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When Home and Work Merge

The onset of national lockdowns in early 2020 (and subsequent restrictions) have made working from home the ‘new normal’. What was once seen as an ideal for many, free from commuting and office politics, suddenly became an enforced reality for all of us.

Our homes, which were previously separate, became our place of work, schoolroom or therapy room. The initial sense that being at home was an exciting new way of living and working, gave way, for many, to a sense that home and work were one and the same.

When home and work take place in the same space does it make us think about what function the workplace has? The workplace allows us to leave a lot of work-related stress there when we go home. Ad hoc chats with colleagues are part of how we manage some of the anxiety and challenges of working life. In short, the places that we work at and the people that we work with, hold a lot of our emotions.

This sense of something being held by a place and the people in it chimes with what Bion (1962) referred to as ‘containment’. Bion’s theory was based on the idea that it’s a person, invariably an early caregiver, who the infant looks to, to help them to process unbearable feelings. The infant cries and expels their feelings and the caregiver, through touch, facial expressions and sound makes these feelings more tolerable and, this in turn, calms the infant.

Bion felt that this cycle of learning what it is like to have feelings contained by another was part of how an individual learns to cope with their own feelings in later life. Once we learn this we can contain our own feelings and we can also trust others to contain them.

How does this translate to the impact on our lives of working and living in the same space? Bion spoke about the impact of the caring parent on a child. Might this sense of something being contained by another also relate to the place in which we work? This place forms it’s own sense of containment that may be lost with home working. It is somewhere that we engage with unconsciously as a space where we leave the challenging feelings that are evoked by the tasks carried out there. This place holds our feelings and leaves us free to go home and leave them behind.

Home working challenges us to find a way to manage this lack of separation and hold a boundary between what is work and what is not – and the anxiety that comes with that. How we do this is as individual as we are.

 

To enquire about psychotherapy sessions with David Work, please contact him here, or to view our full clinical team, please click here.
David Work is a BACP registered psychotherapist working with adults, offering long term individual psychotherapy. He works with individuals in Hove and Lewes.

 

Reference:

Bion, W. (1962). Learning From Experience. London: Karnac Books.

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Supporting children and young people with stress and anxiety

Stress is caused by an existing stress-causing factor or stressor. Stress can be ‘routine’, related to everyday activities or ‘sudden’, brought about by a change or transition, or ‘traumatic’, in relation to an overwhelming event.

During stressful events our adrenal glands release adrenaline, a hormone which activates the sympathetic nervous system, our body’s defence mechanism which causes our heart to pound, blood pressure to rise, muscles to tense, and the pupils of our eyes to dilate. Historically, this prepared us to respond to attackers with one of three responses – fight, flight or freeze.

This stress response can still be helpful to us today. It provides a burst of energy which can help us to stay safe when suddenly facing a speeding car, for example. Or, it might help us meet deadlines and goals through increased efficiency and focus. Our stress response ceases to be helpful if it is activated too easily or at a level which is too intense or if it goes on for too long, preventing us from returning to a relaxed state.

Anxiety is stress that continues after that stressor is gone. When we are anxious, fear can take over whenever there is worry and apprehension. This can lead to irritability, low mood, social withdrawal, lack of motivation, poor concentration and nervousness, as well as physical symptoms like chest pains, disruption to eating routines, dizziness, shortness of breath, fatigue and panic attacks.

There are multiple triggers for stress and anxiety in young people today. Those most commonly reported include school, exams and future prospects; social difficulties including peer pressure, social media issues and bullying; family concerns such as conflict or financial problems; and major world events. For some, these factors can become overwhelming.

A good place to start when helping children and young people with stress and anxiety is to be aware of what we are thinking, feeling and doing ourselves. This will help us to tune in to kids and look after ourselves so that we can stay calm, alert and responsive. There are many routes to self-care – the 5 Ways to Wellbeing is one of them – How are you doing right now? What steps might help you to build your own self awareness and take care of your own support needs?

