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Ruptures in the psychotherapeutic relationship

The relationship

Psychotherapy is fundamentally an exploration of how we relate to ourselves and to others, and the client, therapist relationship is no different. The relationship that develops between client and therapist exists within contractual boundaries, but it is also about people being present and connected. There are moments of great attunement in which the client feels heard and understood in ways that feel different from other interactions. The quality of this relationship is recognised as a central element in helping clients move towards lasting change, regardless of the practitioner’s approach.

We are talking about interpersonal relationships here, and as in any relationship, there are also moments when things do not go so well. A misunderstanding, a disappointment, a look, something that can’t quite be said or understood, but is felt by one or both parties. These moments can play out in therapy in numerous ways and could ultimately cause the relationship to break down. Such ruptures present not only a challenge to the therapeutic process, but also an opportunity: can they be recognised, reflected upon, and worked through together?

What constitutes a rupture?

Sometimes it is obvious when things don’t go well. There might be an immediate verbal response, a silence, or a shift in body language, making it clear that something isn’t right. The rupture is apparent, but not yet understood. In such situations, it seems appropriate for either party to be curious and to explore what has happened. This brings us back to the relationship between client and therapist and asks: are they both able to address what has happened? Can both parties stay with the discomfort and think about it together? Much as in everyday life, this isn’t always easy or comfortable, but it says a lot about what the relationship can hold.

Ruptures, however, are not always so apparent. I had previously imagined that it was only obvious when something was going on. As in everyday life, the immediacy of a response lets us know that something has happened. We are conscious of the rupture.

A client missing a session can easily be explained by practical reasons, life happens, after all, but a client who can’t attend might also be communicating something about how they feel about the relationship. Such a ‘withdrawal rupture’ might not be easy to notice, as the absences might come with good reason. Issues with payments, scheduling changes, or holidays can all be explained, but they could also, in some way, express changing feelings about the relationship. It might not even be possible to see this as a rupture, but it can challenge the therapeutic relationship in subtle and potentially damaging ways.

How can we think about ruptures?

Psychotherapy is always a reflection of how we live in the world. The impact of a rupture on the therapeutic relationship often mirrors how such ruptures feel in real life. The difference, however, is that in psychotherapy we have the opportunity to explore what has happened. Within the therapeutic relationship, we can model behaviour from which the client can learn and develop new ways of resolving ruptures.

Being able to acknowledge that something is happening in the relationship can be unsettling, but it is the point at which meaningful exploration begins. For either party, being curious and open to examining what is going on may feel as though the relationship is being tested. This might be inevitable, but what it does offer is the possibility to develop the relationship further. The capacity not only to acknowledge a rupture, but also to articulate what it feels like, and when both parties can think and reflect together, allows it to be understood and worked through.

Learning from ruptures

A rupture in the therapeutic relationship is always possible. Such moments can challenge the relationship, but when they are acknowledged, explored, and reflected upon, they can lead to a deepening of the therapeutic connection. The experience of working through ruptures in therapy gives a lived example of how this might translate into the client’s life outside the therapeutic relationship.

 

To enquire about psychotherapy sessions with David , 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.

 

Further reading by David Work –

Beyond the label: rethinking assessment and diagnosis in psychotherapy

Wearable tech: when is there too much data?

In support of vulnerability

Trauma and the use of pornography

Reflections on bereavement

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In therapy the past repeats until it can be let go of

A foundational principle of depth therapy is that until mourned, the past is never truly past. It lives on in the present in our relationships shaping how we see others, how we see ourselves and in how others see us. In the consulting room, this process plays out much the same way as it does in our regular lives but here it can be thought about and worked with. We call it transference.

Transference defined?

Transference is the unconscious repetition of early relationships in the present. The patient unwittingly re-enacts old relational patterns with the therapist which gives the skilled therapist an insight and understanding of how the patient learnt to navigate their relationships as an infant and from there onwards. Put simply, these relational patterns were once necessary in order for the infant to get their needs met (to varying degrees) but over time they have harden into fixed ways of relating that restrict emotional freedom.

Freud saw this phenomenon as both the greatest obstacle to therapy and its most powerful tool describing transference as “the prototype of all love.” Transference shows how the mind repeats what is familiar, even when it causes suffering. The therapeutic relationship becomes the arena in which these repetitions can be recognised, thought about, and over time different relational patterns experimented with whereby the patient comes to see the therapist as someone who is different to those in their past.

Why do we repeat relational patterns?

The repetition of the past in the present is not accidental. We repeat what we cannot yet remember or think about with the unconsciously hope that we may eventually get a different outcome. The patient unconsciously assigns to the therapist the role of the critical parent, the unavailable caregiver, or the idealised rescuer, depending on where their relational trauma lies. And these roles cannot be mentalized until they are lived through in the therapeutic dyad.

In this way, the therapeutic relationship becomes both a mirror from the past and an opportunity for change. It reflects the patient’s inner world while providing a new relational context in which that world can evolve.

Working with the transference

A common misunderstanding is that the therapist’s role is to correct the patient’s distortions of reality, however this is unlikely to lead to any relational change as simple insight rarely does. Relational depth psychotherapy instead takes the view of observing what unfolds in the relationship, as a vital indictor of what has unfolded in the patient’s early primary relationship. But, instead of reacting to how they, the psychotherapist, feel in response to the transference, they instead use what is known as their counter-transference to work but the patient’s projections and to name the pain and grief locked within those relational patterns.

Freud called this process working through. It involves returning to these patterns again and again in the therapeutic relationship until their meaning becomes clear to the patient.

The aim is not insight for its own sake, but the gradual loosening of the grip that the past exerts on the present through mourning.

The therapist as separate to the patient

Over time, the work is such that the patient begins to experience the therapist not as a figure from their past, but as a real person with a separate mind. This marks a crucial developmental step which didn’t happen when the patient was growing up and has kept them relationally stuck. It is the developmental step of recognising that others exist independently of one’s own needs and projections.

Analytical psychotherapists call this capacity the two-person world. In this world, the therapist is neither idealised nor devalued but experienced as a whole separate person. The patient’s growing ability to recognise separateness opens the possibility of genuine relatedness in all their relationships.

The emotional demands of change

Transference is not an intellectual concept but an emotional event that is worked with leads to developmental change and psychological maturity. The feelings it stirs can be intense, confusing, and often painful and throughout he therapist’s task is to stay present, holding onto their thinking mind and to use these emotional currents to help the patient understand what happened to them.

For the patient, the process invariably involves mourning. Old hopes of finally being loved or rescued must give way to the reality that the past cannot be undone as its only by grieving what was not possible that a person becomes free to live differently in the present – the past can be let go of.

