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How Psychotherapy can help shape a better world

In Psychotherapy people learn how to reflect more on their lives, choices, behaviours and feelings. This more thoughtful and reflective mode translates into how one sees her or his world and their place within it.

We learn to feel more connected to ourselves and others, and to behave in more thoughtful ways as a result of greater self-awareness. This ‘looking inwards’ has sometimes been mistaken for individualistic or self-indulgent. However, what it does is exactly the opposite – we can only relate better to others and the world around us when we have first developed a better relationship with ourselves. Qualities which are usually seen as altruistic, selfless, and giving usually stem from a place of gratitude and generosity. Whilst some have it in themselves already, others will need to learn it.

Psychotherapy is also about congruence and authenticity. The more out of touch we are with our true values, needs and wishes, the more we suffer. Psychotherapy puts us back in touch with those values, needs and wishes, through a complex process of working through barriers which we have put in place early in our lives.

These needs and wishes are not material or superfluous, but are universally felt needs for connection, love and belonging. The more we diverge from these needs, the more alone and isolated we become. Admitting the need for connection and love can sometimes be painful and even shameful. This is because our fundamental early needs for connection, attunement and love have not been met in the past – to varying degrees.

Only through realising our early wounds, can we begin to heal and move past them into a different way of being in the world which entails connectedness, support, caring and giving. In essence, some of us will need to learn how to feel and give love.

Learning how to love others is the most fundamental quality needed during any crisis. If we can’t love, we harm – ourselves and others. When we love, we can extend ourselves to others, empathise and feel with others. When we truly see someone else’s pain, we see them as a ‘real other’. This applies not just to human beings, but also animals and nature.

In Psychotherapy we can work on lessening this ‘disconnect’ between who we want to be and how we currently live. People discover new ways of being and living as a result of this work. Therefore, in key times such as these, let us move consciously into shaping a better world for everyone and the planet we live in.

 

Sam Jahara is a Psychotherapist and Co-founder of Brighton and Hove Psychotherapy. She has a special interest in how Psychotherapy can influence social change.

 

Further reading by Sam Jahara

Making the most of your online therapy session

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

Leaving the Family

Psychotherapy and the climate crisis

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Why am I feeling more anxiety with Covid-19?

During the last 100 days, all of our lives, across the globe, have been turned upside down. Whilst scientifically overdue and rationally unsurprising, the pandemic has shaken the foundations of our outer, and thus, inner worlds. What we came to see as normal has been curtailed or removed; what we relied on for our own sense of normality has been fractured. 

Is everybody feeling more anxious? 

No, but that does not make those who are wrong or ill. Some people are feeling less anxious as their ‘ordinary’ level of anxiety (which may be quite high) now have an outlet – something tangible to attach to. Think of the example of a soldier who is able to thinking function efficiently in a war zone but who, upon returning home to an ‘ordinary’ environment, struggles to function as they locate threat behind every corner. 

There are also some who have a healthy relationship with their ‘anxious’ selves and are able to recognise the source of their anxiety and to use it whilst holding onto a thinking mind – such folks may feel a broader and deeper range of all their emotions at present but would not describe themselves as ‘more anxious’. This is possible for us all. 

We are all going to die! 

It is a fact – no way round it – we are all going to die. Though probably not from Covid-19. In fact the likelihood of death from Covid-19 is statistically very low. 

I am not interested in getting into the actual mortality rates etc. for Covid as they have little to do with the anxiety I am addressing – suffice to say that Covid is real and each death is a personal tragedy – like deaths always are. 

However, there is more than meets the eye in the sub-heading of this section of my blog which may shed some light on heightened anxiety levels which I shall attempt to explain. 

Let’s start with the premise that human beings, generally, have a strong biological drive to live – like all other mammals. 

Back to Freud 

Freud posited that the majority of our decision making and therefore emotional work remained largely unconscious to us. He was right about this as has been evidenced in neuroscience experiments. 

Freud also suggested that we have a profoundly unconscious fear of death linked to our consciousness of self – we know that we are alive and therefore we also know we must die and this presents a dilemma. 

All anxiety is death anxiety 

Anxiety is not like the other emotions. It is free floating and pervasive. We all must live with anxiety whether it dominates our experience or is just a flicker on the horizon. 

All other emotions are ‘attached’ to something in that we generally know or can work out why we feel a certain way. We generally know what we feel happy or sad for example – and if we don’t the psychotherapy can uncover the reasons. 

