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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.

 

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

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

What’s wrong with good advice?

Psychiatry, Psychology and Psychodynamic Psychotherapy 

Analytic Therapy for Addictions

Loss

Post Natal Depression in Mothers & Fathers

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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

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.

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

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

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

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

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

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

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Steps to a calmer mind

Overthinking and overdoing can lead us to feeling stressed and anxious, disrupt our sleep and even lead to depression. We have previously written about the role of psychotherapy in emotional regulation. However, we all need a daily practice with simple steps to quieten the mind and feel more present with ourselves and others.

If you are on the treadmill of life, struggling to slow down and enjoy the landscape, here are some simple steps to help you with the art of quietening the mind and coming back to your senses. Try to go through it very slowly, pausing after each sentence.

IMG_2205

Sit in a comfortable position…

 

Notice where you are holding tension in your body and what needs to relax.

 

Now, begin by relaxing your eyes…

 

your eyebrows…

 

and your temples.

 

Then focus on your lips,

 

your tongue…

 

and the inside of your mouth.

 

Now feel your throat…

 

your neck…

 

and loosen your shoulders a little.

 

Feel your breath at the chest area and feel your chest opening.

 

Loosen the belly by taking a few deep and slow breaths into your belly.

 

Now become aware of your pelvic region.

 

Notice the length and volume of your legs.

 

Feel your feet.

 

Now… notice your whole body breathing.

 

Every time the mind tries to drift, bring yourself back to the sounds and sensations in your body, including the rhythm of your breath.

 

Take a moment here.

 

Enjoy this wonderful feeling of presence and relaxation.

 

Come back and do it again, whenever you need to pause.

 

Have a great weekend.

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Does psychotherapy cure addiction?

Does psychotherapy cure addiction?addiction

The answer to this question depends very much on whether addiction is seen as a disease in the medical sense of the word, and secondly, on whether it is indeed the goal of therapy to cure.

In response to these questions, I would suggest that rather than being a disease (as the 12-Step programmes are so fond of framing it) addiction is in fact a maladaptive way of managing uncomfortable feelings in lieu of more functional methods. Good affect regulation – the art of navigating our constantly changing emotional states – depends on our ability to use our mind to self-soothe and seek out other humans who will be available to witness and validate our experience. For some, reaching out to others is simply too frightening, and it becomes safer to use a substance or behaviour as a pseudo-other.

I would further suggest that the role of good psychotherapy is to help clients to build their minds so that they can use their minds to regulate their emotional state (see my previous blog on affect regulation.) It is not to cure. That does not mean that psychotherapy is not useful or an effective treatment, but it is a treatment to build the capacity to both process unprocessed experience and to help regulate affect.

What is addiction?

Addiction is a fascinating arena and one in which research is continuing, with conflicting ideas, views and theories competing for attention. However, some things have been established.

Addiction is a repeated behaviour that is used as a way of changing our experience and as a result changes our brain; the more we engage with the behaviour to change our experience, the more it changes our brain, making it more likely we then resort to the behaviour again. For many, it is a painful loop – especially where their addiction is socially unacceptable – drug addiction vs. being a workaholic – and has a higher cost of their relationship to self and others.

All addiction is chemical

Some researchers continue to try and draw a fundamental distinction between substance and behavioural addiction.  All addiction, I would argue, contains elements of both.  For example, someone who has an addiction to the most socially acceptable drug – alcohol – may find that their body goes through alcohol withdrawal when they stop drinking.  However, the success of their sobriety also involves letting go of significant behavioural aspects to their addiction such as socialising with certain friends; frequenting certain establishments; and even letting go of the pleasure of the ritual of pouring that 20-year old whisky from the decanter into a crystal tumbler at a specific time in the evening.  At the point of engaging in the ritual – moving to pour that drink – the addiction has taken over.

And behavioural addictions such as compulsive gambling; sex and pornography addiction and gaming addiction, to name a few, may on the surface seem to be simply behaviours without any substance influence, however, this is simply not the case.  Brain scans have shown that the brains of addicts light up in just the same way as those of substance abusers when that individual thinks about their addiction of choice.

Therefore ALL addictions change the brain and it can be argued that all addictions, irrespective of the substance or behaviour, are in reality an addiction to the chemicals and hormones released in the brain when engaging with that addiction – most notably, dopamine.

Addiction as an attachment disorder

Rather than viewing addiction as a weakness, disease or label for a person’s behaviour, it is far more helpful from both a compassion and treatment perspective to view the addiction as a way that that person regulates their emotional state, and to recognise that this has come about through a lack of emotional witnessing, validating and normalising behaviour (emotional neglect) on the part of their primary caregiver.  The behaviour and/or substance functions as a pseudo-relationship for the addict – one that feels far more consistent, safe and trustworthy than their experience of other close relationships has been.  This is also why despite loving their partners, families and children, some addicts simply cannot face letting go of their most important relationship – the addiction – and will forsake all others to protect it.

Who can heal the addict?

Psychotherapy is often critical in helping people with addictions to learn to adopt more functional ways of self-soothing and getting their needs met in relationship.  However all of this depends on being able to hold onto that thinking mind – the ability to mentalise – first and foremost and this can only happen through a prolonged and attuned therapeutic relationship.

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

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Top tips for breaking a bad habit

stop_smoking_habitWe all have bad habits.  Some are fairly innocuous and others, at the extreme, can develop into behavioural addictions.

