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What causes insomnia?

Insomnia is defined as being a habitual, or regular, inability to sleep.

Whilst it can be linked to medical conditions, the most common causes of insomnia are lifestyle related as well as anxiety, depression and stress related.

With regards to anxiety, depression and stress, insomnia is not only caused by these conditions, but it further exacerbates them too creating a vicious circle.

What can I do to help with my insomnia?

Improve your sleep hygiene

Sleep hygiene is a term used to describe a holistic approach to sleeping encompassing who you are as an individual and your sleep environment. Improving sleep hygiene involves thinking about where you sleep, how you sleep and what may work best for you.  Sometimes this will involve a degree of experimentation, for example, do you sleep better with the window open or closed? 

Stick to a routine of sleeping and waking

Research has shown that we are biologically predisposed to sleep and wake at the same time each day, ideally in synch with the setting and rising of the sun.  Whilst the latter is a far cry from modern life, coming up with a routine and sticking to it can be extremely beneficial to both your sleep patterns as well as your physical health.

Avoid stimulants

We all know that caffeine and alcohol will impact on the quantity and quality of our sleep.  However, watching a disturbing drama right before going to bed – or the news – can have an enormous impact on the ability for us to get to sleep.  It is much better to consume the news in the morning when we have the mental capacity and waking hours to digest it.

Why do anxiety and depression make insomnia worse?

Anxiety and depression are two seemingly different mental health problems that frequently find themselves side-by-side in the same sentence.  This is because they are essentially two-sides of the same coin.

Anxiety is an uncomfortable (at times, unbearable) feeling that gives us the sense that all is not well with the world.  It is an ordinary element of being a human being and many scholars believe that we are ‘cursed’ with anxiety due to our (largely unconscious) awareness that we are going to die.

Anxiety causes restlessness and many people deal with anxiety by channeling it into activity – something that fails when it comes to going to bed.  Anxiety is often described as ‘free-floating’ and will seek to attach itself to something.  We can then convince ourselves that the ‘thing’ our anxiety has attached to is the real problem, however, this is rarely the case.

Depression is a state of inertia but an uncomfortable one.  Anxiety (and stress) can have the function of protecting us from depression, however, eventually anxiety will give way to the hopelessness of depression.  One may think that sleep would come easily in a state of depression but this is often not the case as hopelessness can feel unbearable.

Can counselling or psychotherapy help with insomnia?

If a client presented with insomnia than I would want to understand what may be causing the insomnia and to work with the client to gain a deeper understanding of what their feelings may be telling them – particularly any anxiety or depression.

Whilst anxiety is a normal element of being a human being, it should not be debilitating and an ideal is to engage in a meaningful life whereby the anxiety is channelled in a healthy way. 

Alongside this is a deepening of the relationship with ourselves in order to learn to better tolerate difficult feelings without becoming overwhelmed by them.

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy.  Mark is available at the Lewes and Brighton & Hove Practices.

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Why does empathy matter?

When you begin therapy you enter into a particular (perhaps peculiar) type of relationship, one with well defined boundaries and ethics. Beyond its method and structure, at the very heart of this relationship lies empathy.

As a therapist empathy means doing all you can to understand your client from inside their own experience. It requires an ability to communicate this understanding in ways that are sensitive, meaningful and useful, both verbal and nonverbal.

It is a powerful experience to feel understood, listened to, cared for and respected. Over time it can make it easier to have empathy for yourself, to take your own personal pain and suffering seriously, to judge it less, as trivial, stupid or simply a product of your own personal weakness.

When we begin to take our own struggles seriously, we gain access to another layer of empathy: compassion for the child that we were, often a child who made sense of what troubled them by deciding that there must be something wrong with them – that they were the problem. In the context of an authentic and empathic connection with another human being the shame or disgust or guilt that has become so entangled in our sense of self can begin to make way for new feelings. Sadness (perhaps) for what was lost and loving regard for the child who did the best they could at the time.  When there is more space in our imaginations for the reality of our own struggle, we can begin to see other people differently too. When we experience the power of feeling understood we may also experience greater internal space for new thoughts and feelings, both about ourselves and about others.