Secondly, psychotherapeutic work is naturally based on a belief that by talking and thinking about difficulties we create space for creative exploration, digestion/ processing, increased understanding and new perspectives/ opportunities. It can be helpful to take a moment to consider where you stand yourself with regards to talking about feelings.

And do you think your child/ teenager believes it is okay to have feelings? Whether the answer is yes or no, how might he/she have picked up this message? What do we think is likely to help give a message that it is okay to feel feelings and to talk about them?

We can begin by making time to notice how young people are doing, listen to their concerns without judgement and then take them seriously. In ‘How To Talk So Teens Will Listen’ and ‘Listen So Teens Will Talk’, Faber and Mazlish (2006) advocate: “Identifying thoughts and feelings . . . Acknowledging feelings with a word or sound . . . Giving in fantasy what you can’t give in reality . . . and . . . Accepting feelings as you redirect behaviour.” (p31).

To make the above possible, it helps if we can stay calm and avoid becoming either frustrated or overwhelmed with our own worries about the child’s worry. We also want to steer clear of trying to fix things too quickly as this can seem like we’re not really interested in a child’s felt experience.

Being listened to can start to give shape to what might often feel like a formless mass of uncontrolled emotion. Feeling understood can, in itself, help to bring anxiety under control. It then becomes more possible to actively build self-awareness through tools like a stress-graph or diary, which maps stress intensity across a day, week or year. Other visual systems using scales and colours can be helpful too. A 0-5 scale, for example, can enable children to identify the difference between a slight glitch, a small/ medium/ large problem, and a situation which feels quite huge or even like an emergency. Other systems like the ‘Zones of Regulation’ or the similar ‘Just Right State Program’ (widely used in Brighton and Hove schools) help young people to notice their emotional/arousal state at any given time and to learn what helps them either to up-regulate or down-regulate in those moments in order that they can relate and learn effectively.

Specific calming approaches can be taught such as deep belly-breathing or simple, unobtrusive techniques for the classroom like hand-breathing or square breathing. Positive self-statements can also help – in place of an ‘all or nothing’ catastrophic approach (“I’ve messed up this essay, I may as well give up”) the young person might say to herself, “I’ve done it before, I can do it again” or “this feeling will pass”. Others may benefit from being helped to express thoughts and feelings through writing or drawing. Others might need to move around, take sensory breaks, do Yoga, make a mess with clay, cook a meal together, make a special den, imagine a calm place, complete a puzzle, make a list or listen to a favourite story or a book about anxiety, like ‘The Huge Bag of Worries’ by Virginia Ironside. Lots of helpful ideas for activities can be found in Karen Triesman’s ‘Treasure Deck of Grounding, Soothing, Coping and Regulating cards’.

Young people who are feeling sufficiently safe and regulated might also be able to consider the bigger picture of how their thoughts, feelings, body sensations and behaviour all inter-relate and where they might be able to make one small change which could then have a beneficial knock-on effect. Read more on these approaches in books like ‘Starving the Anxiety Gremlin’ (Kate Collins-Donnelly) and ‘Overcoming your child’s fears and worries’ (Cathy Cresswell).

For young people who are specifically stressed about exams, the following links may be helpful:

– The #NoStressSuccess series of video clips on Youtube about a wide range of opportunities for education and training post-16, made by Brighton Met College students.
– The ASAP Science Youtube clips: 9 Best Scientific Study Tips and 7 Tips to Beat Exam Anxiety.

As supporters of children and young people, one challenge we have is to be regulated in the way that we offer help and ideas. If we overload with strategies and things to ‘do’ to make the stress go away, we can be in danger of increasing pressure rather than decreasing it. If we can remember to be accepting of our children and if we model self-acceptance ourselves, we might go a long way towards helping them effectively manage stress in their lives. Dan Millman has said: “Resistance creates suffering. Stress happens when your mind resists what is. The only problem in your life is your mind’s resistance to life as it unfolds.” And in a similar vein, the following Chinese Proverb tells
us that: “Tension is who you think you should be. Relaxation is who you are.”

