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September 25, 2023 by BHP Leave a Comment

When it comes to change, is it better to stop or to start?

Stop the Boats!  You may be familiar with this recent government slogan referring to the persistent behaviour of vulnerable people, risking their very lives in setting out to sea in search of a better future. For me, regardless of how any of us might respond to this slogan in terms of our values or politics, the most deadening aspect of its expression is the injunction to stop doing something.

It is difficult to say the word ‘stop’ without frowning. Say the word ‘start’ and your face opens up. In the inherent wisdom of language, one word feels energy sapping to say, the other enlivening.

Stop the Boats! You may be familiar with this recent government slogan referring to the persistent behaviour of vulnerable people, risking their very lives in setting out to sea in search of a better future. For me, regardless of how any of us might respond to this slogan in terms of our values or politics, the most deadening aspect of its expression is the injunction to stop doing something.

It is difficult to say the word ‘stop’ without frowning. Say the word ‘start’ and your face opens up. In the inherent wisdom of language, one word feels energy sapping to say, the other enlivening.

Much of what appears in the media around the issue of migration is interwoven with metaphors of conflict and talk of enforcement, deterrents and exclusion. As a public response to behaviour that has become recognisably problematic, it has reminded me of personal behaviours at the individual level and how we as practitioners, alongside our clients, seek to make sense of those that have become challenging points of focus for them.

Thinking about unwanted behaviours of our own:

Oftentimes people seek therapy in response to a ‘stuckness’ they feel in some repeated behaviour or fixed way of relating. When I ask about their presenting issue, it’s understandable to hear many say, ‘I just want to stop doing X’. And as with the government’s ‘stop’ campaign, there can be a rush towards their need for relief, alongside a belief that ‘just’ stopping the behaviour will be the most effective route to change.

In the modality of Transactional Analysis (TA), we work with a model of the personality which suggests that our unhelpful ways of being are often related to aspects of ourselves that repeat parentally influenced or child-like processes, which we take on developmentally as part of equipping ourselves to deal with life. We call these processes Parent and Child ‘ego states’, or consistent patterns of thinking, feeling and behaving as our parents once did or as we once did as children.

While many of these processes may have worked for us before, some of them may now be causing us to feel stuck.

In terms of parental processes, part of an unwanted behaviour might be a debilitating voice of harsh self-criticism. Other behaviours might be related to a child-like over-adaptation to the wants of others in our lives. Both processes can lead to anxiety for us and contribute to conflict in our key relationships. And they can be such second nature for us to experience, that only a therapeutic relationship can help us fully identify how we might be limiting ourselves.

Exploring unwanted behaviours in therapy:

Working with these examples in therapy, we might feel a strong pull to concentrate the work on stopping the self-criticism or the automatic need to please others. But one way of conceptualising personal change is to think about our behaviours, however maladaptive we feel them to be, as simply forms of energy. And instead of an urgent focus on ‘stopping’ them, we might allow ourselves to become curious about them, how they recur, how they might have served us well in the past and how much of our energy they consume now.

And thereby we create a collaborative space to explore how we might ‘start’ to expend our energy in different ways, such as finding a more parentally nurturing voice for ourselves or experimenting with ways of asking others in our significant relationships to recognise our needs. By this means we might be said to pour our energy from one place to another in a way that diverts energy previously always available for the problematic behaviour.

Back to the boats slogan, I don’t think I’d be alone in suggesting that solving a complex problem of international migration with energy directed at enforcement and confinement might be better approached through energy channelled into inquiry about the complex reasons for the crossings and asking, ‘What could we start doing instead?’

It’s natural that when faced with a behavioural crisis we feel an urge to act in stopping ways that seek to suppress the symptoms of our difficulties. But if we bring our attention to the deeper meaning of our behaviours, we start to direct energy into new behaviours that can free us from feeling stuck.  

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

Chris Horton is a registered member of the British Association for Counselling & Psychotherapy (BACP) and a psychotherapeutic counsellor with experience in a diverse range of occupational settings. He works with individuals (young people/adults) in private practice.  He is available at our Lewes and Brighton & Hove Practice.

 

Further reading by Chris Horton

The end

You’re not watching me, Mummy!

I’m the problem – It’s me!

Making sense of our multiple selves

Let’s not go round again – how we repeat ourselves!

Filed Under: Chris Horton, Psychotherapy, Relationships Tagged With: behaviour, Relationships, transactional analysis

September 18, 2023 by BHP Leave a Comment

Can Psychotherapy help Narcissists?

In my last two blogs on the topic of narcissism, I have covered off what narcissism is (and is not), and provided my perspective on whether we are, collectively, becoming more narcissistic.

In this final blog (for now) on this topic, I shall offer my perspective on the commonly asked question of whether psychotherapy can help narcissists? As with pretty much every question relating to mental health and psychotherapy, the answer to this seemingly simple question is ‘it depends’.

First off, what is mean by narcissism? Has the person in question received a diagnosis of having a narcissistic personality? And if so, by whom?

The clinical definition of narcissism is one that differs significantly from how the term has been hijacked and is now used in popular culture. Clinicians are far less concerned with outward behaviour that pop culture seems to label as narcissistic and instead think about how the personality of the patient is organised. We are all capable of selfish and inconsiderate behaviour at times, however, this does not mean that we all have narcissistically structured personalities.

I shall not revisit the detailed clinical definition in this blog as for those of you who are interested, you can read more here. However, in summary, someone who has a narcissistic personality style ‘scaffolds’ their sense of self through constant external validation. They therefore have a very fragile sense of self – of who they really are – and instead define themselves by their purchases, conquests or achievements. How most narcissists portray themselves to the outside world (and to themselves) is in direct contrast to how these folks feel on the inside – insecure, inadequate and unlovable.

There is a second type of narcissistic personality which is generally overlooked and often misdiagnosed and that is the deflated or collapsed narcissist. On the face of it deflated narcissists seem to be the opposite to their grandiose counterparts in that they present as depressed and as if nothing they have ever done is any good. However, unlike people with depressive personalities, deflated narcissists are filled with a sense of rage and injustice that they have not been afforded the life and opportunities they believe they deserve – in other words, their internal world is grandiose and consumed by fantasy, whilst externally they seem collapsed.

OK, so now we know what we are dealing with, I can return to the question of whether narcissism can be treated?

The successful treatment of any patient in analysis or psychotherapy is dependent on that patient desire to change. As treatment unfolds, it often becomes clear to the patient what change involves and all change on a structural level is slow and painful. Whilst many people successfully engage with psychotherapy, most if not all harbour a secret wish that change can happen without them actually having to change! This is generally a stronger fantasy in the world of the narcissist.

Unlike other conditions, people rarely if ever present for therapy because ‘they are narcissists’ – after all, why would they? They are not the problem – everyone else is.

As long as the narcissistic person’s defences (systems of external validation) are working, then they simply will not see that there is a problem. If someone with a narcissistic structure does attend therapy it is either because their defences have failed and they want help putting them back in place, or they have reached an age (usually middle-age) where they realise that the quality of their relationships is limited to none existent and they want to understand why. The latter is the hopeful position.

In clinical language, there are couple of formulas that enables us to evaluate how successful psychotherapy is likely to be for someone with a narcissistic personality: firstly, how rigid is the personality – the more rigid and towards the realms of personality disorder, the less likely treatment will be successful; secondly, whether there narcissistic personality is combined with elements of psychopathy (anti-social personality). Where someone has a strong combination of narcissism and anti-social traits (or sadistic traits) then treatment outcomes are very poor.