The therapist as client

All psychotherapists have had their own experience of being a client in therapy. Sharing the most intimate and often painful moments of someone’s life is made possible when you have felt and expressed your own. It is not that as a therapist you become an expert on life (not even your own) but that having undergone your own therapy you will be more equipped with the clarity to differentiate your separate self and experience from that of another.  To understand whose feelings are whose and to have the versatility  and flexibility to step into and out of another person’s shoes.

The circuitry of empathy

Empathy is a complex system of mutual cues and responses that regulates each persons experience of self and other. We observe this very clearly in parent/ infant interactions. How attuned a parent is to the (myriad/micro) communications of an infant will inform the infants reciprocal response to the parent.

It is not that in an ideal world infants and young children would be perfectly attuned to at all times. Over-attunement can be stifling and intrusive. What’s more important is the experience of an ongoing relationship in which misunderstandings and mis-attunements can be repaired.

Emotional neglect and emotional intrusion are flip sides of the same coin. Anyone who has suffered either will have good reason to believe that they may never be understood.

As a therapist we cannot “know it all” for our clients, we cannot tell someone how it is they feel or what is true for them. What we can provide is an open ended, respectful curiosity for our clients and a willingness to share in the important project of “getting it.”  Paying close attention to the unique form of connection that exists with each client means understanding empathy as a mutually influencing system. From this perspective, the communication of empathy becomes much more a mystery to engage with than a tool to master.

 

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.

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Being Embodied in Therapy: feeling and listening to your body

Therapy is often called a ‘talking therapy’ but what is talking exactly?

Generally speaking, what someone says is what therapists consider and explore in session. Body psychotherapies are often the exception because language and thought are understood as different aspects of being in and as the body. The rise of mindfulness-based therapies that explore therapeutic change via awareness of the body as a whole could suggest that the focus on talking therapy is changing.

Despite this, what someone says remains a significant focus in therapy. Other than words, what could be important to pay attention to in therapy and beyond?

Existential therapy is rooted in philosophy. Merleau-Ponty (1962) has been deeply influential in how existential therapy considers the embodied being. Merleau-Ponty illustrated how our embodied nature is our primary experience of the world and how we communicate.

He also emphasised the importance of our existential sexuality (which I will discuss in more depth in a later blog) and embodiment to how we feel and how we react to everything we encounter. This understanding seems fundamental to how we open and close ourselves to the world. Merleau-Ponty reminded us that however we are perceiving experience in our own way, we are always in an interpersonal encounter “like an atmosphere” (p. 168)  .

Perhaps this atmosphere is most readily felt when we open and connect to something that generates sensation, for instance when doing yoga, meditating, making love. Or perhaps when we feel ourselves with others deeply, whether it is in an intimate and caring moment or perhaps feeling a difficult and challenging emotion. This ‘atmosphere’ is incredibly useful to consider both in therapy and in the moment when we feel the cluster of sensations that reveal our ‘being-ness’.

For instance, this atmosphere can point to how we are relating with others. It provides information for us personally but can also highlight how we feel in our relationships. Breaking through repetitive patterns in relationships can be tricky. However, a quick way to cut through stuck narratives is to stop and feel. Pausing the story telling and easing into the direct experience of being with another can sometimes reveal a deeper more intimate layer of being. We may notice we feel more open, or perhaps we may feel more closed. Defences may drop while a sense of feeling exposed becomes more prevalent.

In this moment, we may feel more deeply the sensations which illuminate the connecting space between all we encounter. We may understand more clearly whether we want to move towards or away from something or someone. This understanding can be a hugely significant when we are feeling confused intellectually.

Gendlin’s (1993) writes the “… living body always implies its right next step” (p.32). His commentary about being and focusing in the body seems to support Merleau Ponty’s ideas and suggests that it can be a guiding force to orient and anchor us. Even simple movements, such as feeling the pattern of breath and its impacts, can ground us and bring us into intimately present being. Paying attention to feeling sensations may encourage new understanding to arise. By broadening how we understand ourselves we may find more possibilities emerge where we once felt stuck.

