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The Psychology of Mindful Eating

Mindful eating is based on the concept of mindfulness which in essence means engaging all your senses and eating without distraction. The aim is to be more present and aware during food preparation and mealtimes to reduce overeating, eating too quickly and ‘comfort eating’ (eating to deal with difficult or unwanted emotions).

Although this sounds like quite a simple and achievable task, for many of us it is surprisingly difficult to eat mindfully due to several factors:

– We live in a fast-paced society surrounded by fast-food outlets and take aways. Everywhere you look there is pre-prepared, pre-packaged food to buy pushed by advertising designed to appeal to the part of us that looks for pleasure to get away from any discomfort. Over the last decades we as a society have become more out of touch with where our food comes from and how it is prepared.

– Slowing down any task or activity makes us more aware of how much anxiety and stress we carry and speeding up activities is a strategy that many of us employ to run away from difficult feelings. Therefore, the prospect of slowing down goes against our “fight or flight” responses designed to get away from internal stress or perceived danger. Eating slowly requires a state of relaxation and calm, which is also called “rest and digest”.

– Food and nourishment is a psychological and emotional process rooted in very early infancy and childhood. How we were fed and nourished by our primary care givers will impact how we nourish and feed ourselves in later life. In addition to this, our parent’s relationship with food is an important component, as children model themselves in the adults around them. Our early experiences in the family home shape who we are in many ways, and this applies to food and eating as well.

– Peer pressure and social media, on young people (especially young girls) to have certain body shape and size plays a big role in our relationship with food. Food becomes linked with gaining weight and gaining weight is in turn linked with being unlovable. This cycle works against encouraging children and young people to develop a healthy relationship with food and eating.

Mindful eating requires a whole rethink of our relationship with food and eating involving the whole process from start to finish, which includes where we buy and source our food from, food storage and preparation, how we organise our mealtimes and how much time we dedicate to them.

Psychologically, this is about affect regulation, or a healthy capacity to regulate emotions. In practice it means we can manage our feelings of stress and anxiety by not resorting to overeating or over restricting. Food is designed to nourish and nurture. It is a pleasurable but also functional activity. Our bodies need good healthy food to function well. This includes the process of absorbing and digesting the nutrients we consume. Mealtimes should be stress-free and we should not eat when stressed or our digestion will be compromised.

To conclude: mindful eating requires slowing down and paying attention to our food and eating as much as possible in a relaxed, stress-free environment. Eating should be an enjoyable activity designed to nourish our bodies rather than a mechanism to avoid or manage difficult feelings. Our relationship with food is rooted in early childhood and
infancy, but it is possible to revert bad habits and to tackle psychological issues in therapy, which impacts our negative relationship with food and eating. Restricting access to social media and external pressures to look and eat a certain way will help us focus more on ourselves and our needs, rather than on the perceived demands and expectations of others.

 

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

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

 

Further reading –

Defining Happiness

What are the benefits of counselling and psychotherapy?

Why is mental health important?

What makes us choose our career paths?

Antidotes to coercive, controlling and narcissistic behaviour

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Defining Happiness

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

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

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

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

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

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

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

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

Is happiness a choice? 

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

 

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

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

 

Further reading –

What are the benefits of counselling and psychotherapy?

Why is mental health important?

What makes us choose our career paths?

Antidotes to coercive, controlling and narcissistic behaviour

An in-depth approach to leadership coaching

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I’m the Problem – It’s Me!

Are you curious to know the most popular song in the world right now? Of course, you might not have been able to miss it.

This autumn, a musical milestone was achieved by Taylor Swift, who has become the first musician to claim all ten top slots of the US Billboard Top 100. Of her ten conquering songs the one that’s found most popularity with streamers is Anti-Hero, with its choral refrain, ‘I’m the problem, it’s me’.

And this phrase has been reported as being rapidly taken up in social media trends almost as an anthem for our times. The promotional video accompanying the song depicts multiple versions of Swift portraying a character riven by internal conflict, struggling to relate to others and self-medicating with alcohol to cope.

Clearly, apart from its evident musical catchiness, something in the central message of this song is resonating with fans of an artist whose online followers number more than 100 million, mostly young, people. Is it that the singer’s conflation of her very identity with her problem seems to fit their own experience?

So what’s ‘the problem’?