Assuming we are dealing with someone who has a dominant narcissistic personality, but one that is neither too rigid nor mixed with sadism or anti-social traits, then there is hope.

The two approaches

There are two main schools of thought in the psycho-analytic community around how best to treat narcissism which were put forward by two of the main thinkers in the field – Kohut and Kernberg.

Kohut proposed that because what has been lacking in the narcissistic patient’s childhood was an empathic and attuned parent who could see the child’s needs, the work should therefore focus on an empathic and attuned approach of validating the patient’s feelings and working to enable the patient to both bear their ordinary vulnerability as well as to combat their shame about having emotions.

Kernberg, who it has been argued focuses more on the pathological end of the spectrum, takes a more confrontative approach to the narcissistic patient and advocates (in the context of a robust therapeutic relationship) the need to challenge the perspective of the narcissistic patient and to push them to consider the experience of those with whom they are having a relationship. Kernberg’s theory centres around challenging the narcissists central tenet that everything and everyone revolves around them.

So which is right?

The correct approach to treating a patient with a narcissistic personality will be tailored to that patient by the clinician – just as it is for every patient.

My perspective on treating patients is that where there is genuine will on the part of the patient, treatment outcomes are often successful.

Psychotherapy, whether for someone with a narcissistic personality, or indeed any presenting issue, is a courageous endeavour. What brings most of us to therapy is a need for change and change is frightening and painful.

Whilst it is a part of my role to assess and evaluate whether a patient is suitable for psychotherapy, I do this from a clinical and ethical position, rather a moral one. If I cannot help someone, or believe therapy will exacerbate their symptoms or push them into psychosis, I have a duty to not take them on and to refer them for other treatment.

Narcissism, contrary to TikTok and other social media platforms, is not a trait that can be diagnosed just on how someone behaves or treats us. Often it takes a fair number of sessions before I fully understand that someone is developmentally stuck with a narcissistic personality that dominates. However, as long as they want to attempt to enter into a relational world of others then I believe there is hope.

 

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

Are we becoming more narcissistic?

What is narcissism?

The medicalisation of mental distress

Can chatbot companions relieve our loneliness?

What are feelings anyway?

Filed Under: Brighton and Hove Psychotherapy, Mark Vahrmeyer, Psychotherapy Tagged With: Narcissism, narcissist, Relationships

September 4, 2023 by BHP Leave a Comment

Cultivating a Tolerance for Uncertainty

The 13th century Persian poet Rumi invites us to wait in the unknown in his well known poem Guest House, to wait and see what transformations might occur.
This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture.
Still, treat each guest honourably.
He may be clearing you out 
for some new delight…….                 
                                                           Rumi (Guest House)
Psychotherapy invites something of the same experience as that which Rumi describes – an opportunity, a space, to sit with and pay attention to news from within. The more we sit with experience the more happens – new feelings , thoughts and perspectives emerge and shift and as time passes our tolerance for experience grows. When we pay attention to (rather than acting on) the many conflicting urges within, sitting becomes a different form of action.
Being right/ Being wise
An attitude of unknowing, whilst challenging when in search of solutions, might also protect us against false omnipotence. In a conflict with a partner it is all too easy to be convinced that you are right and they are wrong – to blame the other and exonerate oneself. The reverse might also occur. Either way aggression can turn against the other and/or the self. Misery and/or righteousness are quick to follow.
Like the universe though, we are mostly unknown to ourselves. Assimilating the fact that we do not know everything about ourselves or the other can help facilitate a condition of greater openness and humility. Becoming more interested in learning who (else) we might be requires a different attitude, an attitude of unknowing, wholly different to that of omniscient (although not entirely conscious) dogma with which we so often proceed. Our investment in being “right” will often do more harm than good. Cultivating a more exploratory appreciation of complexity is not a new concern – Socrates taught that much of what passes for knowledge is opinion. It is one thing to be right, it is another altogether to be wise.
My truth v your truth
In couples work in particular it is not unusual to witness people bludgeon each other with their “truth.” Whilst it is not difficult to take sides with truth against lies, realities are often far more complex, and thinking one’s truth is the truth is not truthful. In the context of couples therapy “truths” will often fly across the room like bullets from a gun. Weaponising truth, using it to distance and wound another might feel good in moments of high tension, but using truth to a more compassionate (productive) end means paying attention to how it is delivered.
Growth requires us to allow a space for ignorance in the face of knowledge. This can be difficult …particularly in a long term partnership where so often we are inclined to think that we know our partner better than they know themselves. Knowing ahead of time what is going to happen next is more often a defence against the intensity of experience….. (if we already know it then we don’t have to experience it). In the psychotherapeutic meeting  we allow space for and pay attention to psychic realities… conscious and unconscious. It is possible to hold a lived experience and investigate it at the same time. When we experience life in the present we are also less inclined to become stuck in ruminating about the past.

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

The importance of generosity and forgiveness in a hostile world

Understanding sexual desire

Reflections on freedom and security in a turbulent year

Reflections on getting back to normal

The Passage of Time and the Discipline of Attention

Filed Under: Gerry Gilmartin, Psychotherapy, Relationships, Society Tagged With: couples, Relationships

July 10, 2023 by BHP Leave a Comment

Having Healthy Conversations with Men about the Menopause

The menopause is an important life transition for women. In more recent years there has been more awareness about the menopause, meaning women are more willing to talk about it with each other and their partners. The question is what is the best way to talk about the menopause with your partner, formerly still a taboo topic and one much associated with shame for many women?

As with any conversation about life transitions, creating time and space for these conversations is always a good start. When both partners feel relaxed and more receptive usually conversations flow more easily.

Then it is important that there are feelings of trust between you and your partner from the start. It is going to be difficult to talk about things that make you feel vulnerable if you don’t feel that your partner is someone who is able to support you emotionally.

It is also good to know what it is that you want to say and what you would like to gain from the conversation. Would you like your partner to have more understanding and awareness of what you are going through, leading to them being more supportive? Or maybe there are more specific things that you would like from them?  In a way, talking about the menopause is no different than talking about other bodily changes such as hormonal changes during pregnancy, PMS, etc. Men don’t go through the same hormonal cycles as women, and unfortunately historically this has been seen purely as women’s domain, to be kept amongst women only and mostly hidden. We still live with this legacy today.

It is also good to be realistic – it is unlikely that your partner is going to be able to fully understand and appreciate what you are going through. Every woman is different and therefore will be in a different journey with the menopause. The uncertainty of what our bodies are going to do is a part of this, and therefore one that your partner needs to be aware of.

To share how you feel and what you are struggling with should be a part of any couple’s dialogue. To get skilled at talking about bodily changes, such as fluctuations in sex drive, hot flushes and fatigue, or mood changes such as feeling more energised and creative, less tolerant, etc., are all a part of improving one’s relationship and something that needs to be done jointly. It could be that as a couple you will need to seek help from a therapist to have these conversations, or it could be a matter of trying it several times to see what works and what doesn’t.

The menopause is another transition in the life of a woman and in the life of a couple. Ignoring this or being in denial is not going to be helpful to you or your partner. Having these conversations, even if it feels imperfect or clumsy at first could lead to more intimacy and appreciation between you.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.
Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading by Sam Jahara

Finding Contentment in the Age of Discontent

What causes low self esteem?

Online therapy: good for some but not everyone

The psychology of mindful eating

Defining happiness

 

Filed Under: Relationships, Sam Jahara, Sexuality Tagged With: couples, Menopause, Relationships

July 3, 2023 by BHP 2 Comments

What is Narcissism?