Anxiety is different in the sense that it ‘seeks to attach’ to something. So, rather than being anxious about a presentation, a flight, an exam or a date, our anxiety ‘finds’ something in our environment and then attaches to that convincing us that that thing is what is causing our anxiety. 

Of course real things cause anxiety, however, on a profound (ontological) level, all anxiety stems from an unconscious but ubiquitous knowledge that we are going to die. It is therefore death anxiety. 

Covid represents the perfect vehicle to which our anxiety can attach – it kills. Just not very many of us. It is not a Hollywood movie like Independence Day where the enemy will destroy us all unless we mount a global war (and towards an enemy that we can see – and is monster-like). Covid is invisible to us but nonetheless has triggered a profound death anxiety in all of us – we are primed to feel anxious in the face of death as though we are hard-wired. 

What can I do? 

Earlier I mentioned the term ‘a thinking mind’ and this is one I have written about before. Even though are all primed to feel more anxious when reminded of death (check our Terror Management Theory for empirical evidence of this), it does not mean we need to lose our rational minds and succumb to the anxiety and the accompanying acting out. 

Your mind is capable of thinking and scanning for evidence. For example, if you are reading this piece right now, stop breathe and look around you. Look out of a window and notice that in this precise moment, you are not dying. You can use your sense to ground you: 

  • What can I see; 
  • What can I hear; 
  • What can I smell; 
  • What can a taste; 
  • What can I seen – my breath, my heartbeat, tension in my body etc. 

I must buy toilet paper! 

Much has been made of the compulsive need to purchase toilet paper as the pandemic emerged and took hold. And this seem to be a global rather than local phenomenon (though Americans seem to have a compulsive need to purchase firearms – but that adds confirmation to the theory below). 

So why toilet paper? Well, when anxious humans would rather do something rather than just sit there – and what we often need to do is stop and just sit there. Particularly when we are not about to immediately die. 

Toilet paper is intricately linked to a biological need that we would prefer didn’t exist. The need to defecate. The need to defecate links us to nature and to being, at least in a significant part, animal. Being linked to nature and thus being an animal means that we are mortal – something that is unconsciously unbearable for the part of us that is ‘God-like’ and able to project ourselves back into the past or forward into the future. In short, toilet paper became a manic defense against death but ensuring that we had the ability in the face of death to ‘wipe away’ any evidence of our animal nature. 

Briefly returning to the questions of guns and our American friends – I posit that guns are the way Americans take responsibility for avoiding death anxiety – by protecting themselves against the enemy. Perhaps thank Hollywood for this (even though Covid-19 cannot be shot). Oh, and I am fairly sure they also stocked up on toilet paper.

 

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

 

Further reading by Mark Vahrmeyer –

Why psychotherapy sessions should end on time

Coronavirus Induced Mental Health Issues

Coronavirus (Covid-19) Counselling

How being ordinary is increasingly extraordinary – On the role of narcissistic defences

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Why do I do that? A Dramatherapist looks beneath the surface

I am a dramatherapist and I am talking today about one of my favourite subjects. I am going to explain the benefits of working with creativity in the therapy room.

When we are being creative we are using a part of our brain which does not relate to logic or linear time. This part of the brain thinks in pictures, metaphor and symbols. It is representational rather than objective. It endows personal subjectivity to our experience. It is what makes us human and unique. It records and remembers everything that has ever happened to us, every thought, every sensation, every feeling, every hope, every dream. What a storehouse of information waiting to be revealed!

But here’s the thing. Whereas we can easily access the logical part of our brain, so we know to carry an umbrella when it’s raining. We have learned this, it’s logical. Our creative brain thinks in pictures, sensations and emotions. Experiences and memories are recorded and stored in a different way which means they’re not always readily available for us as information because they reside outside of our awareness.

So for example: you’re normally a reasonably polite friendly person, but behind the wheel of your car you rage at other drivers and you don’t know why you do this. This behaviour stems from something in your psyche that is ‘out of your awareness’. So you can’t stop yourself doing it by simply noticing it and trying to change your behaviour. The interesting thing about this type of ‘out of awareness’ behaviour is that we can’t seem to learn from it no matter how hard we try.
This is where the dramatherapist armed with a creative toolkit can help. We know from research that when the mind is engaged in a creative task, the logical mind takes a back seat. It goes off-line and allows us to tap in to the resources that are held ‘out of awareness ‘ and hidden beneath the surface of our everyday experience.

Here we can see why we behave the way we do and where/ how  it originated. We can explore the triggers. In doing this we can actually heal our past experience and recover form it. And that’s what we want from therapy, right?