 

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

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Sleep and Mental Health

We all need sleep, and it is a natural part of our life. On average, most adults need around 8 hours of sleep per night although this can vary from person to person. While no one is entirely sure why we need to sleep, we do know that it is significant for brain development, and maintains normal levels of cognitive skills such as memory, speech and flexible thinking. Indeed, if have as little as 15 minutes less than our normal level of sleep this can have measurable effects on our cognitive functioning.

While sleep is a very natural and important part of our lives, many people can struggle with sleep and this can have a serious impact on their mental health. A lack of sleep can lead to daytime tiredness and this lowers our resilience and ability to cope with everyday life. This, in turn, can lead to a lowering of self-esteem and we can start to feel more worried or stressed about life. This leads to more difficulties getting to sleep or staying asleep and the cycle continues. When we have problems sleeping, we are more likely to feel irritable, anxious or depressed. In more extreme cases, it can lead to psychosis or paranoia.

There are many types of sleep disturbances – difficulties getting to sleep, difficulties staying asleep, night-time panic attacks, waking up too early etc. To the opposite of these can also be sleeping too much which might be the case with someone who is depressed. There are also sleep disorders such as Narcolepsy or Sleep Apnoea which can have a significant effect on sleep and physical health. If you think you have a sleep disorder, it is important to get this checked out by your GP.

So what can we do if we can’t sleep?

There are some obvious and easy changes that we can make to help our sleep habits:

  • Establish a sleep routine – going to be at the same time every night and waking up at the same time. Setting a habit can help your body get into a routine and make sleep come easier.
  • Make your bedroom a relaxing environment, and if you can, only use your bedroom for sleep and not for watching movies or working.
  • Establish a bedtime routine that allows you to wind down gently.
  • Avoid any caffeine before bedtime, and of course avoid electronic devices an hour or so before bedtime – so switch that mobile phone off!
  • Get regular exercise, but try not to exercise just before bedtime.

If you find you are waking up in the night and unable to sleep try not to worry about it. Laying in bed worrying about not sleeping and how you will function the next day can be torturous. It is better to get out of bed and if you have lots of thoughts, then write these down until your mind is a bit clearer. You could also read for a while to help you relax a little more, and keep a compassionate focus on yourself – getting annoyed with yourself for not sleeping will only make it worse!

Of course, if your sleep problems persist, you should consult your GP as they may be able to offer some medical help. You could also consider psychotherapy if you are finding that worries, stress and anxiety is keeping you awake.

During these challenging times that we are all in, it is vital to get a good night’s sleep, so look after your night-time routine so you are better equipped to face the days ahead.

 

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. He is available in our Hove and Lewes clinics and also works online.

 

Further reading by Dr Simon Cassar

Spirituality and mental health

Living with borderline personality disorder

Online Therapy

Student mental health – how to stay healthy at university

Face to Face and Online Therapy Help Available Now

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Using the body to calm the mind

When we think about psychological difficulties, we often think of these as being purely in the mind.  In some of my other blogs I’ve spoken about the link between mind and body, and this is something I work with a lot in my therapy sessions with clients. 

This is particularly relevant with issues of anxiety; where the fight-flight-freeze system comes into play.  This ancient pathway in our brains allowed us to detect and respond to threats before we even had a conscious awareness of them.  Nowadays of course often the ‘threats’ are more likely to be psychological (fear about a situation for example) rather than a physical threat such as being attacked by a wild bear.  However, our bodies still react in the same way, by preparing our bodies to fight, run, or stand very still and hope the bear doesn’t notice us.  This is why stress and anxiety tends to lead to symptoms such as racing heart, tight muscles and increased breathing rate; all things that would help us to fight, run or stand very still.