Since the time of Sigmund Freud, clinical terms around psychology have made their way into everyday language. Narcissism is no exception to this and yet it stands in a category of its own for both how ubiquitous it has become in popular culture, alongside also being so misunderstood.

Frequently used as a term of insult or abuse to describe someone who displays little regard for others, narcissists are defined in society by their outward displays of behaviour. However, for a ‘condition’ that evokes so much of a backlash, collectively we seem to secretly admire the fantasy life we attribute to narcissists and envy the way they glide through life unaffected by the trials and tribulations of us mere mortals. Narcissism and narcissists are envied and denigrated in equal measure.

Alongside the ubiquity of the term, there is no shortage of material available to enable us to navigate a world filled with narcissistic others. From podcasts to YouTube seminars, TikTok videos to old fashioned books, narcissism is everywhere. Many titles suggest an extreme danger or risk of being near or around narcissists with titles such as ‘surviving narcissism’, ‘narcissism epidemic’ and ‘defeating narcissism’ being common. And yet most of these resources fundamentally fail to understand the essence of narcissism and what constitutes a so- called ‘narcissist’.

Indeed, it is interesting that of all the personality styles, such as depressive or obsessive-compulsive, it is this personality style that has become a label for the entire human being: rather than having a narcissistic personality, people are simply labelled as narcissists.

Popular culture
In recent years few clinical terms have been adopted and taken on a life of their own outside of the clinical context above and beyond narcissism.

When popular culture references narcissism or labels an individual as narcissistic, this is generally based on witnessed behaviour, rather than on any deeper understanding of what may have driven that particular behaviour. Popular culture is not wholly to blame for this as the field of mental health has for years been steadily shifting to diagnosing and labelling based predominantly on outward behaviour, rather than from an understanding of personality dynamics.

The problem is that the word that in a clinical context is used to describe traits or the style of a person’s whole personality, is being used as a description of behaviour – ‘he is behaving really narcissistically’ – which may or not have anything to do with the person’s personality; the behaviour tells us very little. In fact, I am not really sure what ‘behaving narcissistically’ even means!

It is not that there is no truth to the ‘watered-down’ formulation of narcissism in the mainstream, it is just that like so many other mental health terms, the nuance and balance has been lost, not least in the context of the ‘narcissists’ experience of being this way. Fundamentally, what’s lost is empathy.

Narcissism is not an illness, it is a personality style
I would suggest that the psychoanalytic field provides us with the most accurate understanding of narcissism and its impacts, as rather than focusing on external patterns of behaviour, psychoanalytic theory considers both the inner world of the patient – what it is like to be them – and their relational world – how do they relate to themselves and others. In other words, when clinicians talk about narcissism they are referring to a particular type of personality that has ‘narcissism’ as its dominant style.

What is a personality?
Personalities are something we all have and whilst we generally have a mix of styles, most of have a dominant one. So, when we consider somebody’s personality style, we are thinking about what trait is dominant and how rigid their personality is – this can be imagined as a scale from healthy functioning, through to personality disorder (and just to further muddy the waters, there is little agreement on at what point someone is personality disordered).

However, there is a further complication when considering narcissism: narcissism like all more dominant personality styles, one that has come about through relational injury during the first two years of development. It rarely appears in isolation to other personality styles and the other main personality styles frequently, if not always, show elements of narcissism in their foundations. It is therefore not always easy to spot.

What are the traits of a narcissistic personality style?
Most people who have a narcissistic personality present outwardly as grandiose, entitled, selfish and are constantly looking for external validation. However, what presents externally as grandiosity belies an internal world characterised by a deep sense of inadequacy and fear.

People with narcissistic personalities fear ‘being found out’ – they fear intimacy and vulnerability as they imagine everyone will see what they see: that they are unlovable.

There exists in the narcissist a constant drive to shore up their fragile self esteem through the external world – what they buy, who they are seen with, what they achieve. Whilst we all garner external validation to some extend in these ways, most of us have a solid enough sense of self to hold onto a real sense of self esteem that does not need scaffolding.

When it comes to relationships narcissistic people face an enormous dilemma as they desperately need others – to both tell them how wonderful they are, as well as to avoid their primal feelings of abandonment. However, they cannot relate in a two-person manner, meaning that whilst they need greatly, they love shallowly.

Narcissistic people protect themselves at all costs against ‘narcissistic injury’ which comes about when their feelings of shame are triggered. And feelings of shame arise when narcissistic people are challenged or called out – it is unbearable for them and they respond with shame which is transformed into rage. This holds the key to why narcissistic people cannot have real relationships: they cannot content with difference which is what we encounter when we are in a real relationship with another ordinary complex human being.

There is one other ‘type’ of narcissistic style which often gets missed in clinical diagnoses and that is the depressed, or collapsed, narcissist. On the face of it this person would seem to be the opposite of the grandiose narcissist and this is in fact correct! However, what looks to be collapsed, depressed and an outward expression of worthlessness, hides an inner world where this character feels utterly entitled to far more than they have and are. They are rageful that the world has treated them in this way and secretly feel entitled to specialness.

Final thoughts
Narcissim is a complex topic to grasp and even clinicians often struggle to fully make sense of whether someone if a narcissist or not.

One of the problems is that people with this structure tend not to present for psychotherapy and if they do it is never because they feel ‘narcissistic’. It is therefore not a condition that is in their awareness.

There are no dependable tests to check for narcissism and just because someone behaves in selfish or egocentric ways, it tells us nothing about their personality structure – after all, can’t we all be selfish at times?

Ultimately, a skilled clinician works out through the therapeutic relationship whether someone is narcissistic. It is a combination of understanding the clinical theory as well as relying on their felt experience. Being in relationship with a narcissistic personality does not feel like an ordinary relationship. They may greatly need you or ‘brush you aside’, or a combination of both but what they cannot do is relate in an equal two-person manner. Their vulnerability and humanness is hidden for fear of shame and abandonment – the narcissistic injury.

 

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

The medicalisation of mental distress

Can chatbot companions relieve our loneliness?

What are feelings anyway?

Client or patient; patient or client – does it matter?

The psychological impact of the recession

Filed Under: Mark Vahrmeyer, Mental Health, Relationships Tagged With: Narcissism, narcissist, Relationships

June 12, 2023 by BHP Leave a Comment

What Causes Low Self-Esteem?

Low self-esteem stems from beliefs that we have about ourselves, a negative self-evaluation which is usually rooted in childhood experiences. The way we were spoken to, treated, and made to feel as children has a significant impact on how we see and therefore relate to ourselves later in life. Some of us may also have grown up with parents who were not very confident and had low expectations of themselves and their children. Social class, culture, race, gender, sexuality, and disability are also societal and environmental contributing factors to how we self-evaluate.

Knowing where negative self-belief and low confidence comes from is the first step in effecting change. Feeling things that we don’t understand can be confusing and cause anxiety and depression, further perpetuating negative self-belief. The next step would be to begin challenging these beliefs and check them against the reality of your life and achievements, skills, etc. Many of the beliefs we carry are just that: thoughts about ourselves that do not match reality. This can lead to perpetual feelings of failure, regret or agonising about every small decision for fear of making mistakes. Some of these feelings can be debilitating and hold us back from moving our lives forward with confidence in our decisions.

Awareness of negative self-talk is also useful in that we can choose to gradually replace this self-talk with more positive inner dialogues. Sometimes people are surprised at how much time they spend being self-critical. The way we think has a direct impact on how we feel, therefore it is important to work on these issues.