The word ‘problem’ has been defined as ‘a situation, person, or thing that needs attention and needs to be dealt with or solved’. Just to speak the word involves compressing the lips twice to form the first syllable with its explosive ‘p’ and ‘b’ in a verbal stumble, almost expressive of something being expelled. It’s derived from the Greek ‘proballein’, a combination of ‘pro’ meaning ‘before’ and ‘ballein’ meaning ‘to throw’. And perhaps there is an ancient wisdom in the root of this word in its suggestion that we experience the need to ‘throw’ a perceived problem out of us.

Working with ‘the problem’ in therapy

This has recalled me to thinking about the uses of therapy as a means for practitioner and client to work purposefully together in addressing the recurrent phenomena of ‘the problem’.

Narrative therapy offers a framework for supporting families and individuals who present accounts of their life experience as ‘problem saturated’. Where someone has concluded they are the problem, in locating the problem inwardly in this way, they have formed what is called a ‘dominant story’ about themselves, one that could become powerfully restricting in narrowing possibilities for them to uncover other meanings or perspectives on their lives. It’s argued that this way of seeing only supports and sustains the presenting problem.

Linked with the original meaning of the word as ‘throwing’ something away from us, narrative therapy invites us to separate the person from the problem. Therapist and client engage in a collaborative search for an ‘alternative story’ that will challenge a person’s dominant story through techniques of ‘problem externalisation’. This starts with the contention that ‘the problem is the problem’ and focuses instead on the relationship between the person and the problem.

In therapeutic practice, fruitful ways of externalising any problem often involve using language creatively in naming it and even placing the problem where it may be visualised in the room and personified in its own right as an entity with its own curious qualities. So depending on the nature of the difficulty, practitioner and client might be working together to discover more about what the client them self names as, for example, the ‘Anxiety Wave’, the ‘Constant Conflict’ or even, in the case of Taylor Swift’s Anti-Hero, the ‘Monster On The Hill’.

This is an approach that honours the deep distress experienced by many individuals for whom a problem has become an inextricable and debilitating part of themselves. Through supporting them to separate from their problem, alternative stories can emerge that surface previously unacknowledged – or discounted – personal skills and competencies, revealing new capacities for agency.

Arguably Taylor’s song has done a service for those who most identify with her protagonist’s dominant story of problem internalisation. I hope it leads them to ways in which they might find their own alternative stories to effect preferred positive change in their own lives.

 

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

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

 

Further reading by Chris Horton – 

Making sense of our multiple selves

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

How are you?

Out of Sight, Out of Mind

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How to Minimise Christmas Stress if you’re Hosting

Christmas can be an emotionally challenging and difficult time for many of us. There is such expectation on how Christmas ‘should’ be, yet like the weather, it often fails to deliver on the ‘winter wonderland’ scenes on
the TV adverts. For so many of us our family experience often falls far short of the loving idyllic family reunions depicted in those same snowy adverts. And if you are hosting, this can bring with it an added pressure to deliver the ‘perfect Christmas’.

There is lots of advice available on how best to organise yourself practically in advance in the big day, such as food prep hacks, however, I wonder if there is another way of not only coping but getting something
from the day for yourself?

Think about your own needs first

An example that I often use in clinical practice when illustrating to patients how it is vital that they think of their own needs, is the pre-flight safety briefing that happens before a plane takes off.

Anyone who has flown has sat through at least one of these and there is a particular point in the briefing where the cabin crew explain what you should do if the cabin loses pressure, the oxygen masks drop down and
you are travelling with a dependent. The correct approach is to attend to your own mask first and then your dependent, however, it is surprising how many people think that they should help their dependent fit their
mask first, before attending to their own. Why is it this way around? Because if you try and help your dependent first and have not tended to your own needs, there will be two people in distress rather than one.
And yet for so many of us the inclination is to ignore our own needs and attend to those of others.

Applying the same logic to Christmas, before deciding whom to invite and having any conversations with family and friends about the day itself, first think about your own wants and needs. What are your physical limitations and needs? What can you and can’t you do? How many people can you host without feeling overwhelmed? Who’s company do you enjoy and who is draining? What do you want to get from the day?

The next step is to think about what is negotiable and what is a firm boundary. For example, it may be that you are willing to cater for an additional number of people if you have help or support from others with
cooking. Or, it may be that you are willing to tolerate the presence of someone you find contentious, if another member of the family assures you that they will help you manage that person. However, a firm boundary may be that you have a certain time by when you request everybody leaves (stated in advance).