Why transference matters

Transference provides a living picture of the patient’s inner world and defines how they do relationships. It brings into the open what might otherwise has remained hidden in repetition throughout the patient’s life. Without transference, depth therapy is imply not possible and the therapeutic encounter remains insightful at best.

The goal therefore is not to eliminate transference but to firstly understand it and then help the patient work through it. This is not easy work for the therapist as they must not only be asking themselves ‘who do I represent in the transference?’ But must also survive the patient’s idealisation and hate. Resolution means recognising these patterns for what they are: echoes of earlier life and not the reality of the therapeutic relationship.

Relational freedom

When the transference has been worked through, the patient no longer needs the therapist to embody old roles and this becomes a felt experience in the encounter. The patient can tolerate the therapist as separate to them and neither perfect nor dreadful. The therapist can be disappointing to them in an ordinary way. This is what psychoanalysis calls relational freedom. The patient becomes able to love, to hate, to desire, and to depend, all while knowing that both self and other remain distinct.

Psychotherapy is not an intellectual exercise. It is a living relationship that requires both participants to learn to feel and to think together. The transference provides the raw material for transformation IF the therapist is skilled enough to hold it and work with it.

 

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 by Mark Vahrmeyer –

AI psychosis: why depth therapy cannot be automated

All depth psychotherapy is trauma therapy – and the rest is marketing

Why there is no such thing as a patient

How AI tools between sessions are undermining the therapeutic relationship

Masochism and the impossibility of desire

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AI psychosis: why depth therapy cannot be automated

Artificial Intelligence is increasingly being promoted as a tool for psychological support, whether through chatbots, self-help apps, or experimental “AI therapists.” The proposition is seductive: instant access, apparent empathy, and cost-effective delivery. Yet beneath the promise lies a profound risk, one I would call “AI psychosis.”

By this I do not mean psychosis in the clinical sense of delusions or hallucinations, but a subtler psychic rupture: the erosion of one’s tether to reality through the absence of another mind.

What therapy is, and what it is not

Psychotherapy, especially in its depth forms, is not about validation or advice. It is not a clever mirror that simply reflects the patient’s words back to them in more soothing tones. Therapy is about encounter the lived experience of two minds, each shaped by history and desire, meeting in a room and grappling with what emerges.

The therapeutic relationship provides the possibility of containment. Patients often bring unbearable aspects of themselves, shame, rage, despair, and unconsciously project these into the therapist. It is then the therapist’s task to think, metabolise, and eventually return them in a form that can be borne. This is projective identification, first described by Melanie Klein, and it is the bedrock of working with unconscious life.

An AI system may imitate empathic reflection, but it cannot contain. It has no inner world in which to digest the patient’s projections, no unconscious with which to struggle. It can only give back what is put in, albeit in a superficially polished form.

Theory of mind and the human gap

A defining feature of human development is what psychologists call “theory of mind”, the capacity to recognise that other people have minds separate from one’s own, with distinct thoughts, feelings, and perspectives. It emerges in early childhood and is foundational to empathy and relatedness.

When a patient engages with a therapist, the implicit knowledge that the therapist is a separate subject is vital. It introduces tension, frustration, disappointment, and through these, growth. We learn that the other does not always agree, does not always understand, and does not always meet our needs. The self is refined through this
recognition of difference.

AI, by contrast, is a perfect mirror. It mimics the form of thought but is devoid of subjectivity. It has no unconscious, no history, no desire. To interact with AI in place of a therapist is to face an uncanny replica of mind without the unpredictability of being.

The hall of mirrors

Object relations theory teaches us that the self emerges in relation to the object – the mother, the father, the analyst. Winnicott’s “good-enough mother” is not one who perfectly mirrors the infant but one who fails just enough that the infant comes to know separateness. It is in the gap between wish and reality, between omnipotence and frustration, that the self takes shape.

An AI therapist cannot fail in this sense. It can only provide the illusion of infinite mirroring, validating whatever is presented. The patient, encountering no true other, risks a psychic implosion a retreat into a hall of mirrors where there is reflection but no recognition, echo but no encounter. Over time, this can create a disconnection from reality that mimics the fragmentation of psychosis.

This is what I mean by “AI psychosis”: not psychosis in its psychiatric form, but a creeping detachment from the world of subjects and objects. The user becomes locked into a dialogue with a machine that looks and sounds human but lacks the fundamental ingredient of humanity.

The false promise of validation

There is a cultural trend toward equating therapy with validation. Patients seek to be understood, to be reassured, to be told their feelings are legitimate. While this is part of the therapeutic process, it is not its essence. Depth therapy is not about making the patient feel comfortable; it is about facilitating growth, which often requires discomfort.

AI, precisely because it is designed to be agreeable, risks colluding with the patient’s defences. It can only validate; it cannot challenge, frustrate, or surprise in ways that arise organically from the subjectivity of another person. Without this dialectical tension, therapy collapses into self-confirmation and superficially comforting, perhaps, but ultimately stultifying.

Why depth therapy is the antithesis of AI

Depth psychotherapy insists on the difficult work of being with another person, with all the unconscious mess this entails. The therapist is not a neutral mirror but a subject whose countertransference, frustrations, and limitations are part of the process. This is why psychotherapy is not customer service. It is about reality, not illusion.

The essence of depth therapy is precisely what AI cannot provide: another embodied mind that can think, contain, and survive the patient’s projections. Where AI offers frictionless interaction, therapy demands the patient confront difference and disappointment. Where AI mirrors, therapy metabolises. Where AI risks disconnection, therapy fosters integration.

It is precisely the friction, the ruptures, and the misunderstandings within the therapeutic relationship that allow the patient to grow. Without these, there is no therapy — only simulation.

Conclusion

The lure of AI as therapist lies in its efficiency, its endless patience, and its capacity to mirror. But in eliminating the difficulty of relationship, it strips therapy of its essence. Without another subject, the patient loses contact with self and world.

To place AI in the role of therapist is to invite a slow drift into unreality, where the self is endlessly reflected but never truly known. This is the danger of “AI psychosis.”

The future may hold many uses for artificial intelligence such as in in data analysis, medical imaging, even as an adjunct to psychoeducation. But psychotherapy is not, and must never become, one of them. For to automate therapy is to abolish its heart: the living, embodied presence of another mind.

 

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 by Mark Vahrmeyer – 

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All depth psychotherapy is trauma therapy – and the rest is marketing

Spend ten minutes on social media and you’d think trauma therapy is a rare, specialist service that only a select few therapists can offer. The implication is clear: most therapy isn’t “trauma-informed,” so you need to shop for the right label.