One way I get my clients to tap in to their ‘out of awareness’ experience, is to use a method called hot-penning. First of all I prepare my client using relaxation techniques to enable a clear focus on the issue at hand. The client then takes pen and paper and writes whatever comes to mind. The rule book is thrown out and the pen is given free reign. The writing need not be logical or sequential, it may be a stream of words, you’re allowed to swear, it does not have to make sense. After a couple of minutes of loosening up the client will generally begin to write meaningful narrative which can be very revealing. Clients are so frequently surprised by their own articulacy and the wisdom that they express. Quite often there will be the ‘a-ha’ moment.

In my experience when the client has insights unprompted by the therapist they are more motivated towards lasting change.

Dramatherapy as a creative therapy can help the client to begin to live more fully ‘in awareness’ and be less affected by ‘out of awareness’ behaviours which formerly tripped them up.

Magdalena Whitehouse is an experienced HCPC Registered Drama Therapist, working with individuals, couples and  groups. Magdalena is available at our Brighton and Hove Practice.

Further reading by Magdalena Whitehouse –
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Paying attention to stress

We are evolutionarily wired for stress.  For our early ancestors, inhabiting a natural world beset with predatory dangers the flight/fight response was crucial to survival.  The same alarm system exists today for the same survival purpose evolution originally intended. 

What is different is that today the more likely sources of threat ( at least for those of us living in the industrialised world) are emotional.  Our biology, psychology and physiology are interlinked in subtle and complex ways, all with implications for our health and well being.

A stress response is activated when an event, physical or emotional is perceived as threatening.  As human beings we make multiple assessments via our central nervous system to interpret a stimulus and prepare ourselves to respond. Our response will be a combination of physiological and behavioural adjustments commensurate with the perceived degree of threat.  What is “commensurate” varies from person to person.  Each stress event is experienced in the moment but may have resonance from the past.  Our personal histories as well as our dispositions influence our response to a stressful event.

Acute v chronic stress

Whilst on the one hand stress can be understood as a physiological event vital to survival, on the other it is increasingly understood to have a corrosive effect that impacts negatively on our long term health.  Here it is important to distinguish between acute and chronic stress.

Acute stress triggers immediate discharges in the nervous, hormonal and immune systems, activating flight or fight reactions that help us survive imminent danger.  These are highly adaptive and highly effective responses.  In the case of chronic stress, the same systems are activated(over and over) but without resolution.  The effect is elevated cortisol and adrenaline levels which can damage tissue, raise blood pressure and undermine the integrity of our immune functioning.

For many people, functioning with chronically elevated cortisol and stress hormones is normal.  The circumstances of our early lives, including our attachments may have necessitated a state of hyper arousal and vigilance.  Without any conscious awareness our bodies stress responses can remain highly active.  Indeed it may be the absence of stress that creates unease in the individual habituated to its hormonal high but such a state of addiction to our own stress hormones may have serious implications for our long term immune functioning and health.

When we are unaware of what is happening in our bodies we are unable to act in self preserving ways.  The same is true of our emotional states.  If we are unable to identify what it is we feel, we will struggle to communicate it.  Our capacity to identify our emotional states will largely depend upon the messages that were conveyed to us early on by significant others.  A child may conclude that “I am not ok when I am angry” for instance, based on the blatant or subtle (verbal and non verbal) responses of a parent/ group of which they are a part.  In order to prevent the threat of rejection or shame the child will learn to shutdown or repress the unacceptable expression of anger.  This repression if it is to remain successful will require constant vigil and adaptation, such that overtime the legitimate expression of anger will be compromised and confused.

Self awareness

We need to develop a degree of emotional competence and fluency in order to protect against the hidden stresses that can pose such a (ticking time bomb) threat to our health.  This means being able to identify and express our emotions effectively, to assert our needs and maintain healthy (physical and emotional) boundaries.  It means being able to distinguish between past and present realities such that we cultivate awareness (and compassion) for unmet childhood needs.  Remaining disconnected with these aspects of our personal histories can contribute to hidden stress with potentially serious implications for our physical and emotional health and well being.

 

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 –

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

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Can Mindfulness Replace Psychotherapy?

There is a lot of hype surrounding mindfulness at present. The NHS now sees it as a psychological intervention, and large corporations recognise that calm, happy  employees are more productive. But how realistic is mindfulness, a secularised and stripped-down version of the Buddhist practice of meditation, as a long-term psychological intervention?

What is Mindfulness?