How Relationships Affects Self-Esteem
Cultivating positive and healthy relationships is essential in gaining more confidence. A sense of belonging and acceptance comes from a variety of places, but the main place that it comes from is relationships. Therefore, being in relationships that don’t make you feel good about yourself, where you are badly treated, taken advantage of, etc is only going to make you feel worst about yourself. This includes both personal and professional relationships.

The definition of a healthy relationship is one where there is mutuality and exchange of support, ideas, validation, trust and honesty. The more we base our relationships on these principles, the stronger they will grow. Sometimes low self-confidence can get in the way of building relationships or seeking career opportunities for fear that others will think that we have little to offer. Again, challenging these beliefs and checking them against reality can help us to start to behave differently, take more risks and challenge ourselves in a good way.

In Psychotherapy we work with the root causes of low self- confidence, for instance how early relationships have contributed to the beliefs that we have about ourselves today, and then gradually replacing these with more helpful and realistic beliefs about who we are and what we are capable of. This usually leads to making better choices in life in the areas of work,  relationships and health.On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals, couples and groups in Hove and Lewes.

 

Further reading –

Online therapy: good for some but not everyone

The psychology of mindful eating

Defining happiness

What are the benefits of counselling and psychotherapy?

Why is mental health important?

Filed Under: Mental Health, Psychotherapy, Sam Jahara Tagged With: Relationships, self-care, Self-esteem

May 29, 2023 by BHP Leave a Comment

Is Desire Spontaneous?

“Dr Meades asks Daphne how she can help.
‘It’s rather personal dear.’
Dr Meades smiles encouragingly, …
‘You see I’m about to embark on a love affair. It hasn’t quite begun yet, but
it will be … well, frankly, quite a passionate business.’
Dr Meades’s face retained its amiable smile. Only her eyes widened to
take in Daphne’s information.
‘An affair? I see … well how can I …?’
(Diski, 1991:125)

In Jenny Diski’s 1991 novel, “Happily Ever After”, Daphne Drummond is 68, an eccentric lady novelist who hasn’t published recently and a tenant living in the attic of a house owned by Liam. Liam is anthropologist obsessed with sex and young voluptuous female bodies. He has given up his family and his academic job to marry one of his students, Grace. Fairly quickly his sexual obsession and desperate love-making becomes tedious and Grace takes younger lovers. Liam spends his time drinking whiskey, daydreaming about sex and sinking into self- pity. He is irritated and disgusted by Daphne.

Daphne loves Liam and she has plans. She campaigns to convince him of the possible pleasures he might enjoy with her aging body. Her aim is to erode his disgust and make him curious. Their first sexual encounter happens when after a heavy drinking session, dehydrated and miserable, he wakes up to find Daphne has tied him to the bed and is gently exploring his body. Touching parts of his body at the same time as touching her own; sniffing, licking and making appreciative noises. At first he keeps telling her to stop but gradually he finds he is becoming aroused.

Arousal versus desire

Although she focuses on women’s sexual experience, in her 2020 book “Mind the Gap”, Dr Karen Gurney makes a distinction between arousal and desire. She cites Basson’s 2000 circular model of arousal and desire for women where arousal comes before desire. Gurney’s point is that sexual arousal may not be related to a partner but may well be a response to someone or something in the world, something heard, touched, seen, read or imagined including erotic art or literature. Experiencing sexual or sensual stimuli is the first step towards arousal. This may be in the company of a sexual partner, dinner in a beautiful restaurant or a hot night in a club, or it might be alone, reading and sunbathing or noticing an attractive stranger on a train. Think of all the pleasurable sensations and fantasies that can be enjoyed.

Distraction affects sexual arousal, so whilst spontaneous sex is seen as something good, planning does matter. There are environmental distractions like noise and interruptions. I’m sure anyone who has been interrupted by a small voice calling out Mummy or Daddy knows how off putting this can be. Distraction can also come from concerns about body image and performance perhaps fuelled by comparisons with depictions on social media. There are also concerns about whether the other person is really enjoying it, will you have an orgasm and is this kind of sex ok. Gurney notes research that suggests actively focussing on arousal, thinking about how good it feels and how into the other person you are turns up the sexual response and is more likely to lead to satisfying sex.

Diski’s description of Liam’s transformation from disgust to arousal turns on him seeing his bondage and Daphne’s pleasure from a position of a voyeur rather than a participant, “He began to feel the appropriate responses of a consumer enjoying a pantomime of lust designed to inflame the passive observer’s sexual temperature.” (Diski, 1991:133) Liam is then begging her to not to stop. He is finally overcome with desire for her in a way he has never desired anyone before. When she unties him he makes an investigation of her body, finding pleasure in the present and past life that is written there, “It was more sensual than anything he had ever imagined.” (ibid., 139). Helped by the lubrication Dr Meades has prescribed, Liam finds a new kind of lovemaking with Daphne.

Gurney’s advice to the women who come to her with ‘low’ desire is to ask them to notice when they are aroused and to try and build on that to create desire and anticipation. For some women making plans to enjoy sex may go against their beliefs and culture however desire doesn’t just come out of nowhere; as Gurney points out if you wait for spontaneous desire to arrive it may be a long wait. Of course Gurney also makes it clear that the psychological and emotional context is significant, in her book she discusses relationship issues along with aspects of cultural and religious shame. Putting these aside, Gurney’s message is encouraging. It liberates us from the myth that  spontaneous desire indicates a ‘good’ sexual relationship. By explaining that desire follows arousal and emphasising the importance of fanning arousal, by addressing the elements Gurney is helping women and their partners to revive the benefits and pleasures of an active sex life.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch. Online therapy is available.

 

References –

Basson, R. The Female Sexual Response: A Different Model. Journal of Sex and Marital Therapy, 26, 51-65 (2000)
Diski, J. (1991) Happily Ever After. Hamish Hamilton. London.
Gurney, K. (2020) Mind the Gap: The truth about desire and how to future proof your sex life. Headline Home. London.

Filed Under: Relationships, Sexuality Tagged With: relationship, Relationships, sexuality

May 22, 2023 by BHP Leave a Comment

Does your Life Story make Sense?

Why are stories so important to us humans?

Human beings are the story species. From the earliest mythic hunts retold around tribal fires to the modern-day family evenings spent bingeing on the latest Netflix series, stories have captivated us. And yet, when it comes to our own life story, we are more liable to tell well-practised narratives that are unable to explain our struggling relationships, our lack of fulfilment or a life we feel adrift from.

As the human mind and its cognitive powers exponentially increased over millennia, humans found themselves increasingly at an evolutionary advantage. Like no other species, humans were able to learn from the past – through memories recalled and pored over – and imagine and shape future possibilities. This way of experiencing ourselves has placed us at the centre of our own story-world with us as the protagonist of a story moving from the past to the future in a continuous present. This uniquely human experience, where we can out-think our competitors, also tends to mean that we get pulled along by the mesmerising, dreamlike narrative.

Is what we experience and do in our awareness?

Though we believe we live in our own lives close-up and in technicolour, the truth is that much of what really happens is hidden from us. This can be a difficult thought to accept. We get a sense of this being true, however, when we try hard at our relationships, for example, but they keep breaking down in similar patterns, or when we achieve a life-long goal but it doesn’t make us happy. We can get a sense that our stories don’t match up with our experience.

The majority of the processes that the body and mind carry out – such as controlling our heart rate to deciding if we trust a person we’ve just met – are performed out of our awareness. This can be likened to an iceberg where only one tenth of its mass is visible above water. Nine tenths are out-of-sight below the surface.