This is marketing, not clinical reality. If you are in depth psychotherapy, psychoanalytic, psychodynamic, relational, or any integrative work with substance, you are already in trauma therapy. It’s not a niche. It’s the core of the work.

The social media framing doesn’t just mislead the public, it obscures what trauma actually is and how psychotherapy addresses it.

Trauma is a state of overwhelm

Trauma is not just an event. It is an internal state of overwhelm, which is to say the point at which an experience exceeds your capacity to process it. The psyche cannot integrate what has happened, leaving it lodged, often in the body, raw and unresolved.

This can happen in response to the obvious horrors: abuse, violence, catastrophic loss. But it can just as easily stem from the chronic and subtle: persistent neglect, emotional absence, shaming. Trauma is not defined by the size of the event but by the inability to process it.

The antidote: feeling, not just knowing

If trauma happens when experience cannot be processed, its antidote is not intellectual insight alone. It is feeling fully, safely, and in a way that no longer tips you back into overwhelm.

Good psychotherapy is where this happens. In the safety of the therapeutic relationship, the unprocessed emerges, sometimes as memory, but often as emotion, bodily sensation, or relational pattern playing out in the here-and-now. This is where the work is: making space for feelings to be experienced and integrated. That is how the trauma stops dictating our lives.

When “trauma” loses its meaning

The term trauma has become so common it risks meaning almost nothing. Everything from a bad date to a slow coffee order is now labelled “traumatic.” In one sense, this reflects a cultural shift towards acknowledging psychological injury. But in flattening the term, we lose the ability to distinguish between distress, difficulty, and the kind of psychic injury that overwhelms our capacity to process.

When every wound is trauma, depth and nuance disappear and “trauma therapy” becomes a brand rather than a discipline.

The red herring of “trauma therapy”

All competent depth therapists are trained to work with trauma. It is not an add-on. It is the fabric of the work. Whether the trauma is obvious or hidden in the patterns of everyday relationships, the task is the same: to create a space where what was once unbearable can be felt and integrated.

To suggest otherwise by implying that “trauma therapy” exists apart from psychotherapy, is a red herring. It creates unnecessary hierarchies and false distinctions, and plays into a consumer model of therapy that mistakes labels for depth.

Depth therapy has always been trauma therapy. Long before hashtags, before influencers, before “trauma-informed” was a marketing term, psychotherapy has been about one thing: helping a person bear what they could not bear before. That is the work.

 

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 by Mark Vahrmeyer –

How AI tools between therapy sessions are undermining the therapeutic relationship

Why there is no such thing as a patient

Masochism and the impossibility of desire

Dissociative identity disorder: a rare trauma response, not a social trend

Can AI offer therapy?

 

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Why there is no such thing as a patient

Winnicott’s radical insight: There is no such thing as a baby

Winnicott’s claim that “there is no such thing as a baby” is one of those deceptively simple psychoanalytic truths that resists being reduced to metaphor. He wasn’t being poetic. He meant it literally: there is no baby in isolation. There is always a baby and someone. A baby and a mother, a baby and a caregiver but always a baby and a mind that receives it.

The relational nature of the human mind

Winnicott’s insight destabilises the individualistic fantasies we carry into adult life. reminding us that the mind is not a closed system but a product of relationship. A mind emerges through and with another mind. To exist, we need to be held in another’s gaze, fed by another’s psyche, recognised by an other who precedes and survives us.

Implications for psychotherapy practice

This has radical implications for the practice of psychotherapy.

In my consulting room, I often encounter patients who believe the work of therapy is something they must do alone. They ask for tools, strategies, frameworks. They want insight without intimacy. As though the mind could be changed the way one tunes a machine.

The therapeutic relationship is the treatment

The unconscious does not respond to tools. It responds to presence. Just as the infant cannot form a self without the presence of a sufficiently attuned caregiver, the patient cannot reorganise the psyche without the presence of an attuned other. There is no such thing as a patient in isolation.

There is always a patient and a psychotherapist. Therapy is not introspection nor insight; it is a relationship.

The therapist as a real other

The psychotherapist is not a neutral technician applying treatment protocols to a disordered mind. The psychotherapist is a human subject who brings their whole being into the room: receptive, responsive, resilient. They offer a mind that the patient can borrow, use, even attack in order to become a person with a mind in their own right.

The patient must use the therapist
To say the patient must “use the therapist” is not a metaphor. It is the very core of psychoanalytic work. The patient tests the therapist’s reliability not through reasoned conversation but through enactment: will you still be here if I disappoint you? If I ignore you? If I rage at you? The psychotherapist’s role is to stay in their chair. To neither abandon or intrude upon the patient.

Internalisation and the capacity to be alone

Through surviving these tests, the therapist becomes internalised, not as a fantasy figure, but as a real object who has been experienced in the flesh. This internalisation is not immediate. It is slow, unpredictable and ultimately earned. It marks the transition from dependence to autonomy: the capacity to be alone, which Winnicott insisted could only develop through the experience of being with another. What a lovely and profound paradox!

The consulting room as a space for relational healing

In this way, the consulting room echoes the nursery. But it is not a regression. It is a re-doing of something that may never have happened the first time. A second chance at relational being.

Conclusion: A patient and a therapist

So no, there is no such thing as a patient.

There is only a patient and a therapist.

A mind with another mind.

And from that encounter, something new can be born.

 

 

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 by Mark Vahrmeyer

How AI tools between therapy sessions are undermining the therapeutic relationship

Masochism and the Impossibility of Desire

Dissociative Identity Disorder: A Rare Trauma Response, Not a Social Trend

Can AI offer therapy?

Why staying in your chair is the key to being a good psychotherapist

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How AI tools between therapy sessions are undermining the therapeutic relationship

The space between psychotherapy sessions is not empty. It is saturated with psychic material such as fantasy, frustration, longing and resistance. It is where the work reverberates, where the transference lives on, where the unconscious continues its motion. Yet increasingly, this space is being colonised by something that feels helpful: AI therapy.

Apps that prompt, soothe, or mirror back “empathy” through an algorithm are now pitched as the perfect between-session companion. They offer structure, safety, even surrogate support. But what seems like a supportive bridge is, in psychoanalytic terms, a subtle sabotage. It redirects the patient’s libidinal energy away from the therapeutic relationship, diluting its potency. And it replaces the analytic third with a pseudo-subject that can only simulate understanding.

The therapeutic relationship is not interchangeable

Psychoanalytic psychotherapy is not about problem-solving or advice. It is about the patient’s relationship with the therapist—as a representative of their internal object world.