Many of us try our hardest to break bad habits, but end up failing miserably.  There is a particular time of year – New Year’s – when many of us set out to ‘turn over a new sheet’ and to give up on habits that may not serve us.  And the statistical evidence shows that on average, only around 8% of us manage to stick to our resolutions.  We then generally put this down to us being weak-willed in some way, but the real reasons why breaking a bad habit is so hard are more complex.

Why are bad habits so hard to break?

Neuroscientists are starting to unlock the secrets of how our brain plays a key role in us staying stuck in old habits.  And it has a lot to do with dopamine – a neurotransmitter that helps control the brain’s reward and pleasure centre.

Our brain gets very easily distracted and searches for past rewards that it felt when engaging in an activity – even when the rewards are no longer there or perhaps never were.  Dopamine causes our brains to gravitate towards behaviours and activities that were previously pleasing.  And once a habit gets laid down, we have much less control of our brains than we like to believe.

So, rather than being weak-willed, our brains (or a part of them) are hijacking our behaviour to seek out its dopamine hit.

Top tips

How do we break this cycle?  Well, researchers are now suggesting that instead of focusing on stopping the negative behaviour, we should instead focus on replacing it with a new one that will give our brains some reward.

The first step in this process is to identify what the exact nature of the reward is that we get from the behaviour.  For example, if we find that we snack late at night because we are hungry, then changing meal times; changing food types; moving exercise routines etc. can all help to change our cravings.  It may be, however, that we snack because we are feeling bored, in which case, going for a walk around the block may be a suitable substitute.

In the 12-step program, participants are invited to HALT before engaging with their addiction.  HALT is an acronym that stands for asking the questions: ‘Am I Hungry, Angry, Lonely or Tired’.  Often, it is one of these feelings that is driving the addictive craving.

So, instead of self-critiquing when we once again go down the rabbit hole of a bad habit or addiction, get really interested in the following questions:

  • What am I feeling?
  • What triggered me? – time of day, activity (e.g. drinking correlating to smoking)
  • What would meet my needs in this moment?

By engaging with these questions, you can take control by focusing on putting in place a behaviour or set of behaviours that makes you happier and provides your brain with dopamine for the right reasons.

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

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Holiday Blues?

holiday bluesThis time of year can evoque a range of feelings in most of us. Whilst some of us may have a festive and positive outlook on Christmas and look forward to spending time with friends and family, for many it is a time filled with conflicting emotions. Some of us have difficult memories associated with Christmas and family gatherings. For me, this season was always associated with positive memories of my grandmother. After she recently passed away, Christmas became a reminder of her absence.

Going through sad and difficult times without ignoring or suppressing feelings can be a challenge. When working with my clients around grief, loss and relationship issues I tend to be curious and ask questions about what they are experiencing and really honour those feelings, after all, they are there for a reason. In the absence of an experienced professional to guide you through this process, here are some ideas to help you not only cope, but make the most out of a challenging time.

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.

Challenge Expectations

There are many ways to spend your holidays. If you rather be on your own or spend it some place else, then why not? Just because it’s tradition for many families to gather at Christmas, it doesn’t mean you have to! If you fear that saying ‘no’ to family gatherings will upset or disappoint family members, explain that you are making a different choice this year and that you hope they will be supportive of your decision.

Spend Time Reflecting

The end of the year can be a good opportunity to review and reflect on the past year. Reflections on your present life in terms of what is going well and what could be improved on is a good starting point. Are you following your dreams and aspirations? How are you contributing to causes that you care about? What are some of your wishes for the future? Where would you like to see yourself this time next year?

Make Positive Decisions

Many people come to psychotherapy to reflect on and improve their lives with the support of an impartial other. It is never too late to become more self-aware and make significant changes in the areas of your life that you are not happy with. Whether you are experiencing grief, going through relationship issues, depression, anxiety or feeling stuck in your life, an experienced counsellor or psychotherapist will explore those feelings with you in a supportive, interested and non-judgemental way.

Wishing all a relaxing holiday and a fruitful year ahead.

Sam Jahara

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The Therapy Room

Therapy RoomBrighton and Hove Psychotherapy started after Mark and I decided it was time to get our own premises. Finding the right work environment wasn’t easy. We spent years practicing from other clinics, never quite satisfied with the therapy rooms we used. Although, arguably, good therapy work can take place almost anywhere. A warm and welcoming therapist certainly contributes a great deal towards making her/his client feel comfortable. After all, therapy is a meeting of hearts and minds, and this matters more than the walls it takes place in, right?

There is no right or wrong answer to this, except that the environment I work in matters a great deal to me. It is to do with my wellbeing and that of my clients. If I feel stressed, distracted or uncomfortable it will invariably impact on how present I can be with my clients.

Of course there is no perfect place to work in. There will always be a certain degree of intrusive noise, which sometimes can be used for some interesting and positive therapeutic explorations. However, there are certain vital qualities that I need from my environment in order to get into the frame of mind that I wish to be in to work well.

In order for me to enjoy my work and do it well I need to be open, present, attuned and ideally relaxed. To get myself in this receptive frame of mind I make sure I engage in a self-care routine which involves attending carefully to my physical and emotional wellbeing. I see the space I work in as a reflection of how well I care for myself and for others. A significant amount of my time is spent in the therapy room, thus it needs to have the sacred qualities of a welcoming home: light, air, comfort, beauty and silence. And finally, our space is gladly shared with other therapists who value themselves, their work and the space they work in as much as we do. In my opinion, it shows we care for ourselves and the people we see.

Sam Jahara

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