How the past presents in the ‘now’

Another key factor is that many of our life decisions were made in childhood. This might sound strange, perhaps even outlandish, but think about it. Did you decide the family and culture you were born into? Or did you choose the personalities who surrounded you and their specific needs and struggles? Of course not. You – like all of us – did the only thing you could as a child: you adapted to your environment to try and get your needs met. While the impact of that process and what the cost was to you is often unseen.

Within early and intimate relationships, we do the best with what’s on offer to receive some level of acceptance and approval. These hidden life decisions, based on the logic of a young, immature mind, set us on a course for life as we try to make sense of experiences and create an unconscious working model of how we can be in relationships with others and who we are in those relationships. As a consequence, our self-stories have likely faced little challenge through their life journey to where we are at this very moment.

Through our life, we have been surrounded by other people’s stories – in our family, with friends, in the broader culture. These can have a positive, reinforcing impact on us. They can also overly influence us, make us maladapt and even make us lose touch with our own stories. Or trying to make our life fit someone else’s story.

How psychotherapy is about your story

People come to psychotherapy often due to problems encountered in their immediate lives, such as suffering from depression or a relationship breakdown. These issues however often point to deeper, underlying issues. Therapy offers the opportunity to look at what is going on underneath the one tenth of the iceberg. We do this together, therapist and client, in a collaborative process, using curiosity and compassion. It is through this unfolding process that a fresh and more connected story can emerge.

Through this therapeutic re-storying process, you engage with your personal narrative as the adult you are now, not the younger version of yourself who found themselves locked in rigid narrative episodes. As Jeremy Holmes, psychiatrist and writer on attachment theory and narrative, said, “Each story is there to be revised in the light of new experience, new facets of memory, new meaning” in a process of “narrative deconstruction and construction”. It is through this therapeutic work of review and rebirth that “narrative truth” and new meaning can surface and your story not only becomes understandable and real but it again becomes yours.

The mythologist and academic Joseph Campbell, who wrote about the ‘monomyth’ or common hero stories common across cultures, said, “I don’t believe people are looking for the meaning of life as much as they are looking for the experience of being alive.”

And perhaps this is a key aim of working with story in therapy: through opening up and meeting your self-story afresh, you can make sense of it, reclaim it and play an active part in its ongoing development. This offers the possibility of living a fuller and more engaged life, where you feel more here and more alive.

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

Thad is an experienced psychotherapeutic counsellor and a registered member of the British Association for Counselling and Psychotherapy (BACP). He works long-term with individuals in our Brighton and Hove practice.

Filed Under: Brighton and Hove Psychotherapy, Psychotherapy, Society, Thad Hickman Tagged With: childhood, Mental Health, Relationships

April 17, 2023 by BHP Leave a Comment

Can Chatbot Companions Relieve our Loneliness?

In recent weeks I have seen various articles espousing the virtues of having an ‘AI companion’ or chatbot friend.  Apparently these are particularly popular with the younger demographic. One of these is ‘Replika’ – a prophetic name if there ever was one.

Chatbot ‘friends’ are touted as being helpful in alleviating loneliness through to functioning as some sort of antidote to mild mental health problems. Reading through the ‘testimonial’s’ on Replika’s website the interaction is linguistically framed as a relationship, with reference to the duration the AI avatar and human have ‘been together’ and, based on the published testimonials alone (which are undoubtably biased), some people seem to get something from this encounter.

As a psychotherapist it is not my role dismantle another person’s way of being in the world. This would be arrogant at best and dangerous at worst. However, psychotherapy, at least in the way I practice it, is all about relationship and one of the foundational belies is that what has gone wrong in relationship can only be healed through relationship. This is because human beings, like all mammals, are relational but we are the most relational of all if relational refers to our psychological, emotional and cognitive development being contingent on the consistency of a caregiver. Other mammals, once weaned, can fend for themselves. Humans remain dependent for longer than any other mammal.

We are shaped and defined by the relationship with our primary caregivers and, with the risk of providing an opening for the historical and clichéd attacks on psychoanalysis, we are most shaped by the relationship with our primary carer, who is our mother. 

These early relationships are what help us to understand our emotions and grow a mind. If satisfactory enough, we learn that whilst others can and will disappoint us, we need relationships with others throughout our lives. It is true that some people have more need for contact with others, but contact is needed nonetheless.

In my clinical practice I am always thinking about whom my patient is having a relationship with – even if they are single and isolated, in fact especially so in such cases. As children we internalise important relationships with others, starting with our mothers and then broadening out as we grow older. In the British school of psychoanalysis we refer to such internalised relationships as ‘object relations’. Therefore, when I am thinking about whom someone is having a relationship with, I am referring to their object relations – whom have they internalised and therefore whom are they projecting onto other relationships?

If we have ‘good enough’ parenting, we are likely to feel fairly secure in relationships and are able to operate in a world populated by others. These others have minds that are different to our own and by extension are having different experiences moment to moment. We have internalised a ‘good object’ (good parent) and can tolerate frustrations and difference in others without becoming unduly affected.

An indication of someone who has healthy relational dynamics is someone who is able to tolerate difference in others and hold onto the good of what the relationship offers. One of the (many) frustrations about being a grown up, or rather having a psychologically mature mind, is that we learn that relationships with others are inherently frustrating alongside being rewarding. 

Returning to Replika and systems like it, I can well see why, by applying enough denial to the encounter, it can, on the surface, seem satisfying as despite the illusion, we are not having to content with thew mind of another and thus the difference of another. The system ‘pretends’ to be different but in fact mirrors back to us what we want to see and hear. 

Narcissism by another name

In the myth of Narcissus and Echo, Narcissus is a young man who finds relationships with others confronting. Through happenstance, or what we might call fate, Narcissus finds himself isolated in the woods and discovers the most beautiful ‘Other’ he has ever seen in a still pool of water. This is of course his own reflection and yet Narcissus falls hopelessly in love and even when part of him knows that he is deluding himself, he cannot bear to tear himself away from this ‘perfect Other’. The story of Narcissus is ultimately a tragic one as he wastes his life away yearning for something he cannot have – the perfect relationship.

A character whom is rarely referenced in relation to Narcissus is Echo, the river nymph who loves Narcissus and has been condemned by a Goddess to only be able to repeat the last words anyone says. In other words, she is an echo. She too sacrifices her life waiting for Narcissus to notice her but, of course, as she is ‘different’ he cannot allow himself to notice her other than to drive her away.

I see the rise of these artificial ‘friends’ and the ‘relationships’ that ensue to be modern versions of the myth of Narcissus and Echo. ‘Replika’, or replica, when spelled correctly, quite literally means ‘clone’ or ‘copy’ but one can just as easily translate this to ‘reflection’. Chatbots reflect back to the user what they want to see and hear – from literally dictating how the AI avatar looks, through to receiving the expected responses. The user is turned into Narcissus and an echo is all they receive in return. Of course since Echo in this modern myth is but a machine, ‘she’ will never die.

We all secretly, or not so secretly, hold fantasies of the perfect Other. This fantasy forms the basis of all modern romcoms all the way back through our collective history. It is epitomised in the idea of a ‘soulmate’ and fuels our drive for the perfect partner – something that in itself is driven through technology in the shape of dating apps; we have the illusion of infinite choice but choose nobody as once we do, they become real and thus disappoint.

Growing up psychologically, maturing and individuating, means letting go of fantasies. It means recognising that relationships are essential to us and that in order to have something real and fulfilling, we must tolerate the frustration and sense of difference. 

Rather than difference needing to be threatening, as it increasingly seems to have become in modern society, difference between people is evidence of reality – the very fact that we are encountering a different mind.

