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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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What is a personality?

We all use the word ‘personality’ in everyday language. We might use it to describe how we experience another person (“She has a nice personality.”) We use it to describe elements of how a person may behave, in the case of personality traits.  And sometimes we use it interchangeably with the word ‘character’ to describe somebody. But what actually is a personality, and why does it matter – particularly when it comes to psychotherapy?

As the word ‘personality’ refers to the mind of a person, and as no human has ever seen a mind, in essence, the term is an abstraction. It’s an idea, a way of understanding how we tick, not a concrete object.

The dictionary suggests that a personality is a collection of characteristics that make up somebody’s character.  What, then, is character?  According to the dictionary, it is the mental and moral qualities distinctive to a particular individual.  And character is apparently synonymous with personality!  Confused yet?

OK, so this is how we mental health professionals generally understand personality. Personality is made up of two distinct categories – temperament and character (there’s that word again).

Temperament

Temperament is considered to be the traits that we inherit from our parents – either genetically, or through other biological means.  A person’s temperament may be a higher predisposition to anxiety, a genetic predisposition to addiction, or to being quick to anger. We are either born with our temperament. or it is developed in utero or shortly thereafter.

Character

Character, in contrast to temperament, is something that emerges at a slower rate as we grow, explore our world, relate to our caregiver and mature.  For example, we learn how to relate to others (particularly in close relationships) through our own attachment story with our primary carer. This way of relating takes place over a significant period of time.

Nature vs Nurture

We can substitute ‘temperament’ for the word ‘nature’ and ‘character’ for the word ‘nurture’ to keep things simple.  While most forward-thinking counsellors or psychotherapists will acknowledge that nature and nurture both play a significant role in defining our character, the jury remains out as to exactly where the boundary lies between the two. In fact, there may be no boundary at all!  For example, it is now increasingly accepted that what matters is not so much a genetic predisposition, but epigenetics – how our genes interact with our environment.  Therefore, just because someone has a genetic predisposition towards alcoholism, if they are raised in a loving home where they can develop a strong, solid sense of identity, it is unlikely they will become a full-blown alcoholic.

Why it matters

Therefore, personality matters as it is a word that encapsulates a large part of our identity and mind.  And in mental health, it is particularly important, as when clinicians treat clients or patients, the work will be significantly different depending on whether the presenting issue is an isolated issue, such as anxiety, or whether the problem relates more to the structure of a person’s personality. Just to confuse matters further, if a client presents with anxiety and has traits or a diagnosed personality disorder, the work will be lengthy and complex.

In Lay Terms

If who we are – how we experience ourselves and relate to others – is dysfunctional, damaging or harmful, then deep psychotherapy is required to restructure the personality. As personalities have taken a long time to form, it takes time for them to change. And because personalities are made up of temperament and character – nature and nurture – how much change is possible is something the therapy will uncover. The goal of depth psychotherapy is, of course, to change the level of the personality. However, it is also about developing kindness and compassion for one’s personal limitations and accepting these so we may lead a calmer, more fulfilled life.

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.

Click here to listen to our podcast on this post.

Click here to download a PDF version of this post.

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Love, commitment and desire in the age of choice

Throughout history, the institution of marriage and our understanding and expectations of committed relationships have shifted with the socio-political and economic tides. Where once marriage was primarily an economic arrangement to maintain patriarchy and secure lineage, by the end of the 19th century, new id

eas about romantic love were emerging. Whilst love was not yet understood as a precondition for marriage, it was now considered that marriage was a viable arrangement in which it might flourish.

The social and cultural revolution of the ’60s saw sex liberated from reproduction with the advent of the contraceptive pill. With the rise of feminism and the gay movement, sexuality was redefined as a property of the self and sexual expression as a fundamental human right.

The age of individualism has coincided with an erosion of the old structures and traditional institutions of extended family, community and religion. In the West today, the couple has become the central unit in our social organisation.

Disconnected from many traditional resources, the modern couple is thrown back upon itself to sustain the emotional connection and protections once provided by much larger social networks. A tall order, therapist and author Esther Perel suggests, to find all of this located in one person. We are freer then ever before and yet, paradoxically, also more alone.