We often might think of needing to use our minds (thoughts) to calm ourselves, and certainly in Cognitive Behavioural Therapy this is an important part of learning to manage anxiety.  However, we can also use our bodies to calm our minds.  As well as the messages coming from our brain to our body to say ‘quick, get ready to respond’ our bodies also send messages back to our brains.  So if we can do things with our bodies to calm, that in turn can send messages of calming back to our brains.  A good example of this is breathing:  In flight-fight-freeze mode our brains’ automatic response is to send a message to our bodies to make breathing shallower and faster in order to get oxygen to our muscles to prepare to run, fight or stand really still.  If, however, we over-ride this and purposefully slow our breathing to take deeper, slower breaths, that will send the message to our brain to say ‘it’s ok, we don’t need to be anxious’.  Some people find using a breathing square or star can be helpful.  If you imagine the shape and trace round it in your mind, breathing in as you trace along one side, and out as you trace along the next and so on.

Using progressive muscle relaxation (PMR) is another body based technique that can be really useful.  This involves working through the body from feet to head, tensing and then relaxing different parts in turn.  There are many scripts available online, or even YouTube videos which take you through a PMR exercise.  Again, this helps calm the mind by sending messages from the body back to the brain.  Even just going for a walk can be really useful when we are stressed or anxious.  At times of anxiety or high stress our bodies get flooded with hormones, including adrenaline.  This is what tells the body to prepare to run, fight or stand really still.  All the time high levels of adrenaline are present in our blood we will be in fight-flight-freeze mode.  Adrenaline is used up by our muscles, so doing activities that use our muscles will reduce the amount of adrenaline in our system.  So things like going for a walk are great for reducing adrenaline.

Most people anecdotally have probably found that when we are stressed or anxious going for a walk or taking 10 deep breaths can be useful.  As we can see there is a very real reason for why this can help; our bodies can be used to calm our minds.

 

Please follow the links to find out more about about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

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Paying attention to stress

We are evolutionarily wired for stress.  For our early ancestors, inhabiting a natural world beset with predatory dangers the flight/fight response was crucial to survival.  The same alarm system exists today for the same survival purpose evolution originally intended. 

What is different is that today the more likely sources of threat (at least for those of us living in the industrialised world) are emotional.  Our biology, psychology and physiology are interlinked in subtle and complex ways, all with implications for our health and well being.

A stress response is activated when an event, physical or emotional is perceived as threatening.  As human beings we make multiple assessments via our central nervous system to interpret a stimulus and prepare ourselves to respond. Our response will be a combination of physiological and behavioural adjustments commensurate with the perceived degree of threat.  What is “commensurate” varies from person to person.  Each stress event is experienced in the moment but may have resonance from the past.  Our personal histories as well as our dispositions influence our response to a stressful event.

Acute v chronic stress

Whilst on the one hand stress can be understood as a physiological event vital to survival, on the other it is increasingly understood to have a corrosive effect that impacts negatively on our long term health.  Here it is important to distinguish between acute and chronic stress.

Acute stress triggers immediate discharges in the nervous, hormonal and immune systems, activating flight or fight reactions that help us survive imminent danger.  These are highly adaptive and highly effective responses.  In the case of chronic stress, the same systems are activated(over and over) but without resolution.  The effect is elevated cortisol and adrenaline levels which can damage tissue, raise blood pressure and undermine the integrity of our immune functioning.

For many people, functioning with chronically elevated cortisol and stress hormones is normal.  The circumstances of our early lives, including our attachments may have necessitated a state of hyper arousal and vigilance.  Without any conscious awareness our bodies stress responses can remain highly active.  Indeed it may be the absence of stress that creates unease in the individual habituated to its hormonal high but such a state of addiction to our own stress hormones may have serious implications for our long term immune functioning and health.