Real relationships are about expressing our thoughts and feelings – our experience of the world – and knowing that someone is there to receive them and us, irrespective of whether they ‘mirror’ those exact thoughts and feelings. It is through and via this process that we get a sense of ourselves in the world and with others.

Narcissus was in a clinical sense deluded and descended into psychosis, withering away on the bank of that fateful pool. Chatbot friends encourage this same delusion. I am not suggesting it will lead to psychosis, but reality it is not. There is no relationship to be had and there is no thinking mind alongside you. You are just as alone as Narcissus and cannot grow from a reflection – for that a real relationship is required. 

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 –

What are feelings anyway?

Client or patient; patient or client – does it matter?

The psychological impact of the recession

Why do people watch horror movies?

How to minimise Christmas stress if you are hosting

Filed Under: Families, Mark Vahrmeyer, Mental Health, Parenting, Relationships, Society Tagged With: families, Parenting, Relationships

April 3, 2023 by BHP Leave a Comment

Some existential musings on love, generosity, and the relation between self and other (part two)

(Adapted from a presentation given at the SEA conference November 2022) – (Part two)

Speaking of life itself as a movement of becoming. Have we forgotten the isness and replaced it with beingness, an allegedly unified subject of self-consciousness, contained and stuck within a name or a label? Must knowledge be part of it, must we always think our way in?

Does that remind you of anything? The masculine economy of desire tells us I think therefore I am (Descartes, 1998). It invites us to believe in the binary. But Nietzsche (1886/1978) tells us differently. He gifted us multiplicity, and music to dance to. He invited us to affirm life beyond the narrow confines of self-preservation: to play with all the dynamic forces and tensions.

Perhaps generosity is a type of life force? Bazzano (2019) says, in Nietzsche there is no individual will to power but “power understood as a generous expenditure” (p.95). But generosity is often suppressed in favour of rigid identities. In current culture it seems the human animal is seen as depending upon an idea of self, perhaps influenced by patriarchal forces. Discourses of subjectivity rely on notions of individuality, autonomy, and self-preservation. The different other often becomes a threat as does the potential for an unstable, non-unified experience of self.

And what about suffering? Are we allowed to suffer anymore? Is that not sometimes where the gift of transformation lives? Yes there is a paradox here, as Nietzsche (1974) writes, suffering is markedly personal because it is an aspect of self-expression, in time. In which the very process calls us forth to reshape and become; reinterpreting the past through healing and releasing what was and opening to the new. However, don’t we all rely on each other for that too?

Helene Cixous (1991) tells us “only when you are lost can love find itself in you without losing its way” (p. 39). This feels important to me. In Renshaw’s interpretation, Cixous seems to refer to “the very structure of desire that is made
possible in a non-possessive, feminine relation to difference. She goes on to say:

“Only when we are lost to ourselves, to the extent that being a self means being one and unified, are we opened to the possibility of a becoming that is expansive, abundant, and opened to the indeterminable difference of the other. Only then can love descend upon us the way it wants, in one of its bewitching, magical and divine forms” (p.183)

In her essay, The newly born woman, Cixous (1986) writes of the feminine economy of desire as a notion able to grasp the abundant and often incongruent aspects of desire, refusing to “exclude the contradictory, and the ability to
embrace a cycle of relations that are constituted in movement …never static …marked by movements, towards, away and elsewhere” (p.125).

There is much to consider here. In her book, ‘The Subject of love’ (2009, p.6), the academic Sal Renshaw offers us some questions to ask ourselves.

Perhaps we can explore them together.

“Can we love as a gift that does not return?
What would it take to love the other as other, neither to refuse nor to embrace the
other but to create a space in which the other is met, is brushed against, is
perhaps felt as well as seen”
Can we live our subjectivities in a way in which love emerges in the in-between,
not as something the ‘I’ does or has, but rather as something that happens to us,
that emerges, in the very space of meeting?
What kind of being or becoming, does it take to love the other in their otherness
and not to sacrifice oneself in doing so?
What kind of relations to and between subjectivities make possible a generous
meeting in difference?”

Part one of this blog can be found here.

To enquire about psychotherapy sessions with Susanna, 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.

 

Further reading by Susanna Petitpierre –

Some Existential Musings on Love, Generosity, and the Relation Between Self and Other? (part one)

On living as becoming (part two)

On living as becoming (part one)

Some thoughts on becoming (part two)

Some thoughts on becoming (part one)

 

References – 
Bazzano, M. (2019). Nietzsche and Psychotherapy. Oxon: Routledge.
Carson, A. (1998). Eros: The Bittersweet. Illinois: Dalkey Archive Press.
Cixous, H. (1986 [1975]). ‘Sorties’. Trans. Betsy Wing. In Helene Cixous and Catherine Clement. The Newly Born
Woman. Minneapolis: University of Minnesota Press.
Descartes, R. (1998). Discourse on Method. Indianapolis: Hackett Publishing.
Merleau-Ponty, M., (2012) Phenomenology of Perception. Oxon: Routledge

Nietzsche, F. (1886/1978). Beyond Good and Evil: Prelude to a Philosophy of the Future, trans. R.J. Hollingdale. London:
Penguin.
Nietzsche, F. (1974). The Gay Science. Trans. Walter Kaufmann. New York: Random House.
Renshaw, S., (2009). The subject of love. Manchester: Manchester University Press.

Filed Under: Psychotherapy, Relationships, Susanna Petitpierre Tagged With: Love, Relationships, self-worth

March 27, 2023 by BHP Leave a Comment

Some Existential Musings on Love, Generosity, and the Relation Between Self and Other

(Adapted from a presentation given at the SEA conference November 2022) – (Part one)

Anne Carson (1998) wrote,

“‘Now’ is a gift from the gods and an access onto reality. To address yourself to the moment when Eros glances into your life and to grasp what is happening in your soul at that moment is to begin to understand how to live.” (p.153).

Was it Merleau-Ponty (2012) who showed us that, without you, I do not know who I am. I cannot see the back of my head. I need you, the other, to tell me so I can build a picture of it. Yes, it seems we are made in the social.  But that means there will be ruptures too. Losses and suffering will prevail without our control. Can we transform in them? Do I need your help for that too?

Sal Renshaw (2009) describes the relation between self and other as a continual movement intrinsic to our becoming. Not only does the relation between self and other reveal the movement of becoming. It also signifies the impossibility and impermanence of the unified subject or absolute being. Encountering self and other reveals difference, perceived “somewhere in the space between that which returns to us that which we recognize as the same, and that which escapes us” (Ibid, p. 2).

Sometimes difference is felt as a conflict, sometimes as a threat, sometimes as an interest and an opportunity. But difference can be, and is, an opening into our becoming.

It may entail a complex exploration: maintaining positive regard for the other without being implicated in a kind of sacrificial logic rooted in Christian morality and its derivatives and without being caught in the web of patriarchal narratives. As Renshaw states (2009) writers such as Helene Cixous inform us of the extent to which “women have traditionally borne the brunt of sacrificial logic in a patriarchal structure” (p. 7).

How can we hold a space for a version of selflessness that is generous, alive, affirmative and does not fall into self-abnegation? A difficult task, no doubt. But an important one: “loving the other as other, allowing them and oneself to be born into the present in love” (Renshaw, 2009, p. 176). Perhaps they have forgotten or never knew that difference is the astonishing source of their love.

Isn’t there always more to the story, yes, more to come, more to become?

Is not life itself a movement of becoming …

Part two of this blog can be found here.