Romantic love and desire is now the cornerstone of commitment in modern relationships. Definitions of commitment are largely organised around assumed notions of monogamy.  As Perel reminds us, where once monogamy meant one sexual partner for life, it is now understood as one person at a time. In modern marriage, the new monogamy principle contains an implicit commitment to no longer pursue sex with others.*

The demands on the modern couple are immense and complex. How do we reconcile a need for safety with a need for adventure, and can we find them both in one person? Can we desire, Perel asks, what we already have?

Consumer ideals of personal satisfaction, happiness and fulfilment drive and perpetuate the myth of “the one” perfect partner with whom we might find completion. Seductive as the notion is, it perhaps does more to fuel dissatisfaction and disappointment, as the statistics on divorce might reflect. Indeed, the consumer principle depends upon dissatisfaction, and inevitably and conveniently, peddles the cure. In the digital age, we are drowning in an ocean of relentless choice and the tantalising promise that opportunity and fulfilment could be just one swipe away. Our anxiety is rising in proportion. What impact does this have on modern relationships?

It is so often the case that couples come to therapy as slightly diminished versions of their true selves.  Indeed, relationships can feel so burdensome at times, so filled with worry and responsibility that there may be little space to connect to a sense of ones self at all. Loneliness in the presence of another abounds.

Couples therapy can offer a refuge for couples to pause and reflect, to consider and understand the cultural constraints, constructions and contexts of modern love. It can support people in an understanding of their personal emotional histories and how they inform and shape the people they have become. In our original family, we learn how to feel about our bodies, our gender and our sexuality. In couples therapy, we can explore the impact of then on now.

Whatever else love is, it is a story, and one we might be wiser for reminding ourselves that can be reviewed, re-visioned and retold. Perhaps it is time to cultivate new conversations about love and desire, to set them within an ecological narrative that acknowledges complexity and nuance. One in which we might learn more and fear less the natural tension that exists between the erotic and the domestic and the contradictory longings of modern relationships, such that we can remain alive to our partners, our selves, and our world.

* I speak here in very broad terms and acknowledge newly emerging paradigms in sexual identity and relating. To be explored in future blogs.

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor who is available at our Hove practice.

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Learning to be dependent in the pursuit of independence

When learning to be dependent is necessary

‘Dependence’ is a term that can carry negative connotations. To be ‘dependent’ might imply that we are unable to function alone and that we are unable to be the agent of our own life. It can also be interpreted as subscribing to outdated ideologies of male/female gender roles – the belief that women should be dependent, and men independent.

However, as is often the case in psychotherapy, learning to be dependent can be exactly what a person needs to do. As is always the case in psychotherapy, this dependence is with a view to enabling the client to become genuinely independent. In this sense, dependence is, therefore, a paradox.

Pseudo-independence and emotional neglect

I have previously written about the false sense of independence that some people have, which is born out of emotional neglect – a type of pseudo-independence. In a former blog, I referred to Boarding School Syndrome, in which the illusion of privilege masks emotional neglect and serious attachment disruption.

Pseudo-independence is an extreme reaction against dependence rather than true independence. If, as children, clients have been let down emotionally, or worse, neglected, they learn that nobody can be relied upon. It doesn’t matter whether this neglect came from an upbringing in the social care system or from within the gilded prestige of a boarding school education. These individuals might seem very capable and strong. However, this apparent strength is a mask to protect them from connection, relationships and dependence in the ordinary sense of the word.

Beneath the highly developed outer mask (in the case of neglect couched as privilege) lies a fragile interior. These clients crave connection. They want to be seen and validated for who they are and how they feel. But they find this terrifying. So, instead, they will often throw themselves into high-powered jobs, extreme hobbies or anaesthetise their inner voice with fine wine or expensive drugs.

In the case of someone who has experienced a more outwardly evident neglectful childhood (such as being raised in the social care system) the exterior shell of pseudo-independence is generally less polished and socially acceptable. Instead, their pseudo-independence may be shown through a turning away from society in the form of criminality and a “don’t mess with me” exterior.