The real work unfolds within that living, breathing relationship, often shaped by longing, disappointment, anger, idealisation, eroticism, hate.

When a patient turns to AI between sessions to “process,” “journal,” or receive “support,” they may believe they are helping themselves stay connected to the therapy. In fact, they are often displacing the relationship, venting into a vacuum rather than containing the affect and bringing it back into the room.

This has consequences. Psychic energy that should charge the transference is siphoned off. The unconscious, which needs a real human mind to be received and thought about, is instead met with a programmed echo. A fantasy of self-sufficiency takes hold, and the very dependency that fuels therapeutic transformation is split off.

Containment versus substitution

One might argue that AI provides containment. It offers a holding function, particularly when the therapist is not available. But containment outside of relationship is not neutral. It begins to function as a substitution. The patient who journals into an AI app after a conflictual session may feel soothed but they are no longer metabolising that rupture with the therapist. They are metabolising it elsewhere, safely, sanitised, and in private.

This avoids the essential confrontation: bringing the frustration, confusion, or hurt back into the session and into the relationship. That is where meaning is made. That is where change occurs. Bypassing this moment not only flattens the affect, it reinforces the very defences the therapy is trying to loosen.

Undermining the transference

Psychoanalysis hinges on transference, not as an abstract concept, but as an embodied, lived experience between two people. The space between sessions is part of this structure. It is meant to generate feeling. Missing the therapist, resenting the wait, idealising or devaluing them in their absence—these are not problems. They are the
material.

AI, when used between sessions, acts as a relational decoy. It absorbs and deflects feelings that should be directed at the therapist. It creates a false container for transference affect, preventing it from returning to its source. The result is a therapeutic encounter increasingly starved of psychic charge that is clean, calm, and sterile.

This is not therapy. It is emotional outsourcing.

False self meets artificial other

For many patients, especially those with early relational trauma, therapy becomes the first place where a real self can begin to emerge in the presence of a reliable other. But when that process is interrupted by prematurely discharging affect into AI. A different relational dynamic takes hold: the false self meets the artificial other.

Here, the patient curates their affect. They perform emotionality for a system that cannot truly respond. And over time, the patient may come to prefer this safer interaction. The unpredictable, disappointing, demanding reality of the therapist feels intolerable in comparison. But growth does not come from comfort. It comes from staying in the real relationship, even when it hurts.

The psychotherapist’s absence is part of the frame

Therapy is bounded by time and structure. The session ends. The therapist is not available at all hours. This absence is not incidental, it is analytic. It creates space for projection, for fantasy, for psychic digestion. Patients are meant to feel the gap, to stew, to wish, to rage.

They are meant to wait.

AI collapses this space. It is always available, never absent, never unpredictable. It removes the limit. It flattens the emotional topography between sessions into a manageable plain. But in doing so, it erases the edge. There is no longing, no tension, no psychic residue. Just answers. Just relief.

The promise—and the poison

To be clear: this is not a purist rejection of technological support. Some tools may offer genuine help outside of therapy. But when these tools begin to replace the therapeutic relationship in the patient’s inner world, they no longer support the therapy. They displace it.

The promise is comfort and the poison is disconnection.

Therapy asks something different. It asks the patient to feel, to wait, to hold their experience and bring it not to an app, but to another human being who can sit in the mess with them. Who can disappoint them, hold them, survive their projections, and reflect something true.

Good psychotherapy demands the space between psychotherapeutic work unfolds not just in sessions, but between them. That space matters as it is where the unconscious stirs and something forms that has not yet been said. Where the patient discovers whether they can bear not-knowing, not-solving, not being rescued by words on a screen.

In filling that space with AI, we risk not only weakening the therapy, but we risk weakening the patient’s capacity to think, to feel, and to relate.

Between sessions is where the work deepens. Let’s not give that away to an algorithm.

 

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 by Mark Vahrmeyer

Masochism and the Impossibility of Desire

Dissociative identity disorder: A rare trauma response, not a social trend

Can AI offer therapy?

Why staying in your chair is the key to being a good psychotherapist

What do dreams mean?

 

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Holding the frame: the role of boundaries in psychotherapy

Why psychotherapists must remain vigilant about boundaries

Despite training, supervision, and ethical guidelines, psychotherapists—like all human beings—remain vulnerable to lapses in judgment. At best, these take the form of clinical misattunements. At worst, they can result in serious boundary violations with lasting harm. Understanding the structural and psychological functions of boundaries is essential to safeguard both therapist and client.

Clients come to psychotherapy principally to work on their relationship with self and others. Usually these relationships are not working because of dysfunctional patterns that are learnt in childhood and repeated in adulthood.

These patterns invariably also show up in the relationship with the therapist, also called transference. The client transfers onto the therapist their past relationships and acts as if in the past with their family of origin. This manifests in a number of ways, and it is the job of the therapist to point this out and work with it – also called ‘working through’.

Awareness of how transference plays out both in therapy and in the client’s wider relationships is essential to stopping or reducing these unhelpful and dysfunctional patterns so that the client can live in the present and relate accordingly, instead of acting as if they were still back in the traumatic past.

Regardless of whether the therapeutic approach is relational, behavioural or analytic, understanding how transference shapes the therapeutic relationship is essential, and an ability to work with it is key in addressing the root causes of the client’s relational issues. Alongside transference, therapists must attend closely to their countertransference—the emotional and bodily responses elicited by the client. These responses can be fertile ground for insight or, if unexamined, a pathway to boundary violations.

Hence the importance of tight professional and ethical boundaries which can contain reenactments (repetitions) of the past in the present, and a framework which enables the client to work through painful losses, stuck belief systems, and destructive behavioural loops.

Failure to notice how the past manifests in the present can lead to all sorts of reenactments of the client’s past in the relationship with the therapist which can in turn lead to ethical breaches, poor therapy, and conduct which is unprofessional and harmful to the client. Here are some common examples:

How dual relationships undermine safety, blur roles, and risk psychological harm

Therapist enters into a personal or business relationship with their client. This is one of the most serious ethical breaches, the main source of complaints and the most harmful scenarios in a psychotherapy relationship. Clients are not supposed to gratify the therapist in any way, be it through a professional relationship other than the therapeutic one, or in a personal way through a romantic, sexual or friendship liaisons. Of course some situations are more harmful than others, but all entail a crossing of boundaries from which there is no return.

The moment these boundaries are crossed, the therapy has ceased to be helpful and has become harmful. Whether this takes place during the therapy or after it has ended has equal damaging consequences.

It is the job of the therapist to protect the work and treat the client as someone who is seeking the help and support of a professional who is safe, boundaries and professional. The therapist is in a position of power. Therefore these boundary breaches are an abuse of their power. 

