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How much time should I devote to self care?

In this blog I explore the concept of self care – what it means and how much time you need to consciously devote to active self care per day: it is probably less than you think!

What do I mean by self care?

In basic terms, self care refers to ‘looking after oneself’. Some people really struggle with the basics of this and once external factors such as poverty have been eliminated, good basic self care correlates to good mental health.

People struggling with depression can find it really difficult to undertake tasks such as getting out of bed in the morning or getting themselves to work.

People with anxiety can struggle with focusing, controlling their thoughts and feelings and in holding onto a thinking mind.

And people who are dealing with eating disorders can struggle to eat for healthy reasons using food to suppress difficult feelings (obesity) or retain an illusion of control over the body (anorexia).

And people who struggle with bulimia can struggle to ingest ‘bite size chunks of life’, instead feeling flooded by others and eventually having to vomit it al out.

These are all real and serious mental health problems and psychotherapy is there to work through what set up these coping patterns and to bit-by-bit help people to better manage their emotions.

The 50 minute hour

Most psychotherapy session are of the duration of what we in the trade call ‘a psychotherapy hour’, which is in fact 50 minutes.

Good psychotherapists stick to the hour and do not overrun as this is unhelpful for the client – it demonstrates poor boundaries and a lack of self care on the part of the therapist.

Over time, clients must learn to keep the therapy and their therapist ‘alive’ between sessions; they must learn to bridge the gap from one session to the next. This means internalising their psychotherapist and thereby holding themselves in mind outside of the therapy room in the way their therapist does. This is where the shift happens from dealing with the presenting crisis (depression, anxiety etc.) to more sophisticated methods of self care.

Psychotherapy is not enough, but it is essential

It is not enough to simply attend therapy and then expect miracles to happen- they won’t.

By bridging the gap between sessions, clients hold themselves in mind and can become curious about what else would be helpful to them in living calmer, more fulfilling lives.

At first bad habits may get dropped – staying up late on work nights, drinking a glass of wine or two every evening, eating junk food – and then a shift can occur to an active engagement with good habits.

These are in addition to living a calm and ordinary life and are constitute self care that is aimed at good mental and emotional health (arguably good physical health too).

Examples may include yoga, meditation, dancing, singing, walking, swimming, meeting friends for connected conversation and so on. The list is virtually endless providing whatever you engage in is mindful (you are present with what you are doing) and leads to sustainable and enduring good feelings afterwards.

Can you spare 4% of your day?

Imagine if all it really took was 4% of your day to make an enduring and significant difference to how you felt and felt about yourself? Well, this is arguably a good figure (and achievable figure) to aim for and guess what? It is only one hour of your day!

So, on days when you are not in therapy, how about spending one hour actively self caring by mindfully engaging with an activity (or activities) that makes you feel alive, positive, brings you into you body and sets you up for the day?

Dedicating one hour per day to self care is a good way of bridging the gap between sessions and in devoting the weekly therapy hour to active self care on the other six.

 

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

 

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

 

Further reading by Mark Vahrmeyer

Why is Netflix’s Squid Game so popular?

Space: The Final Frontier of Manic Defence

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

What is the purpose of intimate relationships?

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Enhancing the Positive Self

Why is it that we find it so difficult to identify the positives in ourselves and so easy to see the negatives?

As human beings we seem to be programmed to be able to identify our failings, e.g. what we’re no good at, what we haven’t done or what didn’t go well. Or it might be that you can’t stop thinking about the one negative comment that was made about something you did at work or the one criticism that you received amongst all the compliments. It maybe that you find it really difficult to accept compliments, that you dismiss them, play them down or bat them back instead of fully accepting them.

We can have a bias to notice our faults rather than our qualities. This can stem from being taught in our early experiences to focus on our mistakes and wrong doings and being told as a child to do better.

We may also have encountered disapproval or ridicule if we have shown appreciation of our own successes. Consequently we may have stopped valuing our achievements and come to believe that anything we do well is luck.
We can find it difficult to think well of ourselves. To think well of ourselves or to say positive statements about ourselves can feel uncomfortable, risky or just wrong. This may stem from being told to not be big headed, to not boast or blow your own trumpet and not to get to big for your boots.

Thinking negatively of ourselves can lead to low self esteem, depression and anxiety. If we hold negative beliefs about ourselves we tend to screen for evidence from our experience that these beliefs are true. This leads to negative thoughts, in particular self critical thoughts or anxious predictions, which then corroborates and strengthens the belief.