How does learning to be dependent lead to healthy independence?

Well, psychotherapy is about learning to have a relationship with both our therapist and with ourselves. It is a process of giving voice to parts of ourselves that we have had to repress, split off or even kill off to survive. It is a relationship in which, week after week, the client learns to be seen and heard, to be accepted and validated. Little by little, if the client allows themselves to really feel seen and heard, and believes it, then it must mean that the other person in the room matters to them. Thus, it is through the psychotherapist mattering to the client that they can finally learn to rely on another emotionally.  Then, a collaboration can begin, with the psychotherapist coming alongside the client to help them make sense of their world.

In every psychotherapeutic relationship, the end is always in sight. It may be a very distant sense of an ending on the horizon, which may be many years away. Nonetheless, it is there. Therefore, the willingness of the client to allow the psychotherapist to matter to them, though this relationship will, one day, come to an end, is courageous. The process of becoming dependent and then becoming independent marks a shift in the relational quality of the client. If they can do this with a psychotherapist, maybe they can allow someone else to matter to them in an ordinary way.

Through learning ordinary dependence, which they never learned in the first place, clients can learn to navigate the ordinary ebb and flow of relationships. They will then discover that dependence on another is not terrifying, after all.  Even when we eventually have to say goodbye.

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.

Click here to download a PDF version of this post.

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Psychotherapy for Social Change

Like many of us, I have been emotionally moved and disturbed by recent political events. Concerns over the choice of US president, the rise of the far right in Europe and Brexit have been driving many of us towards social and political initiatives.

I always believed that our work as therapists could make a real difference in people’s lives and that we could change the world one person at a time. The work of raising awareness, reducing psychological pain, educating and facilitating growth, empowering and encouraging people to live more authentic lives – all have an impact not only in an individual’s life, but also in their relationship with others, beginning in their immediate family and spreading to their community and society as a whole.

However, in turbulent times like this, my work within the confines of the consulting room does not feel like enough. The demonstrations on 21st January moved and inspired me to become even more involved in social change. The personal is the political. We all exist in a social, political and historical context and bring this with us into the therapy room. Whatever my part is in society, I hope I can continue to contribute in whichever small way by joining forces with a larger collective of like-minded individuals. May we as a society move more towards values that support fairness, equality, and better relationships between people, nations and the environment.

I hope this isn’t a utopic hope for the world, which denies the shadow aspects of human beings. In the therapy room, as in life, the personal is the political and I will continue to hold the values dear to me both within and outside of these four walls.

Sam Jahara is a UKCP registered psychotherapist and relational transactional analyst.

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Four domains – maintaining wellbeing in turbulent times

Recent geopolitical events, notably the new American administration and the Brexit vote, can lead us to ever more uncertainty about the future. Facing this type of uncertainty can lead to anxiety about what the future may hold. Alternatively, we can experience despair and ultimately, depression about our powerlessness to affect what may happen in the future. While we may not be able to predict or have a big impact on what may be coming, we can do a lot to look after our wellbeing. This may enable us to face the future with a degree of equanimity.

 The concept of wellbeing is much spoken about, and can be viewed from a complex academic perspective. At the other end of the spectrum, it can become a rather glib, throwaway term. However, we can look after our own personal wellbeing by paying attention to four important domains in our lives. Putting a bit of effort into each can help us to feel better in ourselves and maintain a positive worldview.

The Physical Domain

Looking after our physical health is a key part of wellbeing. For some, this is a part of everyday life. Going to the gym, running or playing team sports are great ways to increase physical fitness, and all enable us to feel more rooted in our body. However, this level of physical effort is not for everyone. We can do a lot to increase our physical health by simply walking a little more than we might do normally. This is promoted actively by the NHS, which outlines the positive physical and emotional benefits of being more active each day. 

It may seem daunting to reach the desired goal of 10,000 steps per day. However, merely increasing how much we walk each day takes us a long way towards increasing our physical health and fitness. For example, we might choose a longer route when we have to walk, stroll around the block after dinner, or walk up stairs rather than using the lift.

