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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 epi-genetics – 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, change on the level of the personality. However, it is also about developing a 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.

Click here to listen to our podcast on this post.

Click here to download a PDF version of this post.

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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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