Wants vs needs

The nature of Christmas combined with the pressure to host, can often mean that any consideration of what you may want from the day gets lost and the focus shifts to being one of ‘surviving the day’. What if it
does not have to be like this? What if you could take some time to calmly consider how you would like not only to ‘host’ the day and cater for everybody, but to play an active role in creating the day that you would like? In other words, what if you were to value your own needs as much as you value everybody else’s?

Hosting does not mean sacrificing yourself

Consider how you do not need to sacrifice yourself in order to host an event for others. People who are worth being in relationship with (and therefore arguably worth spending Christmas with), should be people who are interested in your well-being and needs and will therefore be open to hearing about not only what you can and can’t offer on the day, but also what you would like from it. If they aren’t, then perhaps question whether they are really wanting to celebrate with you as a person, or are simply making use of what you can provide.

Support through relationship

Putting your needs into the mix can feel daunting if it is not something that you are used to doing. And it is generally only possible if we can rely on having an ally, or allies, by our side who are encouraging – this is
often our partner or a close friend. If you are in a relationship, talk to your partner about your needs and wants of Christmas well before the day arrives.  Explain to them how you wish to approach hosting Christmas and risk asking for support – emotional as well as practical. This is something you can do with a friend, or friends too.

It can also be really helpful to agree up front how you will ask for support on the actual day and how you would like your partner or friend(s) to support you. Examples may be anything from starting the day together and connecting, through to specific practical requests. You can demonstrate support for each other throughout the day through small reassuring gestures such as visually checking in with one another or making physical contact.

Reality Testing

Christmas is only a day and that is really worth bearing that in mind. However the day goes, the world will keep on turning and in all likelihood, the relationships that matter will still be there for you. The expectations we feel in relation to Christmas are largely in our own head and can therefore be challenged.  By pausing and accepting that there is no such thing as a ‘fairy-tale Christmas’ we can gain a little space to see it for what it is. It does not have to be perfect nor is it likely to be. Is the goal a ‘picture perfect’ Christmas, or one in which you feel like you are connecting with loved ones and friends?

The past is not the present

For many, memories of past Christmases are difficult and they can reappear like ghosts. However, these ghosts need not dominate your experience in the here-and-now. Accept that it is a difficult time for you and know that it is for many others too, be compassionate with the feelings that the season evokes and remember it is only a day. Sometimes we feel strong emotions on particular days that are simply reminders of the past – echoes – and we actually have the power to create something different. The more you are able to anticipate your wants and needs ahead of Christmas, the less likely the ghosts of the past are to appear and dominate the day.

Alcohol generally makes things worse

Nobody is telling you not to drink on Christmas Day. However, if it is a day that evokes sadness or anxiety, alcohol will not improve these feelings for long. Once it wears off, they will be back with a vengeance and accompanied by a hangover. The opposite of using alcohol to self-soothe is to soothe through relationship. Even if you are not in a relationship with another, you are in a relationship with yourself and can hold yourself in mind.

Even if the day feels full and focused on others, it is always possible to take a few minutes out to calm yourself. You can breathe, come back to the here and now and remind yourself –  Christmas is only a day.

Listen to your body

This doesn’t mean act impulsively. It is more about listening for what the vulnerable part of you needs. This may be a hot bath with a good book, a warm drink by the fire, a nice home cooked meal or spending time with a supportive friend. It could also be a long run, or a dance or yoga class. Whatever self-care tool helps you feel well and connected should form part of your preparations for the day and be in place after the day.

 

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 – 

Can couples counselling fix a relationship?

How to get a mental health diagnosis

What is psychotherapy?

How to improve mental health

How do I find the right psychotherapist?

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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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Avoidance in therapy as the axe for the frozen seas between us

In this blog I will briefly discuss avoidant attachment strategies and how what can look like independence is actually a sort of suit of armour designed to protect and hide a locked box of vulnerability and need, preventing mutual dependency and intimacy.

The person who has developed the avoidant strategy has done so in order to cope with a lack of understanding and attunement to their needs from their caregivers, and have therefore had to deny their needs to themselves and make the decision (unconsciously) to repress or bury these needs and create an equilibrium for themselves where the pain, disappointments and griefs of these unmet needs are locked away. They can often find alternative ways to feel good about themselves and compensate for the shame of the disappointments and low self-esteem that they feel as a result of this lack of attunement. These alternative strategies can lead them to developing their intelligence as a way to circumvent their feelings and they are often very successful in their field of work. The problem of course is in their relationships, sometimes their relationship with themselves or parts of themselves.