 Of course, increasing our physical activity is only part of the matter. We also need to consider our diet and aim to eat as healthily as possible, with plenty of fresh fruit and vegetables.

The Emotional Domain

Looking after our emotional health is also very important in improving our overall wellbeing. This can be as easy has having open and honest conversations with those who are close to us, which is a great way to deepen our relationships. Alternatively, writing a daily journal to explore our deepest thoughts and feelings can help us understand ourselves better and make sense of our inner world. Seeking professional help from a therapist is also an important step if our emotional world becomes overwhelming, or if we are unable to make sense of what is going on for us.

The Intellectual Domain

Our intellectual health is another very important area. It can often be overlooked once we have finished with formal education. However, keeping our minds sharp and alert to new ideas can be very inspiring and satisfying. It also helps us to approach the world from a fresh perspective. We can look after our intellectual health by taking a course (there are many free online courses available), reading an inspiring book that gives us new knowledge, or even by watching some of the short, powerful talks we can find on websites such as TED. 

The Spiritual Domain

The spiritual domain can often be overlooked, but can be hugely important to our overall wellbeing. For those who are religious, this can consist of spending a little more time in contemplation or prayer. For those who are not religious, spending a few moments each day in quiet meditation or practicing mindfulness (or even taking one of the many available mindfulness courses) can be very beneficial and can help to attain greater inner peace and an enhanced perspective on the world. If none of these appeal, you could simply spend a few moments each day noticing the beauty of the natural world around us.

Actively working for a short while in each of these domains every week can do a great deal to improve physical and mental energy levels. It can also give a sense of control of one thing we can have a huge impact on… our own wellbeing.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy.

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Mutual Disappointment – Surviving a Long Term Relationship

couple-1751250_1280At a recent clinical supervision session in Lewes, my supervisor and I were discussing the realities of being in a long-term relationship. By long-term, we were thinking about decades, rather than months or years, and in this context, we were together considering what individuals must accept about a long-term relationship and thus about themselves.

It is a relatively recent phenomenon in social and human development that we pair-bond for reasons of love (rather than status, wealth or lineage) and thanks to modern medicine and increased living standards, we live much longer than our recent ancestors. The former brings great expectations around what our relationship should offer us; the latter means that long-term relationships can last for many decades.

In working with couples, I often invite them to think about the purpose of their relationship. This may not sound romantic and idealistic. However, every human needs a purpose (generally multiple purposes) and every relationship requires a mutually held sense of purpose to bind the couple together. And with longevity and changes to social structure now meaning that the sole purpose has ceased to be to raise children, the objective of a romantic relationship is likely to change throughout the time the couple spend together. I will write more about the purpose of a relationship in the future. However, for now, let us return to the cheery topic of mutual disappointment.

There comes a point in most relationships where there is a realisation that the person we have chosen, the person we lusted after and loved – were willing to change the direction of our life for –  is simply not who we thought they were going to be. I don’t mean that we are struck, as is so often the case, with the shattering of a delusion when we see our idealised partner do something human for the first time; we must all go through that shift where lust wanes, and we accept our partner is a fellow human with his or her faults. No, mutual disappointment is something deeper. Perhaps it strikes when we realise on a more profound level that the person we picked, with whom we built a life and chose to have children, has not delivered us the life we had imagined. Thus, mutual disappointment is not about discovering that our newly acquired lover snores, or leaves the cap off the toothpaste. It is a reflection of our disappointment and mourning of how our imagined shared life with our partner simply is not the reality.

It all sounds terribly negative. However, I would suggest that mutual disappointment in a relationship need not necessarily lead to rupture and conflict, as it is, in fact, less about our partner and more about ourselves. We must come to terms with the reality of our lives and accept that many of our youthful dreams for ourselves, and the partner who would perhaps rescue us from mundanity, cannot be fulfilled. Nor should they.