To change this negative view of ourselves we need to focus more on all the positive aspects of ourselves. A useful exercise to shift your focus to a more positive view of yourself is to write a list of all the positive aspects of yourself, to consider all your achievements, skills, qualities, strengths, and good characteristics of yourself.

We rarely pay attention to all the positive things we do, our qualities, positive outcomes or positive comments from others. The fact that we don’t do this can make this a challenging exercise to do. It maybe that you only come up with a few to start with and that’s ok. It doesn’t mean that you don’t have any qualities or strengths, it means you are out of the habit of noticing them.

It can be useful to ask for the help of a close friend or family member, someone you know who would be supportive and may have a different perspective of you than you do of yourself. Be aware you may still get into negative self evaluations or discount the positives as being small or not significant. You wouldn’t do this with the negatives so don’t with the positives! Also remember you don’t have to do these positive things 100% of the time, that wouldn’t be possible.

To build on this it can be useful to keep a positive data log in which you recognise examples of your positive attributes on a daily basis, i.e. at the end of each day write down examples from your day that illustrate certain positive qualities you have. For example: listened to a work colleague – considerate and a good listener, did the hoovering – being house proud, played with the children – fun to be with. By keeping a daily record you will not only be acknowledging your positive qualities as things you did in the past, but also acknowledging them as things you do everyday.

Increasing your awareness of your positive qualities on a regular basis can have a positive impact on how you feel about yourself. It can help you to view yourself more kindly, to appreciate and value yourself. This in turn can help to improve self esteem and self worth.

Melanie Fennell (2009) writes on Overcoming Low Self Esteem and suggests the following questions to help in identifying your good points:

What do you like about yourself, however small and fleeting?
What characteristics do you have that are positive?
What are some of your achievements, however small?
What are some challenges you have overcome?
What are some skills or talents that you have, however modest?
What do others say they like about you?
What are some attributes you like in others that you also share?
What aspects of yourself would you appreciate if they were aspects of another person?
How might someone who cares about you describe you?
What bad qualities do I not have?

 

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults.  Rebecca is available at our Brighton and Hove Practice.

 

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

 

Further reading by Rebecca Mead –

Is that a fact or an opinion?

As we come out of lockdown, will a number of us be feeling socially anxious?

New Year’s Resolutions

Making Changes

Interpersonal Therapy (IPT) explained

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Save? Edit? Delete?

In 2002 an Australian journalist coined the term ‘selfie’. June 2007 saw the launch of iPhone and by 2013 the word ‘selfie’ was chosen by the Oxford English Dictionary as the ‘Word Of The Year’. Never as individuals have we been more likely to have a picture taken as we are now. An awareness of how we look, other than what we see in the mirror, is part of our lived experience.

Technology allows us to edit, manipulate or delete images, as we choose. What we don’t like can be edited out, what we can’t bear can simply be deleted. We can edit our selves to a degree that subverts reality.

The selfie could be seen as an expression of a narcissistic, self absorbed, society in which the individual and their image becomes overly important. The selfie could also be a reaction against societal expectations and ideals and a means of expressing individuality. Through a picture one can imagine themselves to be all the things that they might feel that they are, or aren’t.

Which side of the debate you find yourself on we can’t avoid this idea that there is a good, idealized image of ourselves which is sought, and a bad, devalued, version which can end up deleted.

When we speak of idealization and devaluation we’re looking at ways of coping with unbearable feelings. Taking, editing and sharing the perfect picture projects our idealized sense of who we are to the world. It helps us to defend against those feelings which come when confronted by an image that shows a version of ourselves that we find hard to see.

This ‘split’ into either good or bad, idealized and devalued as seen through the relationship to pictures may be revealing unconscious feelings around our sense of who we are. Can we bear to hold onto the images of oneself as ‘less than perfect’?

Thinking about this spilt therapeutically it invites an exploration as to what the client makes of their rejection of some and celebration of other images. Can we help them to recognise these splits and to consider what they might be an expression of? The aim of this is to help the individual to integrate both the idealized and the devalued parts of themselves into a coherent sense of self.

The selfie as a metaphor for how we feel about ourselves could feel like a simplistic idea, but if we can’t hold on to the images that aren’t ideal, are we showing more than we think?

 

David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove and Lewes.

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

 

Further reading by David Work –

Football, psychotherapy and engaging with male clients

When Home and Work merge

 

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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

Face to Face and Online Therapy Help Available Now

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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

Face to Face and Online Therapy Help Available Now

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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.

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 with us by telephone or email. Online therapy is available.

 

Face to Face and Online Therapy Help Available Now

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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

Face to Face and Online Therapy Help Available Now

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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.

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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.

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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

At 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.

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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