To enquire about psychotherapy sessions with Susanna, 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.

 

Further reading by Susanna Petitpierre –

On living as becoming (part two)

On living as becoming (part one)

Some thoughts on becoming (part two)

Some thoughts on becoming (part one)

What is the Menopause? (part one)

Filed Under: Mental Health, Psychotherapy, Susanna Petitpierre Tagged With: Love, Mental Health, Relationships

March 20, 2023 by BHP Leave a Comment

You’re not watching me, Mummy!

Is it ever too late in life to change? Despite many decades of accomplished professional practice and conspicuous recognition for his achievements, the psychotherapist Irvin Yalom was stunned to discover he still had personal work to do.

In his memoir, Becoming Myself , he recalls attending an academic event where he realises (1) he is to be the target of gentle but sustained mockery from his Stanford University colleagues. That night he has a powerful dream from which he wakes to conclude, ‘I am still looking for validation, but not from my wife, my children, my friends, colleagues, students or patients, but from my mother!’

Although Yalom’s real mother was long dead at the time of his unsettling dream, his self-discovery revealed that her frequent harshly critical judgements of him as a child had become part of his lifelong personality, rising suddenly within him at times of stress, such as when he became the particular focus of others’ attention. In his dream, isolated and scared, he plaintively cries out, ‘How did I do, Momma? How did I do?’.

We might pause to consider how it could possibly be that a richly experienced practitioner, one expert in helping others to understand themselves better, could be so suddenly blindsided by such a self-revelation. On the other hand, what Yalom is disclosing about his experience here might be seen as one of the most fundamental of human realities.

In psychotherapy we speak of the developmental process of ‘introjection’, whereby we unconsciously adopt the thoughts, feelings and behaviours of significant others, particularly the most powerful others in our early lives. In the modality of Transactional Analysis we call this part of us our Parent ‘ego state’. This proposes that during the
development of our ‘self’ we naturally take into our own way of being key aspects of the others we depend on, how they think, feel and behave: we thereby install their potency into our developing personality.

This is a natural survival strategy and serves us well when it provides us with valuable parental impulses that guide us to operate safely in the world and help us to nurture ourselves when under stress. The downside of this strategy is that, depending on the quality of the care we received and how we responded to it, the Parent ego state we carry
forward can contain persecutory impulses, parental fears and smothering tendencies combining in us to create significant inner conflict in our adult life.

Engaging in psychotherapy can be effective in helping us to explore those aspects of ourselves that seem to echo the powerful personalities of our past lives. Careful exploration with a curious and empathic therapist can help us to surface parental messages we may be carrying that contribute to previously unexamined self beliefs. In uncovering these ‘introjects’ we can more clearly see how what we chose to take on from others in the days when we first learnt to be ourselves might be limiting us now in living more freely and spontaneously in the world.

Yalom’s insight, late into his own life, was to see that the way he had incorporated his mother’s harshness into his own process was preventing him from being able to truly recognise and celebrate his own worth.

His particular way of dealing with this was to look for the compassion in himself for ‘that mother that I disliked so thoroughly.’ He writes of achieving a different perspective on her through his later realisation she had a deeply conflictual relationship with her own mother, always remaining desperate for a recognition from her that never came.

Coming to understand the possible motivations behind his mother’s persecutory behaviour, Yalom found a way in which he could simultaneously diminish the power of the fierce inner critic that he had made of her. Like many of his patients, he discovered it was never too late to become himself.

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

Chris Horton is a registered member of the British Association for Counselling & Psychotherapy (BACP) and a psychotherapeutic counsellor with experience in a diverse range of occupational settings. He works with individuals (young people/adults) in private practice.  He is available at our Lewes and Brighton & Hove Practice.

 

Further reading by Chris Horton –

I’m the problem – It’s me!

Making sense of our multiple selves

Let’s not go round again – how we repeat ourselves!

How are you?

Out of Sight, Out of Mind

 

Resources –

(1) Yalom, I (2017). Becoming Myself: A Psychiatrist’s Memoir. Piatkus 1

 

Filed Under: Chris Horton, Families, Parenting Tagged With: Family, Relationships, transactional analysis

March 13, 2023 by BHP Leave a Comment

What are Feelings Anyway?

Everyone knows what a feeling is, right? Well, it turns out that this is not the case and many of us are either unable to experience feelings at all, or get thoughts and feelings mixed up.

Early on in my training I had a tutor who would tell us ‘when in doubt, hunt the feeling’. It is arguable that this is the purpose of the therapeutic interaction that enables both empathy and relational understanding to take place.

So what is a feeling?

Feelings are emotional responses that we experience which can then be thought about and communicated using language. Let’s delve deeper and understand how feelings operate.

When we have a physiological response to stimuli – this can be external or a thought process – the cluster of physical responses are called ‘affect’. Affect is primal and is something we find across all mammals. Broadly, affect is a proto-emotion and expresses itself through what we would describe in words as:

Seeking;
Rage;
Fear;
Panic;
Play;
Lust
Care.

Affect is not relational, meaning it neither functions nor is used to communicate feelings to another.

Above affect we have our emotions, which are more sophisticated and nuanced and whose function is to let both us and those with whom we are in relationship know about what is going on for us. Emotion is the link between mind and body, and, affect and feeling. Our primary emotions are:

Fear;
Anger;
Sadness;
Joy;
Disgust;
Surprise.

Emotion defies language in that it can be felt and communicated through relationship and experience. However, effect is communicated using projection and projective identification – the ‘putting’ of feelings into another.

Feelings sit at the highest level and are behavioural and cognitive. They can be thought about and defined in language and conceptualised by another.

How can things go wrong?

Infants do not have the ability to use language and nor do they think using words. They experience affect in their body and communicate their emotions to their primary carer using projection. With early trauma where the primary carer (the mother) has not been adequately internalised, the infant projects their affect out into the universe, rather than into the other. They can neither make sense and soothe themselves nor locate soothing in another and are adrift with overwhelming emotions.

In psychotherapy

In relational psychotherapy, feelings are communicated through verbal and non-verbal cues but are also present in the transference in the shape of emotion. By receiving the patient’s projections and giving shape and form to them in the therapy, the therapist assists the patient in digesting their emotions and converting them into feelings.

When is a feeling not a feeling?

Often people will talk about feelings when these are actually thoughts. In language this is expressed as ‘I feel that…’. As soon as the word ‘that’ follows the word ‘feeling’, you know you are dealing with a thought.

Why does all this matter?

Integrating thinking and feeling lies at the heart of the therapeutic process. If unexpressed and crucially, unexpressed in a relationship, then a person is likely to remain stuck experiencing the world and their current relationships clouded by past experiences. In the words of Freud: “Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”

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 – 

Client or patient; patient or client – does it matter?

The psychological impact of the recession

Why do people watch horror movies?

How to minimise Christmas stress if you are hosting

Can couples counselling fix a relationship?

Filed Under: Mark Vahrmeyer, Relationships, Society Tagged With: feelings, Relationships, understanding

February 20, 2023 by BHP Leave a Comment

Defining Happiness

Happiness is linked to a sense of joy, ease, and gratitude. It is also linked with a general positive evaluation of one’s life, past and present, which usually contributes to positive expectations or and looking forward to the future.

An ability to sustain a state of happiness depends on many factors, including how a person deals with stress and adversity. There is strong evidence that early attachments are a crucial determining factor in a child’s brain development, and consequently the formation of their world view and perspective in life. For example, a child who grows up with ongoing exposure to stress and trauma, and few or no positive early relationships is likely to feel preoccupied, anxious, and even depressed rather than happy and at ease. In turn, a child who grows up feeling emotionally and physically safe, though positive early relationships with others and therefore themselves, will very likely continue to cultivate these qualities throughout life.