When we are unaware of what is happening in our bodies we are unable to act in self preserving ways.  The same is true of our emotional states.  If we are unable to identify what it is we feel, we will struggle to communicate it.  Our capacity to identify our emotional states will largely depend upon the messages that were conveyed to us early on by significant others.  A child may conclude that “I am not ok when I am angry” for instance, based on the blatant or subtle (verbal and non verbal) responses of a parent/ group of which they are a part.  In order to prevent the threat of rejection or shame the child will learn to shutdown or repress the unacceptable expression of anger.  This repression if it is to remain successful will require constant vigil and adaptation, such that overtime the legitimate expression of anger will be compromised and confused.

Self awareness

We need to develop a degree of emotional competence and fluency in order to protect against the hidden stresses that can pose such a (ticking time bomb) threat to our health.  This means being able to identify and express our emotions effectively, to assert our needs and maintain healthy (physical and emotional) boundaries.  It means being able to distinguish between past and present realities such that we cultivate awareness (and compassion) for unmet childhood needs.  Remaining disconnected with these aspects of our personal histories can contribute to hidden stress with potentially serious implications for our physical and emotional health and well being.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin –

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

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Managing Work Stress

Most of us have to work in order to live. For many, work can take up a large proportion of our waking lives with up to a third of our lives being spent at work.

While the primary reason for working is to make money, our work life can (and should) be much more than that. Working and having a career can become an intrinsic part of our identity and can indeed give us meaning and purpose in the world.

When we meet a new person, one of the first questions we often ask them is: “What do you do?” We can identify ourselves by our work and the position we hold within it, and our work can become one of the most important aspects of our life.

When our work life becomes stressful, our emotional response to it can become out of proportion to the actual situation. We can feel that our livelihood is jeopardized and at a deeper level it may feel like the very core of our being is threatened. Stressful situations at work can soon spiral out of control as we lose our clarity and our ability to stay objective in the face of these perceived threats.

What is stress?

 There is no clear medical definition of stress, but generally speaking we can say that stress is our body’s natural response to demands or threats that are put upon it. The stress response is usually the ‘fight or flight’ response that can help protect us in dangerous situations.

Under normal circumstances, stress is healthy and can help us stay alert, focussed and be more energetic. It can give us the motivation to get up in the morning and get on with our day.

However, if we have a demanding job or there are conflicts at work we can end up in a heightened stress state for a prolonged period of time. This can have a negative affect on both our physical and emotional health and we need to be mindful of the signs that we are becoming too stressed.

 What are the common symptoms of stress?

Cognitive symptoms: Inability to concentrate, constant worrying, racing thoughts, seeing only the negative in situations.

Physical Symptoms: Frequent colds of flu, aches and pains, nausea, dizziness, chest pains, rapid heart beat, loss of sex drive.

Behavioural Symptoms: Changes in sleep pattern, using alcohol or drugs to relax, changes in eating habits, withdrawing from other people.

Emotional symptoms: Depression, anxiety, mood swings, irritability and anger, feeling overwhelmed, loneliness and isolation.

What is causing your stress?

As well as noticing the signs and symptoms stress, we also need to identify the situation that is causing us stress. Some of the main work issues that can cause stress are: being overloaded, conflict with colleagues, management style of the organisation or our line manager, change and personal factors such as work/life balance. Some of these will be easier to address than others, but as a starting point, don’t carry the stress alone.

What can you do?

If possible, speak to colleagues and your line manager, and to your HR department if you have one. Letting others know that you are stressed will enable them to step in and help if they can.

Additionally, think about your work/life balance. Are you spending too much time at work with not enough down time? It’s easy to fall into the trap of needing to work more because you are stressed, which means you have less downtime and hence more stress. Re-addressing priorities in an important part of dealing with stress – make some time for yourself. If you able, do some physical exercise to help you unwind the physical tension. Start a mindfulness practice to allow your mind some ‘time off’. Speak to your GP if you are experiencing the physical symptoms mentioned above. And finally, if it becomes overwhelming, consider speaking to a counsellor or psychotherapist to help you process the emotions than can arise from feeling stressed.

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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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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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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