Mindfulness is essentially ‘awareness’; being able to remain aware of what we are experiencing without becoming attached to the thoughts, feelings and sensations that come and go.

What are Some of the Touted Psychological Benefits?

Few in-depth academic studies have been carried out into the effects of mindfulness on psychological health. Even fewer have approached the question critically with a willingness to consider adverse effects.  However, early indications from pilot studies are that mindfulness can be beneficial (more on this word shortly) for alleviating the symptoms of mild depression and anxiety.

And the Drawbacks?

Dr Bessel Van Der Kolk is one of the world’s leading authorities on PTSD (Post-Traumatic Stress Disorder) and CPTSD (Complex Post-Traumatic Stress Disorder, also known as Childhood Developmental Trauma.) He states that mindfulness does not work for these patients, as they cannot feel.

What he means with this statement is that for traumatised people, the capacity to feel emotions has become compromised. This could be because their childhood experiences prohibited them developing a healthy relationship with their emotional world. Alternatively, this inability to feel emotions derives from massive emotional trauma in adulthood that the person has not been able to process.  Traumatised people, in lieu of feeling, become overwhelmed and then dissociate. They split off their emotions from their experience in the ‘here-and-now’.

Clinically, early studies have shown that mindfulness, when not integrated into psychotherapy, can exacerbate symptoms in psychological illnesses such as Bipolar Disorder and in people with (C)PTSD. Further research strongly indicates that engaging in any practice of mindfulness can lead to a psychotic breakdown in patients with a history of psychotic episodes.  Furthermore, particularly for children living under abusive conditions, mindfulness can strip them of their coping strategies and leave them more traumatised. This is a consideration that schools using this technique would do well to hold in mind.

Impermanence, Suffering and Not Self

These three experiences are what mindfulness can bring us into contact with.  Located away from any spiritual context (Buddhism) and without adequate psychological holding, the silence and emptiness that so many crave through mindfulness can cause a psychological break in others.

What is Change?

In the world of psychotherapy, we look at two levels or orders of change – first and second order change.

First level change is about clients and patients accessing behaviours that enable them to stabilise emotionally. However, this level of change does nothing to resolve the underlying conflict and trauma that drives the lack of stability.  First order change is a critical step to assisting clients and patients in stopping or managing damaging behaviour. This is an important step and can literally be life-changing for people. It is not, however, the goal of psychotherapy, as it does not address the problem.  Managing symptoms is useful but it negates the critical fact that symptoms are already a way of the client/patient managing the problem. They are a form of self-coping, however malign they may seem.

Mindfulness works to bring about first order change but cannot address the underlying problem. Additionally, as traumatised people cannot feel, they may in fact be dissociated during their ‘practice.’ While they may appear calmer, they are unable to use their emotions and ego to make clear informed decisions for themselves.

Early studies have shown that first order change is only sustained as long as the practice is maintained. This kind of change is not structural on a psychological and emotional level.

Why do some Meditators Die Young?

This is a question (riddle) I was posed a few years ago when attending a conference snappily entitled ‘Neuroendocrinology for Psychotherapists’. What was lacking in the title was made up for in the content. A significant number of meditators with a traumatic past think they are meditating when they are, in fact, dissociating. Their emotional and endocrine systems are under immense stress. Long-term, this impacts on their immune system, leading to chronic illness and death.

Second Order Change, or Dealing with the Problem

Psychotherapy is about mind-body integration. It is about providing a therapeutic relationship with the traumatised, split-off, vacant parts of the client/patient which can be seen and related to by the psychotherapist.

Emotions are our compass.  They tell us, moment by moment, whether we want more or less of something; whether we feel safe or a situation is dangerous. Where clients lack the ability to navigate using their emotional compass, they first need to learn to reside in their body – to become embodied. This is achieved through an ongoing stable and in-depth relationship with a psychotherapist who can give shape and form to our trauma through words. Language development is a social process, and so is becoming embodied.

Second order change impacts on our emotions, structure and personality and assists in resolving the problem. Our traumas have happened to us in relationship (with our caregivers or ourselves) and can therefore only be resolved in relationship.

Some Final Thoughts

I work extensively with trauma and actively integrate the body into my work. This, however, means first and foremost to teach a client to remain in the ‘here-and-now’ so that they do not become overwhelmed and dissociated.  The first step in this is that any trauma work is processed with our eyes open, unlike most mindfulness practice.  After all, we cannot be in relationship if we cannot see the other person.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Further reading

How psychotherapy works

How to grow a mind

Remembering in order to forget

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