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April 6, 2020 by Brighton & Hove Psychotherapy Leave a Comment

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

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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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Filed Under: Rebecca Mead, Sleep Tagged With: self-care, self-worth, wellbeing

December 17, 2018 by Brighton & Hove Psychotherapy Leave a Comment

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.  

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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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Filed Under: Mental Health, Psychotherapy, Simon Cassar Tagged With: Mental Health, Psychotherapy, self-care

April 16, 2018 by Brighton & Hove Psychotherapy Leave a Comment

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.

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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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Filed Under: Brighton and Hove Psychotherapy, Mark Vahrmeyer Tagged With: mind and body, self-awareness, self-care

October 30, 2017 by Brighton & Hove Psychotherapy Leave a Comment

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.

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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

Click here to download a PDF version of this post.

Click here to listen to our podcast on this post.

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Filed Under: Sam Jahara, Sleep Tagged With: Mental Health, self-care, stress

October 9, 2017 by Brighton & Hove Psychotherapy Leave a Comment

Student mental health – how to stay healthy at university

Student

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.

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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

Click here to download a PDF version of this post.

 

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Filed Under: Relationships, Simon Cassar, Sleep, Work Tagged With: Emotions, self-care, sense of belonging

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COVID-19 (CORONAVIRUS) Important Notice

We would like to reassure all our clients that Brighton and Hove Psychotherapy is operating as normal despite the current situation.

Our working practices have fully incorporated online therapy in addition to a re-opening of our Hove and Lewes practices for face-to-face psychotherapy in accordance with Government guidelines and advice on safe practice and social distancing.