Happiness can also be seen as a temporary emotional state, which comes and goes. Life satisfaction and mental wellness are qualities which can be cultivated and even created through conscious life choices in areas such as relationships, nutrition, exercise, work and spirituality.

What is the link between social connections and happiness? What aspects of having strong family ties and good friendships promote happiness?

Good relationships are a vital component in living a satisfying and fulfilling life. Human beings are relational beings. From day one we depend on our carers to survive and thrive in life. A sense of belonging, meaning, purpose and acceptance comes from relationships that are healthy, dependable, and enduring. Through others we feel seen, heard, and validated.

In turn, giving to others brings us a sense of satisfaction and fulfilment, and makes us happy as well. We don’t choose the families we are born into; therefore, good family ties aren’t a given for everyone. Those who are fortunate enough to have strong family ties and good relationships with their families are lucky. However, building strong friendships and relationships are also a way of creating a ‘family of choice’ with those we value and with whom we have things in common. Without good relationships we invariably feel lonely and isolated, which leads to poor mental health.

What is the link between happiness and self-compassion and gratitude?

Self-compassion and gratitude are ways of cultivating a positive view of self, others and the world around us. The way we think has a direct impact on how we feel about ourselves and others. This differs from positive thinking or being out of touch with reality. Our negative bias can lead us to developing self-defeating thoughts and a bleak view of the world. This then becomes our reality as we constantly search for things to confirm this view. Things are mostly neither always good nor always bad. The ability to hold a balanced perspective on life and hold both positions at the same time is what defines a healthy mind. Therefore, cultivating a positive thinking loop, rather than a negative one will impact our ability to feel happy.

Is happiness a choice? 

Increasing our capacity to feel a full range of emotions such as sadness, anger, love, etc will also increase the likelihood of experiencing happiness. To feel happy, we need to get better at feeling in general. This means appropriate emotional responses to different situations. There are different ways of developing emotional literacy, psychotherapy being just one example. Therefore, we could say that there is a choice in improving one’s ability to feel happiness, as well as others feelings too.

 

On our website you can find more information about our counselling and psychotherapy services and how to contact our team.

Sam Jahara is a UKCP Registered Psychotherapist, Clinical Superviser and Executive Coach. She works with individuals and couples in Hove and Lewes.

 

Further reading –

What are the benefits of counselling and psychotherapy?

Why is mental health important?

What makes us choose our career paths?

Antidotes to coercive, controlling and narcissistic behaviour

An in-depth approach to leadership coaching

Filed Under: Families, Relationships, Sam Jahara Tagged With: happiness, Relationships, self-care

January 30, 2023 by BHP 2 Comments

Client or Patient; Patient or Client – Does it Matter?

A topic of certain difference, and at times discussion in the field of psychotherapy, is whether we refer to those we treat as ‘clients’ or ‘patients’.

Why might this matter?

On the face of it, it should arguably matter little to someone attending psychotherapy, as to what the therapist calls them on paper; in the room they will be referred to by name and thus, to some extent, the nomenclature used is academic.

However, psychotherapy is about how the psychotherapist thinks about the person who engages their services and this thinking will inevitably influence how the psychotherapist refers to those who come to see them and vice versa.

Why such different terms?

Psychotherapy was born out of psycho-analysis. And in both classical and modern psychoanalysis, as well as in the language of many psychoanalytical psychotherapists, the term patient is commonly used.

Historically, this is derived from Freud’s use of the term, whereby he situated psycho-analysis firmly in the medical field.

There is an additional term that is used in analysis which is ‘analysand’ – the person who goes for analysis. Whilst it bridges the gap between client and patient, I find it somewhat clunky and it is not a valid term to use in psychotherapy.

Who is the expert?

Much progress has been made in the field of psychotherapy to shift from a ‘blank-screen’ model on the part of the psychotherapist, to a relational approach – meaning broadly that the psychotherapist plays an active role in co-constructing the relationship and works within the context of the relationship to bring about change.

Many in the more humanistic field argue that one of the goals should be to bring about as much equality between the therapists and ‘client’, so as to eliminate the power imbalance.

Whilst a noble endeavour, I think this is naïve, as firstly, we are are there in an expert capacity and those of us who are trained and work at depth, understand that we carry an enormous burden of responsibility to those who engage our services. We are therefore, not equals.

Secondly, depth psychotherapy, using a psychoanalytic model, works with what the client or patient ‘projects’ onto us – something we refer to as transference. In the transference, we inevitably represent one of the parents for the client and it is arguable that the treatment process in psychotherapy is one of re-parenting.

Parents and children are never equal

I believe that roles come with firm boundaries – many of which are frustrating. For example, it is a parent’s role to always be a parent to their child. This role will evolve and change over time and eventually there will be two adults in the relationship, however, this does not imply that there are two equals. Part of the frustration of being a parent (and the child of a parent) is in acknowledging the firm boundary, meaning that a parent should not become a friend to their child, no mater the age of that child. This does not mean that this does not happen in some families, however, I view this as unhelpful.

The therapeutic relationship between a psychotherapist and their client or patient is sacrosanct – as should be the relationship between parent and child. We are there in an important, and at times, critical capacity and co-create with those who come to see us a deep intimate relationship that must be alive, messy, creative, conflictual, loving and hateful – but always and forever boundaried.

Boundaries frustrate but facilitate grieving

Over the past decade of being a UKCP registered psychotherapist, I have seen a fair few people come and go from my practice. Most have stayed for years and, I believe, done some very good and important work.

As in life, the relationships we form with those whom we see week after week matter to us and I have grieved with the end of the work and having to say ‘good-bye’ when treatment ended.

The grieving is necessary as, irrespective of how much we have come to matter to each other, I shall always be in the role of psychotherapist for all of my former patients. Most will never cross my threshold again, however, it is vital that they can hold me in mind in the role they assigned me and that I don’t deviate from that position and ‘befriend’ them. Whilst this may feel seductive to both sides (as it does for a parent and child), the boundary enables the relationship to work and continue working in the capacity it must for the patient.

On why I use the term ‘patient’

I have shown my hand in the previous paragraphs in using the nomenclature of ‘patient’ and shall now explain why I have, over time, shifted in my way of thinking.

Patients come to me because they are in distress. I am there as an expert, not to tell them how to live their lives, but to help them understand how and why they live their lives they way they do and offer them a stable and secure relationship through which to bring about change.

Psychotherapy is about change – it is not about enabling existing behaviour and this needs to be agreed between therapist and patient.

I view the term ‘client’ as representing a grey area when it comes to boundaries – with clients we can ‘have a chat’ and maybe take the relationship outside of the context in which it began. It also seems to me to be very transactional. This is a personal view and not an accusation of anyone who has a preference for this term.

My work as a psychotherapist is to ‘treat’ my patients. I am accountable for understanding their minds and helping them find a way through their distress. If they knew how to do this, they would not need me.

Lastly, rather than being a distancing term, I view ‘patient’ in this context of one towards which I can show the upmost respect. It does not imply, to me, that I am better than them, but it does show that I am willing to take on the responsibility for my part in their treatment and that the boundary will always hold. For me it is ultimately a term of ‘love’, in the way Freud meant it.

 

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

How to minimise Christmas stress if you are hosting

Can couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

Filed Under: Mark Vahrmeyer, Mental Health, Psychotherapy Tagged With: Mental Health, Psychotherapy, Relationships

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