We are all bombarded by celebrity lifestyles on a daily basis. Programmes abound promising instant stardom, wealth and fame, which judging by viewer ratings, have an almost manic appeal as vehicles that offer us a chance of being rescued from our lives, and thus death. But the vast majority of us slowly, often unconsciously, let go of many of the unrealistic dreams we once held for ourselves that protected us against the harshness of life. With that, have to accept our partners as fellow humans who have disappointed us, whom we have disappointed, and who themselves are disappointed with who they turned out to be.

Framed like this, holding mutual disappointment in a relationship, making sense of it and mourning it potentially offers an opportunity for a deepening of the reality of what the relationship actually is – a mirror through which to experience ourselves and a system in which we can be understood. That, or we can have a ‘mid-life crisis’, buy a Porsche, divorce our partner and keep on running from the inevitable –  how the passage of time and the knowledge of our own mortality brings with it disappointment of what could have been, but what was not.

If you would like support in navigating the complexities of your relationship in our modern world, please contact us to arrange a consultation with one of our Couple Psychotherapists in either Hove or Lewes.

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.

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What makes a good leader?

The result of the US presidential election has created shockwaves around the world. The USA is taking its first steps into an uncertain future, with the reverberations of one of history’s most brutal presidential campaigns still echoing.    At this time, it seems apposite to reflect on the qualities of a strong leader.

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Most people would agree that self-awareness is a vital element of good leadership. In order to effectively lead a team, group, organisation (or indeed, a country) you need to have a conscious understanding of your own character, desires and motives.

It is vital for a good leader to be able to take a step back and see the bigger picture. They should be able to examine their own internal responses, to have a clear vision and find a way of delivering something to others – a strategy, an idea, a plan – that has been carefully thought through.

 

The ability to reflect on emotional responses is crucially important – not to just blindly react to a feeling, which might lead to lashing out or sinking into despair, but to be able to identify it and to be curious about where it originates and what it might be telling you.

A strong leader will be resilient and robust enough to see challenges as opportunities for growth and to adopt a responsive, rather than a reactive style. Someone who has developed their self-knowledge does not become triggered easily or allows perceived slights to their ego to distract them from their objectives.

The ability to communicate effectively is also highly important. An effective leader should be able to listen attentively and empathise with the points of views of others, especially if these differ from their own. It is important for a leader to bring diverse people together to obtain a variety of different viewpoints. However, this does not mean that leaders should unquestioningly accept ideas – the ability to effectively challenge and provide constructive feedback is hugely important and will earn respect.

A strong leader should be firm but fair, and should set and hold clear boundaries, inspiring trust and confidence in others. This can be a difficult tightrope to walk – too harsh, and you alienate others. Too soft, and you are not taken seriously.

Of course, this process of self-development will never be entirely finished, but the ability to dispassionately examine your own behaviour and feelings is key to developing your capacity for self-awareness.

Unfortunately, as we all know, sometimes, the people that are chosen for leadership roles are not necessarily those who encompass these ideal qualities. Many people have stories of workplace bosses whose unreasonable behaviour makes work difficult for everyone they encounter. It remains to be seen how effective the new President of the United States will be in encompassing these qualities.

However, we can all work towards adopting these characteristics in our daily lives. After all, we all control our own behaviour and reactions to events in the world. You are in charge of all the various physical and mental components that make up the whole of ‘you’, whatever that may be. While matters of world leadership may be outside our control, we can start with ourselves, today.

Kate Connolly and Sam Jahara

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Being in therapy is the most normal thing

While stigma around mental health issues remains an issue, there is an increasing willingness to talk about touching-1mental health issues both in the media and in society as a whole. Even if much of that talk centres around the woefully inadequate state provisions for mental health support and treatment, to some extent, the debate is being had. This can only be a good thing. For counselling and psychotherapy, the knock-on effect is that more people are willing to enter into therapy, prompted often by some crisis in their inner or outer world. Again, this is a good thing. However, to limit thinking about counselling and specifically therapy to a support or treatment for mental health problems or as something that is to be accessed only during times of crises misses much of the point.