Therapeutic relationships should always remain as such and the boundary held during and after the work, to protect the good work done. Some clients will wish for the relationship to become more. The therapist in his or her role becomes over time many things for the client: authority figure, mentor, teacher, parent, malevolent or benevolent figure, etc. These have to be held as projections and not-real. This isn’t to say that the rapport and good working relationship is not real, but the therapist has to be comfortable with being projected onto and hold these projections and feelings, whether positive or negative, with neutrality and not act on them.

When the therapist succumbs to impulses to gratify themselves or the client by changing the relationship into something else, the therapist has left their professional role and thereby their usefulness to the client. Moreover, it takes away from the client their opportunity to work through patterns that cause suffering. 

The Rule of Abstinence: resisting personal gratification in service of the client’s process

The rule of abstinence in psychoanalytic psychotherapy in simple terms entails not giving the client direct satisfaction, for instance by offering personal information or explanations that do not aid the therapy or furthers the client’s development. Psychotherapy is not about satisfying the curiosity of either client or therapist. Arguably, anything that goes against the rule of abstinence is not a useful intervention and therefore does not help the client. This is because direct satisfaction takes away from the client’s capacity to symbolise (Etchegoyen, 1999 p.12). Symbolic meaning is essential in any therapeutic work and what leads the client to a deeper understanding of their psyche and therefore of themselves. Developing the capacity to symbolise is essential in that it is what enables the client to observe, understand, think and reflect on their life situation, and ultimately what enables a person to change.

Therapists are human beings and therefore experience human responses to their clients all the time. Some of these feelings can lead them to feel compelled to explain themselves (different from accountability), answer personal questions, defend themselves or overshare. Unfortunately there are many cases where therapists have acted on strong feelings with disastrous consequences for the both the client and themselves.

Offering up information or answering certain direct questions without exploring the symbolic meaning behind the client’s curiosity, or the therapist’s motivation to share, bypasses an opportunity for both client and therapist to truly understand what is happening in the client’s inner-world. This isn’t to say that every question the client poses needs to be interpreted or analysed, but it is a skill to navigate through the different possibilities a client presents us with in every session. 

Some of the questions we need to ask of our interventions are:

  • Does it further the work?
  • What is the therapeutic use to the client?
  • Does it aid the client’s development?
  • Is this for my benefit or for the benefit of the client?

As Etchegoyen states: “The aim of Psychotherapy is to cure, and any process of communication that does not have this purpose will never be Psychotherapy”. 

Holding the frame in practice

Therapists must not only understand boundaries intellectually but embody them in their clinical stance. This means cultivating emotional neutrality, self-reflection, and supervision as ongoing supports in maintaining the therapeutic frame. Ultimately, boundaries are not barriers—they are the structure that makes healing possible.

 

Sam Jahara is a UKCP registered Psychotherapist, Supervisor and Executive Coach. She is also the co-founder of Brighton and Hove Psychotherapy. Sam works with individuals and couples from Hove and Lewes.

 

Further reading by Sam Jahara

The psychology of the cult leader

Why therapists need their own therapy?

Radical self-care as an antidote to overwhelm

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Why do boundaries matter in psychotherapy groups?

The importance of boundaries in psychotherapy

I think it’s probably fair to say that all models of psychotherapy view boundaries as important. Analytic therapies particularly emphasise the role of boundaries and see them as integral to the psychotherapeutic process.

There are many ways of understanding why boundaries are crucial. When I reflect on my work as a therapist, I particularly think about how boundaries seem to offer containment, safety and consistency. These conditions seem vital for many reasons, not least because many people who enter therapy have not had them met sufficiently in their childhood.

In one-to-one therapy, it is the therapist who is responsible for holding the boundaries and keeping the work feeling safe and contained. For example, you can reasonably expect that the therapist will be on time to sessions, will aim to give plenty of notice for cancelled sessions (except obviously for emergencies like sickness), will keep the things you share and your identity confidential. It would also be reasonable to expect that the therapist will not be eating food or drinking anything other than water in the session and not be under the influence of drugs or alcohol. Most models disapprove of therapists making any physical contact with you – so no hugging or touching. And of course, essentially, the therapist must not confuse or abuse the relationship by becoming, or trying to become, something else, for example a sexual or romantic partner, friend, confidante or fellow patient.

Not only do boundaries offer a particular containment to the therapeutic work, how a patient might respond to them will also provide information and insights. This can prove useful for helping to understand ways in which they might struggle in the present or how boundaries (or perhaps lack of) were experienced as a child. Sometimes when people challenge boundaries in therapy, they are really trying to check that they will hold.

While therapists will regularly find boundaries pushed in individual work, overall, those who have had sufficient training and are working ethically, and in a patient-centred way, are generally able to keep the boundaries intact and the work secure and contained.

Boundaries in psychotherapy groups

In a group, keeping the therapy and members feeling contained becomes more complicated and the role of holding the boundaries can’t just reside with the therapist.

Before joining a group, potential members are asked to consider and commit to maintaining the group’s therapeutic boundaries. These are pretty much the same as those outlined earlier. In addition, keeping relationships safe and protected is helped by an explicit boundary of not having contact outside. Sometimes this isn’t possible for various reasons. In this situation, members need support and help from the group and therapist to maintain enough personal distance outside the group so they can keep themselves and the group feeling safe.

These boundaries are not rules for group members (there are no consequences to breaking them – within reason at least), but it is understandable that they can feel like it. Some of these boundaries are more obvious and easier to adhere to than others. For example, I have rarely experienced a group member under the influence of alcohol or drugs during a session and my experience is members are also very respectful of the need to protect each other’s confidentiality.

Where the boundaries become harder to maintain is more likely to be around repeated cancellations or lateness, or leaving the group without the required notice period. Also drinking coffee, tea or juice in the session, as opposed to just water, is in my experience not an uncommon boundary flouting. It’s harder perhaps to register the importance of these kinds of boundaries being held and to see why it matters. It can feel difficult for group members to question when they are being pushed by someone in the group. It’s easy perhaps to feel that they are making a fuss or doing something that is really the therapist’s ‘job’.

Because in group therapy there is more than one patient, there are multiple possibilities of boundary reactions and breaches, sometimes simultaneously. The group can feel the unsteadiness this creates at times. The therapist and the group members need to hold firm to help the group feel safe enough. The best way to do this is to name and talk about those times when members might test or push at the boundaries and explore the impact on the group, as well as the meaning for the individuals.

