  For example, it may mean coming to terms with the end of a relationship and accepting our role in its demise; or it may mean coming to terms with a biological loss – such as an inability to have a child – and accepting that this is not fate, but painfully, it is random and unfair.

Protection in a higher meaning

There is an illusion of protection in imagining that ‘things happen for a reason’ when this is not how the world operates.  This does not negate personal responsibility and cause and effect.

Perhaps this is ultimately where we can draw a clinical distinction between fate and destiny: once we have come to terms with reality and accepted the experiences of the past and the limitations of the present, then where we take responsibility for our life, we are shaping our destiny.

In this sense destiny is self-prescribed based on authentic living and choosing a life of substance.  It means identifying and then choosing to engage with that which brings our life meaning.  It means making decisions with as a full an understanding as possible of the implications of those decisions and the losses that accompany them.  And all decisions are accompanied by loss.

Opportunity cost

Economists often talk of opportunity costs – the cost paid in making one choice and therefore forfeiting the other possible choices.

Opportunity cost applies just as much in the field of psychology.  If we make certain choices in life, we will not be able to choose other life paths.  Despite what Instagram and Facebook promise – none of us can have it all!

One can argue that the terms of fate and destiny are simply that – words to describe something.  However, when our experience of the world is shaped and understood through words, they become exceptionally powerful.  Therefore, whilst not as esoteric and catchy, I prefer the terms ‘loss and responsibility’ as replacements for ‘fate and destiny’.  At least we can come to terms with loss and then exercise a conscious sense of responsibility in shaping our lives going forward.

Mark Vahrmeyer is a UKCP registered integrative psychotherapist who draws strongly on existential thoughts and theory to help clients make sense on an increasingly senseless world.  He sees clients in Hove and Lewes.

 

Further reading by Mark Vahrmeyer –

How do I choose a Psychotherapist?

Is growing up in a different culture always a good thing?

What causes insomnia?

Why does psychotherapy matter in the modern world?

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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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