Recently, a client of mine told me about a trip to the cinema at the weekend. As he was sitting in his comfy chair enjoying the prelude to the main feature, the screen flashed with three words: ‘Amazing. Awesome. Astounding.’ What transpired next was not God revealing himself/herself from the heavens (or insert whatever experience that would, quite literally, bowl you over with awe.) What came next was a preview of the films being released this summer. My client relayed this story, remarking on how nowadays everything seems to have to be somehow awe-inspiring. It no longer seems to be enough to simply state, albeit with a small degree of marketing spin, ‘Here are our new releases this summer, which we really think you will enjoy.’

This brings me back to psychotherapy and how being in therapy is the most normal thing in the world when the world seems to propel us to feeling and expecting a life of extremes. Therapy is not extreme. It is a weekly dialogue, often on the same day and time, that continues. It is a space and within that, a relationship where we can learn to be ‘normal,’ if normal means becoming curious about the subtle nuances of experience, understanding why we may react a certain way and how our past subtly but continuously influences our present until we shine the light of consciousness upon it.  And it is about how a relationship develops over time without needing the extreme highs and lows of excitement and chaos to make it meaningful; the relationship to our psychotherapist and to ourselves.

So, paradoxically, if being in therapy is about being normal and finding a way to be normal in the world outside of therapy, this is then perhaps exactly what makes it if not abnormal, then quite unique in a world where nothing ever seems enough. Being in therapy during a crisis can be very holding, supportive and important, but it is not really psychotherapy. Psychotherapy is the very normal process of being in a contained, meaningful, ongoing dialogue with another human being through whom we can get to know ourselves and recognise that we are simply normal after all, and that that is a good thing.

If you would like to explore the ‘normalness’ of an ongoing therapeutic dialogue with one of us in either Hove or Lewes, please get in touch.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice.

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Who to tell that you’re in therapy? And why?

Alice Ayres

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Sitting on the Tube with a relatively new friend, I suddenly found myself feeling awkward in the middle of an anecdote. “And on a Thursday evening, I…I…”

I cast a sideways glance at him. How would he react? Could I trust him not to judge me negatively? In the heat of the moment, I came up with a compromise.

“I see a therapist. For, like, general life direction stuff, you know?”

I waved an airy hand. He nodded understandingly. I sat back in my seat and breathed a sigh of relief, feeling rather pleased with myself. Not only had I negotiated the tricky subject, I had portrayed myself as a forward-thinking career woman. I was going places and seeking direction! I certainly wasn’t sitting at home in my dressing gown every Friday night eating Maltesers and talking to my cat. I don’t believe my friend was taken in for one second, but there you go. In my mind, I got away with it.

Who can you trust?

If you’re going through a tough time and seeking help for it, it can be hard to know who in your life you can trust to talk about it. Despite the excellent work being done by several charities to reduce stigma, to me, personally, it still feels like a risk. That’s one reason I write this blog under a pseudonym, after all, although I’m experimenting with being more open. Encouragingly, I haven’t yet had a single negative reaction (although neither has anyone said “Anxiety and depression? You? But you’re always so positive and upbeat!” Perhaps I look naturally morose.)

It’s a hugely personal decision, and everyone will be different. For example, despite (or perhaps because of) my strong family history of mental illness, I would rather do almost anything than talk to my family about it. Work is the other big issue, and here’s another great reason to write under a pseudonym.

To disclose or not to disclose?

I have never willingly disclosed any form of mental health difficulties I have experienced to any employer I have had, even though doing so might have meant that I could have accessed additional support. I simply don’t trust them not to treat me less favourably, despite legislation and everything else that might protect me. I am envious of people who can be open with their employers, but for me, it has never felt like an option.

Fortunately, my work has rarely been affected, although I’ve had a number of close shaves. At the start of this year, when things were really bad for me, I went through a period of waking up every single night at 3am. When it was time to get up and go to work, I experienced severe stomach cramps and crippling headaches, which never troubled me at the weekends.