The aim, however, is not for members to never push boundaries (although it is a reality that some group members feel less compelled to than others). A group situation with no boundary challenges is unrealistic and, given what can be learned, not necessarily always helpful.

The theory underlying group analysis sees problems as belonging to the group, not just located in the individual member, and so anyone shaking the group boundary will be viewed as not just acting something out on their own behalf but also – more unconsciously – on behalf of the group. The culture of the group analytic therapy group, which includes being curious, means there is rich and therapeutic potential in thinking about the meaning of a boundary push on several levels – what it means for the individual, for the other group members and for the group as a whole.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.  She also offers couples therapy at BHP.

 

Further reading by Claire Barnes –

What is transference and why is it important?

What happens in groups: free-floating discussion

It’s not me… It’s us!

What are the benefits of a twice weekly therapy group?

Understanding feelings of guilt

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Why staying in your chair is the key to being a good psychotherapist

When working with trainees and supervisees, I frequently refer to the need for a psychotherapist to ‘stay in their chair’. Let me explain.

Psychotherapy is a relationship. It is a very intimate and unique relationship between the clinician and their patient, which is principally about the needs of the patient. This, however, does not mean that the psychotherapist acquiesces to every whim or request a patient may have. On the contrary.

The key to any successful relationship, whether a friendship, a romantic relationship or a parent-child relationship, is that there are clear boundaries. Often, if not always, when a patient comes into therapy it is because they have grown up in an environment where the boundaries were poor, inappropriate or non-existent. In other words, they grew up with relational deficiencies.

Poor boundaries create a psychological and at times physical environment, where there ceases to be a differentiation between self and other. This is often referred to as a merger. Where children grew up with a parent or parents with poor boundaries, the experience can be hugely impactful on their psychological and emotional development and, in attachment language, leads to insecure or disorganised attachment styles. In simple terms, it makes it very difficult for these individuals, once adults, to have healthy boundaries in two-person relationships; they are either at the mercy of the other, or conversely, make everything about themselves and fail to recognise the needs of the other.

As a psychotherapist with fifteen years of experience, I have yet to meet a single patient who crossed my threshold, who did not have issues with relationships and thus had attachment damage. It’s the work.

One of the primary roles of the psychotherapeutic relationship is to have a caring, loving relationship with the patient, that is in their best interests. It therefore is boundaried by definition.

One of the tenets of working as a psychotherapist is that it is always in the best interest of the patient for the clinician to hold the boundaries. Even if the patient pushes against these – and they will. Just as it is a parent’s role to hold the boundary with their child and hold their best interests in mind, since they cannot.

So, now we are coming to the meaning of ‘stay in your chair’ which I mean both literally and figuratively. Put simply it means stay in your role and hold the boundaries, because without boundaries, the psychotherapy ends.

Patients who have not grown up with clear and supportive boundaries will unconsciously try and recreate a familiar dynamic, generally stemming from their childhood, in the psychotherapy. Us clinicians refer to this as transference, which is a form of projection from the patient onto the clinician. The difference between projection and transference is that the role of the psychotherapist is to think about and understand the projection onto them, and within this to recognise the relational blueprint of the patient and whom the psychotherapist represents for the patient. In simple terms, the patient will attempt to ‘play out’ the most influential relational patterns from their childhood with their psychotherapist. And if this is not caught and thought about, then the therapy simply becomes a repeat of the patient’s childhood experience.

Whether a patient attacks or seduces, our role is to stay in our chair – to remain consistent and constant and to hold the boundaries. Patients will invariably ‘act out’, which is to say that they will embody and play out dynamics that are counter-productive to the therapy, but familiar to them. Our role as a clinician is to survive these acting outs and to protect the therapy at all costs, Sadly, the concept of psychotherapy has become increasingly diluted in the UK, in part due to a lack of differentiation between counselling and psychotherapy and a general ‘race to the bottom’ amongst training institutions. The result is that therapists increasingly have no concept of ‘staying in their chair’ and either move towards the patient when seduced into a collusion, or back away and abandon when attacked.

Lastly, this is not to say that as psychotherapists we should accept or ‘put up with’ attacks from patients. On the contrary, the boundaries are there to protect us too, and if a patient verbally attacks and cannot return to think alongside their therapist, then they may simply be unsuitable for the work, which is also a boundaried position to hold.

 

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 by Mark Vahrmeyer –

What do dreams mean?

Is starting psychotherapy a good New Year’s resolution?

Twixtmas – surviving that dreaded time between Christmas and New Year

How to minimise Christmas stress if you are hosting

How do you get self esteem?

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The therapeutic journey: a pilgrimage to the soul?

As a psychotherapist, I’ve come to understand healing as a profound journey—not unlike the transformative experience described in the photo of the welcome sign below, sent to me by a colleague who has recently walked the Camino de Santiago.

Just as pilgrims leave behind their familiar comforts to venture into the unknown, therapy invites you to embark on an equally courageous inner expedition.

Imagine therapy as a sacred space—much like Beilari—where ‘we share rooms with strangers’ and strip away the protective layers we’ve constructed. In our therapeutic alliance, we challenge the ‘lives of comfort and privacy’ that have insulated us from our deeper truths. We step away from the ‘habitual rush accelerated by lists of obligations and the interest of our agitated minds’ and create a different sense of time—a healing time where introspection and self-discovery take precedence.

Just as Beilari invites pilgrims to ‘divest ourselves of the character we have believed we are’, therapy offers a similarly profound opportunity. Here, you’re not defined by your social roles, professional identities, or family expectations. Instead, we sit metaphorically at the same table, creating a space of radical authenticity where your essence can emerge.

The therapeutic journey is about understanding that the ‘unknown parts’ of yourself are not to be feared but explored. Like the pilgrim’s path, this route is not always comfortable. It demands courage — the courage to look deeply, to accept what you discover, and to transform. We seek ‘discernment in difficulty’, learning to see challenges not as obstacles but as gateways to deeper self-understanding.

In our work together, we’ll explore the illusion of separation. Just as Beilari suggests that an ‘unknown person is really a part of ourselves’, therapy helps you recognise the interconnected nature of your experiences, emotions, and inner landscapes. We are not isolated beings but part of a larger, more complex human narrative.

This journey requires an ‘open heart’ and a willingness to be vulnerable. Like a pilgrim stepping into an unfamiliar landscape, you’ll be invited to exchange profound glances with your inner self — to share the essence of who you truly are, beyond the masks and defenses.

I offer you a therapeutic space that is ‘unconditional, non-judgmental, non-transactional’. This means our work together is not about fixing or changing you, but about accompanying you as you uncover your most authentic self. We walk together, but you are the pilgrim of your own soul’s journey.