The strategy seeks to enable them to have self-worth while keeping painful feelings of rejection at bay, they have found others unreliable and can therefore only trust themselves. They create an image of themselves that appears independent and strong but comes at the cost of denigrating others, especially those that are more comfortable with the parts of themselves that seek mutual reliance and inter-dependence on others. In extreme forms these others can stir up painful feelings of envy and hatred although these feelings too are disavowed. A calm state of coolness is sought that numbs any sort of emotional aliveness. However, this defence is often a fragile one and when a crisis occurs as it always does at some time or other in life then these defences can shatter, leaving the person distraught and desperate, unable to manage or deal with the emotions that now can’t be neutralized. Suicide can be one tragic outcome.

Brett Kahr, a British Psychoanalytic Psychotherapist, discusses the pain of this strategy which can be handed down generationally: – “Although many people inflict horrific cruelty upon their partners, the vast majority cause pain as a result of emotional unavailability, fuelled by avoidant attachment structures.”

Therapy takes time and requires an enormous amount of patience and keeping the patient in therapy is no easy task. However if they stay then perhaps the patient can slowly start to develop a more trusting relationship with the therapist, who can attune to them, who doesn’t need them to be other than who they are, who can accept their need for distance and who can digest their sometimes overt, but often covert denigrations, understanding them without retaliating or shaming them but not colluding either, calmly without judgment bringing to awareness what the patient is doing and the fear and pain behind these defences against relatedness.

The Author, Colum McCann, describes the work of literature, and I think his description also describes the therapeutic process.

“The job of literature is to acknowledge the heartbreak of the world and then to share that heartbreak in the hope that somehow you can find a little light, just a little, no matter how damaged and bruised. This light, then, must necessarily acknowledge the darkness. At the same time, it might just lift a portion of the dark, past the curtains, awaken us.”

He goes on to quote Kafka, “A book must be the axe for the frozen sea within us.”

So too must therapy.

 

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

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Back to ‘BACE’ics

Work life balance is fundamental to our mental wellbeing and can easily become out of sync without us even realising it, particularly when we are feeling stressed.  This imbalance can lead to depression and anxiety.  Going back to basics and keeping an activity diary for a week or two can provide us with useful information.  Broadly speaking we are interested in 4 different areas:

1/ Bodily Self Care – this would include how we look after our physical body, i.e. exercise, nutrition, rest and sleep, self-grooming, medication, etc.

2/ Achievement – this would include work, study, housework, any tasks / activities that gives us a sense of having achieved something.

3/ Connecting with others – this can be family, friends, work colleagues – in person, over the telephone or social media.  It can simply be being in an environment where there are others as long as we feel connected. It can also include connecting with animals.  Our pets can be very therapeutic.

4/ Enjoyment – hobbies, interests, fun activities, relaxing activities – anything that gives us a sense of pleasure

Each day categorise how you are spending your time into each of the areas.  Sometimes one activity may fulfil more than one category, e.g. walking the dog can be exercise so would meet bodily self care, it could also be an achievement if you really didn’t feel like going, it could be connecting with others as you may have met other dog walkers, and you may have enjoyed it.

By monitoring our activity according to these categories we can gather information and gain a sense of where there are gaps, where we might need to make some changes in our lives.

In my work as a CBT therapist I see all too easily how we can forget to enjoy ourselves.  We can get so caught up with work and what we think we should be doing we can lose sight of enjoyment and connecting with others.  Or we may have crammed so much into our day that we have no time to stop and just be.  Activity monitoring can be a useful tool for anyone who wants to take stock and see whether they are tending to their mental wellbeing.  To help us do this we can use a form called BACE (https://www.get.gg/docs/BACEdiary-weekly.pdf)  which is a daily activity monitoring form.  You will notice that the word BACE is an acronym for the four areas.

Once we have gathered information and highlighted the areas that need to be addressed we can use the same form as a daily planner to set ourselves small goals to address the gaps.

Sometimes the simplest strategies are the most helpful.

 

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.

 

Further reading by Rebecca Mead –

Interpersonal Therapy (IPT) explained

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So what exactly is Mindfulness?

 

The term ‘mindfulness’ is much spoken about these days, especially in relation to mental health and wellbeing. But what does it really mean? Mindfulness generally relates to a meditation practice that has its origins in Buddhism. It is thought that the Buddha was practicing mindfulness when he gained enlightenment, and it is one of the key meditation practices for Buddhists.