My boss never spoke to me about my sickness absence record, although I remember one time when I was sitting in her office, pale and hollow-eyed from lack of sleep, staring at her, hoping she would ask me if I was OK. But she never did, and I staggered back to my desk like a dutiful zombie to fight my way through another day. I could make tea, crack jokes and just about do my job properly, but I felt numb inside. I remember thinking, “Why can’t any of these people tell how bad I feel?” But of course, depression is invisible. Nobody really knows unless you tell them, but having these conversations can be incredibly difficult.

In an ideal world, everyone would be able to be open about experiencing difficulties with mental health. It’s getting better, but we’re not there just yet. In the meantime, though, there are people who can be trusted. If all else fails, there are always Maltesers, and my cat.

The writer of this blog is not a current or past client of any therapist presently or formerly practising at Brighton & Hove Psychotherapy. Alice Ayres is a pseudonym.

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On Brexit and the Psychological Defence of Splitting

On Friday, everybody in the UK awoke to a new world. The dust has yet to settle and the repercussions of the vote to be enacted; we live in interesting times.GBP-Brexit (1)

Whilst I have a view on whether we should or should not leave the EU, this blog is not about that. It is about how as a population we have literally been split down the middle and how this process – splitting – can be seen as a psychic defence process of the same namesake. If it does, what does it say about all of us?

Splitting is the technical term for ‘black and white’ or ‘all or nothing’ thinking. We can all be guilty of this at certain times – particularly when put under pressure and feeling fear (more about this shortly.)

Splitting is therefore an inability of a person to mentally hold the positive and negative qualities of self and others: it a failure to mentalise – to hold an integrated self and other in mind. It is described as a primitive defence (primitive referring to a defence we learn early in life) and stems (or so the theory goes) from the infant’s inability to see both the satisfying aspects and frustrating aspects of their caregiver’s attention to them as being from one and the same person. The infant therefore ‘splits’ the parent (or object) into a ‘good Mummy’ and a ‘bad Mummy’.

How does splitting work in relationship? Well with relationship to others, it creates enormous instability, as the other is experienced as either good or bad, loving or hating, black or white, British or foreign. And this split is experienced in the relationship to self too, so that undesirable, unthinkable or unacceptable aspects of the self are ‘split off’ and projected onto others, further fuelling the relational instability. Interestingly, splitting is one of the defences most associated with Borderline Personality Disorder.

The campaign for the EU or for the UK – as it was presented to us – has left the population with little ability to hold their splits by virtue of it culminating in base choice of ‘Remain’ or ‘Leave’. Add to the mix the fear and hate-based rhetoric by politicians and the media, and it becomes a challenge for any one of us to not become aroused (impassioned) about our positions by denigrating the views of the other camp.

I would suggest that the reality for all of us is that how we feel about the EU and Britain’s identity and role in Europe – and therefore by extension our own role and identity – is conflicted. Again, whilst remaining unbiased in my views, factual evidence would suggest that being a member of the EU has brought benefits and challenges and idea of leaving promised, at least in phantasy, much the same (again, phantasy as much of what was promised stirred unconscious desires of identity and safety without us as yet having an evidence that this will be the outcome).

So now, in the aftermath of the vote, where the political establishment is in turmoil and the media in overdrive, how do we reflect and hold our splits? Perhaps we can recognise that in every Remain voter, there is a part that would vote Leave, and that in every Leave voter, a part that would vote Remain. To accept this means accepting that ‘the other’ is not inherently evil, stupid, or self-centred, but has felt obliged to split off their conflict and ambivalence.

Being honest with ourselves about our own splits and how fear, stress and the political system forced a split is the first step, the second is perhaps in noticing that nothing has as yet changed. We are all feeling stress and worry, which raises our arousal levels and drives us to seek a sense of knowing and security – this is human nature. But pausing, breathing, switching off the constant manic newsfeeds and slowing down will create significantly more of a felt sense of safety and security than continuing to allow the chaos to create psychic splits in us that cause us to react rather than act.

For some tips and guidance on developing a daily practice that can help bring about a felt sense of stability and calm, please see our blog on mindfulness.

Mark Vahrmeyer is a UKCP Registered Psychotherapist working in private practice and palliative care.

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