‘Buen Camino’ as they say — good journey. Every step you take in therapy is an act of courage.

We’ll work to cultivate ‘lightness in every step’, openness to what emerges, and the strength to strip down to your most alive, human self — ‘vibrating in Divinity’.

Your therapeutic pilgrimage awaits. Are you ready to take the first step?

 

Shiraz El Showk is a Training Member of the Association for Group and Individual Psychotherapy (AGIP) and a registered Training member of the UKCP, She is experienced in Psychodynamic counselling and Psychoanalytic Psychotherapy work with individuals, on both long and short term basis. Shiraz works from our Brighton and Hove practice, Lewes practice and online.

 

Further reading by Shiraz El Showk –

Surviving family festivities: a psychoanalytic journey through the twelve days of Christmas

Parents – the ghosts and angels of our past

Is an AI therapist as good as a human one?

What is the unconscious? (part one)

Why is three the magic number? Third spaces, secure bases and creative living (part two)

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No space to be heard?

When life feels like it’s getting on top of us, it can feel like there’s no space for our thoughts and feelings to be heard. This can make us feel isolated, and the problems we’re trying to deal with seem a lot worse. This points to the core of what therapy offers: physical and psychological space where you can voice your problems and feel meaningfully heard and understood.

This article aims to introduce some of the different types of space we use in therapy and how they might help.

Trusted space

The consulting room where the therapy takes place is separate from your everyday life, free from interruptions and what’s said there is confidential. This aims to provide a safe, non-judgemental space you can have faith in.

Coupled with this, you will have chosen a therapist who you believe to be a skilled and empathic professional. Feeling comfortable and confident with your therapist is key to a successful outcome. As this understanding between you develops, you will increasingly feel open to discuss in-depth the problems that brought you to therapy.

Space to explore

From this foundation, therapy is able to move into an exploratory space, where you and your therapist work together to listen with curiosity and compassion to the feelings and experiences that you’ve often kept hidden.

As the work deepens, you are likely to connect more fully with your current emotional difficulties, and also with earlier, often buried experiences. It’s common to start feeling heard and understood in a new and profound way. This alone can have a powerful impact.

Potential space

Old patterns, often learned deep in the past, start to show themselves. There can be a sense of more space opening up between you and previously overpowering feelings.

This often brings emotional and psychological relief, while showing different ways of seeing problems and understanding how you might approach them.

The British psychoanalyst, Donald Winnicott, coined the concept ‘potential space’ to refer to a transitional area that lies between fantasy and reality in therapy, where therapist and client start creatively considering new and different options. Not only does this enable fresh insights and understanding but it starts opening up new possibilities for the future.

Space to take away

The course of therapy not only provides a space once a week for the therapy itself, but increasingly develops an internal space – within you. Through your experience of therapy, you develop the capacity of internalising not only your new understanding of the problem you’re working on, but also how to understand yourself in the face of problems you may encounter in the future.

Therefore, this internal space not only gives you more understanding of your patterns, relationships and needs, and the ability to manage feelings and respond more constructively in the present, but you get to take this internal space away with you, to refer to and use whenever it is helpful to hear yourself, know what you think and feel, and envision what might be the way forward. This is perhaps therapy’s biggest gift.

Opening a space

With our lives putting ever-growing demands on us, we can be under pressure to act unconsciously and repeat unhelpful patterns. Therapy offers us the opportunity to do something different: to give ourselves a moment to pause, to listen to what we really think and feel, and see how we might adapt to be more in line with ourselves, and feelmore fulfilled.

Viktor Frankl, the existential psychotherapist and Holocaust survivor, wrote in his book Man’s Search for Meaning: ‘Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.’

 

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

Thad is an experienced psychotherapeutic counsellor and a registered member of the British Association for Counselling and Psychotherapy (BACP). He works long-term with individuals in our Lewes and Brighton and Hove practices.

 

Further reading by Thad Hickman

Does your life story make sense?

When something has to change

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What Can Couples Counselling Help With?

Couples Counselling or Couples Therapy can help the couple communicate better, look at past influences on present behaviour and help the individuals within the couple understand themselves and their partner better. Depending on approach to couples therapy, the therapist will either work with the here-and-now issues and provide the couple with tools to better communicate and relate to one another, and/or look at the dynamics stemming from each person’s family of origin and what each brings into their relationship.

In a sense, the role of the therapist is to introduce the individuals in the couple to one another. There are sides of ourselves that might be difficult to show to our partners without the help of a third party who is “looking in” the relationship.

Observation

The couples counsellor acts as an observer of the couples existing communication style, noticing how they interact both verbally and non-verbally. This information assists the therapist and the couple in helping to identify unhelpful patterns and difficulties in getting important messages across. Communication involves speaking, listening and other vital non-verbal cues.

The aim is to achieve greater awareness of how we come across by slowing things down, reflecting on what was said and noticing how things are received by our partner. Patterns of communication usually stem from how we were taught to communicate in our family of origin, therefore what comes naturally may not be what is needed to improve a relationship.

Mediation

Some couples work involves mediation between parties, especially in situations of conflict and impasse. When the couple gets stuck in recurring patterns of behaviour, a skilled third party can assist in calming things down when exchanges get heated, keep track of certain dynamics, and suggest new and different ways of dialogue that are more conducive to conflict resolution. Ideally, in time, mediation is no longer needed and the couple will eventually learn to slow things down themselves and reflect on their style of relating without the help of a professional.

Education

The therapist’s role is also that of an educator in the art of relating and communicating better. People who are very skilled in other areas of their lives can get stuck when it comes to their relationship. There is no shame in being a master communicator in your job but completely fail when it comes to your relationship. This is because there is so much more at stake. The closer we are to someone, the more difficult it is to see things clearly. Some people may feel resistance to coming to couples therapy because they don’t want to be taught to do something that they think they should know themselves. However, a certain degree of humility when it comes to improving your marriage or partnership, can go a long way. Afterall, we are all learning new things all the time.

Final Thoughts

It might feel daunting for couples to talk about the difficulties in their relationship to a total stranger. It can also feel exposing to talk to a stranger about your feelings in front of your partner. However, this very exposure is what enables us to lower our defences and put us in a more receptive and reflective frame of mind. Individuals within a couple often, over the course of their relationship, built walls around themselves as a protection against emotional
hurt and pain. Within a safe space and with a trusted therapist, the couple can hopefully begin to talk about and understand the origins of these feelings. This usually leads to partners getting to know each other better and feeling closer as a result. With more tools and healthier patterns of relating learnt during the sessions, the couple should feel more equipped to continue working on their relationship even after the therapy has ended.