However, the practice of mindfulness has been taken by psychologists out of its Buddhist origins and used as a technique to help with gaining better mental health and having a healthier and calmer outlook on life. Mindfulness is often used to help treat anxiety and depression, and is recommended by the NICE guidelines for people with depression to help prevent further depressive episodes.  

How do I practice mindfulness?

To practice mindfulness is really quite simple. You just need to be aware of what is going on in your body, with your thoughts and emotions, and keep your focus trained on a meditative object such as your breath. Find a quiet place to sit, where you won’t be disturbed for a few minutes, close your eyes, and pay attention to your breathing. Notice the air coming in through your nose or your mouth. Notice how it feels, notice how your chest or abdomen rise and fall with each breath. Notice how your body feels different with each in-breath and out-breath. This seemingly simple practice is actually quite hard to do. You will notice that as you try to focus on your breath, your mind will start to wander. You’ll start thinking about things you need to be doing, planning your next activity, or wondering if you are doing it right. Also, you might start to notice feelings coming to the surface. Maybe you will feel anxious, or notice some sadness connected to an event that happened earlier in the day. When thoughts and feelings arise, all you need to do is to notice that they are there. Give them a label “I’m feeling sad” or “I’m planning” then bring your attention back to your breath. Do this gently and kindly. With regular practice, this will become easier, and you will find that your times of practicing mindfulness will become calmer and you will feel more peaceful. Also, you will start to notice how your mind wanders. You’ll notice the patterns of your thoughts and your emotions and you’ll become less entangled  with them. After a while, you’ll start to realise that while you have thoughts and emotions, your are not your thoughts and emotions. They are part of you, but you don’t have to become consumed by them.

 By having a regular practice of mindfulness, you can learn to regulate your emotions, and be able to tolerate more difficult emotions easier. You’ll also have more control over your thoughts and be able to step back from your thoughts when they are leading you to dark places. With time, mindfulness can help you become more compassionate to yourself and the others in your life.

And for how long?

It is often asked how often and for how long we should practice mindfulness meditation. The answer to this really depends on how much you want to commit to your wellbeing. A regular, daily practice is important. So try to practice every day if you can. In terms of duration, start small with about 5 – 10 minutes each day. Then start to work up to longer durations. Most people find that it will take about 20 minutes for the mind to really start to settle, and it is after that you will gain some of the deeper benefits of mindfulness. If you can, set aside 40-60 minutes each day to practice mindfulness. However, as we live in a busy world, setting aside this amount of time can be difficult, so if you can’t spare it, or just don’t want to do so much, stay with a smaller amount and keep your practice regular.

Mindfulness is a very important meditation practice that is accessible to all. The are many free videos and podcasts that will guide you in your practice, and many course available to teach it.

Combining mindfulness with psychotherapy is a very powerful way to understand your inner world and to make significant changes in your way of being in the world.

Simon Cassar is an experienced integrative existential psychotherapist and mindfulness practitioner providing long and short-term psychotherapy to both individuals and couples in Hove and Lewes.

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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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Burnout and compassion fatigue

Therapists, counsellors and anyone in the helping professions can appreciate both the rewards and hazards of their respective career choices. We can give people advice on how to care better for themselves, while at times not applying the same self-care principles to ourselves. At the worst, a lack of self-care can lead to burnout and compassion fatigue.

I believe that a lot of the difficulty lies in our deep-rooted beliefs and values about work, leisure and what constitutes self-care. ‘Helpers’ generally work hard, tend to focus on other’s wellbeing above their own, and want to make a difference. It’s our job to offer an outside professional perspective to our clients/ patients, but it can be challenging to approach our lives with the same objectivity. That’s why therapists also need therapy!

We are required to engage in continuing professional development, supervision and personal therapy and to abide by rigorous ethical standards. This is all in the service of ethical practice and self-awareness. These are valuable tools to help keep us in check and maintain an outside perspective on how we are doing as professionals. However, self-care goes beyond this and needs to extend to our lives outside work.

Achieving a well-balanced life is a work of art and an ongoing process. Knowing the principles of self-care is just the beginning. I’ve recently re-read an old article which was handed to me when I was still a trainee therapist. At the time, I couldn’t fully appreciate what it meant to self-care and have a balanced life. Now I believe it’s a fundamental part of my work, and ironically, one I had to work hard to put in place.