 

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

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Relax: Watching people using their hands

Stuck at home I don’t always want to chat with friends and family or listen to any more news, podcasts or watch TV drama or read a book. Yet I want to be taken out of myself. I want to be elsewhere and with my own thoughts at the same time.

Being engaged in an activity that uses our hands is recognised as having therapeutic benefits. During the privations of Covid-19 lockdowns making and baking have become popular. You can find numerous examples of famous faces presenting the results on social media. For example, the Olympic diver Tom Daley says he took up knitting to help him relax and he has knitted clothes for his husband and child. Finding no knitting patterns for men’s swimwear he adapted a pattern for bikini bottoms and produced a pair of crocheted speedos for himself.

There is also a therapeutic effect when we watch someone else using their hands. Think about the close-ups on hands in cooking programmes. Might this satisfaction in watching be something to do with mirror neurones. Discovered in the 1990s, mirror neurones fire in the brain of observers whilst watching or listening to another person performing an activity. The neurones that fire in the brain of the person performing the activity are mirrored in the observer. That is, the same neurones fire in the brain of the observer. It seems we can experience what another is experiencing at the same time. This has led to research investigating the role of mirror neurones in how empathy operates and how we learn.

Whilst watching the gardener raking the Zen garden in this video clip, I find I can sense his body movements, almost feel the weight of the rake and the resistance and flow of the gravel. And then I watch it again. I can be there in that garden and at the same time sitting at home relaxing into my own thoughts and imagination.

 

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

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What shapes us?

We all have key figures in our lives, people who either held or hold great importance because of their positive impact on our professional and personal lives. They may have been people who we are either personally or professionally connected to, such as parents, siblings, friends, family members, or teachers, bosses, coaches, therapists and work colleagues, to name a few.

These people become so important to us because we internalise their qualities and also their positive messages to us, whether they were implicit or explicit, verbal or non-verbal.

Therapists are keenly aware that some key elements need to be present in our work in order for a positive relationship to form. We know that many who come to therapy do so because of breakdown or absence of relationship early on, which we can also understand as a scarcity or total absence of some key elements listed below:

Interest and Curiosity

To feel seen, heard and to perceive sense of curiosity towards oneself from another, which is engaged, honest and encourages mutual trust. Delight, enjoyment and even surprise in the exchanges that take place.

Attunement

Usually used in the context of a parent-child relationship, but the word is also used in other contexts. Attunement is a quality where the other person ‘tunes in’ to another, almost as if trying to absorb and understand what the other is communicating on a deeper level. Attuning entails putting oneself aside to hear how the other views and experiences the world.

Consistency

Consistent love and care is something children need in order to feel emotionally and psychologically safe. This continues to be the case for adults, albeit in a different way. The consistency in the care of others is what gives us a sense of belonging and therefore a sense of safety in the world.

Commitment

To feel the commitment of another to a relationship is another form of consistency, but also one that affirms that “I am here for you” or “You can count on me”. This doesn’t not mean that the other won’t disappoint at times or will always be available. But they let you know that you can rely on their commitment to you as a friend, partner or in an ongoing professional relationship, such as the regular long-term commitment of psychotherapy, for instance.

Time

Related to the two above in that there needs to be a consistent time commitment in order for any relationship to work. The gift of time cannot be underestimated, especially in today’s world. With time, important conversations take place, people get to know one another and things are allowed to unfold. We feel valued and important when others make time to be with us.

Connection

Of course this can’t be forced. We either feel connected or we don’t. However, all of the qualities above are conducive to developing a connection with another. Some people are better than others at connecting, both to themselves and therefore to other people. But there are times when the chemistry between individuals exists in a way in which can’t be explained. Some of these formed connections stay with us for a very long time, if not forever.

What are other qualities that you see as essential to forming a positive bond with someone? I look forward to your thoughts.

 

To enquire about psychotherapy sessions with Sam Jahara, please contact her here, or to view our full clinical team, please click here.

Sam Jahara is a UKCP Registered Psychotherapist with a special interest in working with issues linked to cultural identity and a sense of belonging. She works with individuals and couples in Hove and Lewes.

 

Further reading by Sam Jahara

How Psychotherapy can Help Shape a Better World

Getting the most of your online therapy sessions

How Psychotherapy will be vital in helping people through the Covid-19 crisis

Leaving the Family

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What is narcissism?

Narcissism is a Freudian term that has become perhaps more ubiquitous in the social lexicon than any other derived from psychoanalysis.

It is a term that seems to define a generation in the eyes of the media – the Millennials, and one that we use disparagingly to describe celebrities before following them via social media, emulating them or electing them to the highest public office.

Narcissism in psychotherapy

In psychotherapy, narcissism is on a continuum from healthy to pathological. For example, it is entirely possible for a client or patient to lack enough healthy narcissism, in which case, the work is to strengthen their ego accordingly.

The sort of folk who get labelled as ‘narcissists’ – those who crave celebrity status, fame and live up to legend in seeking their reflection in the mirror that is society – rarely presents themselves for therapy. After all, why would they? They don’t have a problem – the problem is everyone else!

When we psychotherapists talk about narcissism and narcissistic defences and structures, it is rarely these people we are referring to. So how can we better understand narcissism as it presents in psychotherapy treatment?

What causes unhealthy narcissism?

Unhealthy narcissism is a defence.  Generally, it comes about through the young infant learning through relational patterns with his or her caregivers that he or she cannot rely on them, leading to a ‘turning away’. This turning away marks the beginning of a defensive structure built around self-sufficiency. However, this is not a self-sufficiency born out of healthy confidence, but one born out of emotional neglect.

Narcissistic structures are often well hidden in clients and patients and difficult to treat. Narcissistic patients and clients tend to treat all relationships, the therapeutic one included, as things that are there to be used and thus discarded when no longer of use. Relationships (in the truest sense of the word) are threatening at a core level to people who rely on narcissistic defences, as any true relating will open them up to a whole host of unbearable feelings and mental pain. The latter lies at the crux of the function of the narcissistic defence; the inability to cope with, endure and make sense of mental pain.

Is working with clients and patients exhibiting narcissistic defences a lost cause? Not if they willingly enter the therapy room and not if they are able to think about their vulnerable side and how they needed to develop a disdain for this part of themselves in order to survive. Without a doubt though, it will be a lively journey, because as the charming, likeable and self-sufficient façade starts to crack, rage, envy and mental pain will emerge and present themselves in the therapeutic relationship. This is often where the therapy can end, as the therapist is unable or unwilling to engage with the enactments that invariably will play out. If, however, these can be worked through, then there is genuine hope.

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.

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