How to prevent burnout and compassion fatigue

The article, written by Vivian Baruch, cites research by other authors into prevention of compassion fatigue and burnout. For therapists (and other professionals) to stay motivated, an interest in activities unrelated to their work, engagement in spiritual and personal development and social support were some of the main factors cited. In addition to this, she listed some of the strategies for prevention of burnout below:

Don’t go it alone

Developing a sense of community and belonging both in our professional and personal lives to combat isolation and ‘refuel’.

Maintain a beginner’s mind

Learning something new such as a sport or hobby relieves us of the burden of being experts. Maintaining a beginner’s mind helps us stay open and curious in relation to our clients, loved ones and the world around us.

Prioritise

As a society we increasingly work harder and for longer hours. Simplifying our lives involves a shift in mindset from economy-driven fears to prioritising a less stressful life.

Heal and nurture yourself

Looking after ourselves physically and emotionally is a daily task. Recognising when it’s time to go back to therapy when old issues resurface, eating well, exercising and having a spiritual/mindful practice are all ways to ‘keep in check’.

You are not ‘it’

Ultimately, burnout involves losing touch with our needs and our centre. We all need ways to reconnect with ourselves and a sense of meaning and purpose. We are responsible to and not for others.

Sam Jahara is a UKCP Registered Psychotherapist, Certified Transactional Analyst and supervisor, working in private practice in Hove and Lewes.

Further reading on the theme of self-care:

Four domains – maintaining wellbeing in turbulent times

Steps to a calmer mind

A daily practice to manage emotions

On having a daily practice

Self-care

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Click here to listen to our podcast on this post.

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Student mental health – how to stay healthy at university

After the long summer, thousands of new students are heading to university. The start of the academic year is an exciting time for many, but it can also be a difficult, worrying time for some. Students today are subject to different pressures from earlier generations – financial, academic, social – that didn’t affect previous students to the same degree. Higher study costs means that an increasing number of students have to balance their study with part-time work. This means that they have less time to form and nurture close friendships and a social support network with their peers.

For those leaving home for the first time, it can be a stressful transition towards independent adulthood. If we look to wider society, the uncertain and competitive job market can put an inordinate amount of pressure on students to perform well as they face an uncertain future. In addition to this, many serious mental health conditions manifest themselves for the first time in young adulthood. The Higher Education Statistics Agency recently revealed that the number of students who drop out of university with mental health problems has more than trebled since 2009-10, with a record 1,180 university students with mental health problems abandoning their studies in 2014-15, the most recent year for which data was available.

It is important, therefore, to keep yourself healthy if you are heading off, or back to university. There are many good resources out there that will give good tips on how to look after your mental health while studying at uni, and here are a few tips that might point you in the right direction.

Physical health

Looking after your physical health is key, especially when you are entering a potentially stressful situation and experiencing big life changes. Having a regular routine of physical activity can be a great help in maintaining good emotional health. This could be team sports, the gym, walking rather than getting the bus – whatever works for you. Also, having a healthy diet and adequate nutrition will also help maintain the energy level that is needed when you are studying and partying hard!

Social health

Going to uni is a social experience. Creating new social networks is part of the attraction of studying in a new area. It can be a lot of fun, and a good social network is intrinsic to having good mental health. But don’t underestimate the impact of not being around your close friends. Keeping in contact with your existing friends who know you well is important too, as building deep friendships where you can open up about your inner world takes time.

Psychological and emotional health

Looking after your psychological and emotional health is obviously a key part in maintaining good mental health. Spend some time noticing your thoughts – what are you telling yourself? Notice also your emotions – how are you feeling on a day-day basis? Being able to identify your thoughts and feelings and to express them in some manner, whether through talking to friends or writing them down, can help you maintain a healthy inner world.

Spiritual health

People often forget about their spiritual health, but this is an important part of our lived experience. Looking after your spiritual health can be simple. You could spend some time alone on a regular basis, spend time in nature, or learn to meditate. Of course, if you are religious, then engage more with your religion. Spiritual health doesn’t need to be about religion, and can be just spending time by yourself and noticing the amazing world that is around us.

Staying healthy at university

Keeping these four areas in mind on a daily basis can go a long way to maintaining a healthy lifestyle. However, when things get a little more difficult, then use the support services that will be available at your university. There will invariably be counselling services and learning support services who will be able to help in your university journey.

Kate Connolly and Simon Cassar

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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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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 mental 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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