These notions and an openness to experience it directly for yourself can be incredibly helpful in therapy. It is also a significant understanding and experience for anyone interested enough to pay attention to what is actually happening in your body, in any moment.

So, despite therapy often being considered a talking therapy there is much useful information that happens beyond this. Paying attention to what is actually happening in and as the body can be a fantastic starting point. This enquiry does not have to be difficult or complicated. For instance, next time you are out walking or sitting down just notice what it feels like. How do your feet and hands feel? Are they relaxed or tense? Do you feel any tension in your tummy? Let go of any judgement or speculation about it and just feel what is actually happening. If you feel like it, try sensitively easing into the tension. Relax, be curious and see what happens.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice and Lewes Practice.

 

Disclaimer: some of the content of this blog was originally part of an essay for a doctoral programme at NSPC. It has been amended.

1)          Merleau-Ponty, M. (1962). Phenomenology of Perception. Trans. C.                     Smith London: Routledge.

2)         Gendlin, E.T (1993). ‘Three Assertions about the Body’. The Folio 12                      (1): 21–33.

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How to find a Therapist

I’m in agreement with Brett Kharr who argues that unfortunately we have a strange situation in therapy where there are an almost innumerable different types of therapies to choose from.  I think this reflects the consumerist, swipe right, swipe left age we live in and actually makes starting therapy more confusing for clients.

Richard Chessick, a Psychoanalyst, writes that;

“It is the experience of the therapists personality and the encounter with the therapist as a human who is truly present, rather than any verbal exchange, that makes the fundamental difference in therapy. It forms a link, that brings the patient in consistently over years of treatment, even at times when the patient is very angry or upset. (85).”

If, as a client, you are serious about wanting to change things and about wanting to engage in therapy then it does pay to think a bit about which therapist and therapy may be a good match for you. Sometimes you may feel comfortable with the first therapist you meet after perhaps doing some online research or obtaining a personal recommendation. Sometimes you may want to have a few initial consultations with different therapists. As a therapist I would always be more than happy for you to do this. As a client I would advise on being as honest as possible with the therapists you meet about this, as it’s a good chance to gage their reaction. A therapist where you feel you might have to worry about hurting their feelings, may not be the best choice.

When I began my training the course leader, in one of our first seminars, talked about the therapists needing to have personal therapy and how to choose and get the most out of therapy, said one thing that has stuck with me –

“Make sure to give your therapist hell”.

I have often thought about that statement and have come to appreciate, that I think at essence, its saying how important it is to be as honest as possible in therapy, especially about the things you don’t want to say and especially about the things you don’t want to say to your therapist.

This may feel strange. You may feel your therapist is annoying, a disappointment, etc.  What’s useful about this and I believe unique to therapy is that the therapist who has had a thorough therapy themselves won’t take it personally, they will be able to reflect on the bits that may be true, but also may be able to help you think about the bits you may be bringing that you may also bring to other areas of your life. Is the experience of finding your therapist annoying/boring/uncaring or whatever, something you experience in other areas of your life in relation to other people? If so the special circumstances of the therapeutic relationship can be a unique chance gain insight into these recurring patterns as they are happening, not just in an intellectual way but also at a deeper more affective level. It is at that level that I believe change can really occur.

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

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Emotional Well-being

When most people hear the words ‘mental health’ perhaps what they are most likely to think of is mental difficulties, or mental ill-health.  I always think it’s such a shame that ‘mental health’ has these negative connotations, whereas just the word ‘health’ doesn’t seem to. 

I am a big believer in being proactive about mental health and wellbeing, and in the importance of doing things to stay mentally and emotionally well – just as you might keep active, eat a healthy diet and clean your teeth to keep your body well and healthy.  There is, perhaps unsurprisingly, a huge overlap between a person’s emotional and physical wellbeing. The negative impact of stress on health and wellbeing has been well researched. 

Positive Psychology is a branch of psychology founded by Martin Seligman, which is concerned with the positive aspects of life; it focuses on potential and thriving, or as one book puts it ‘positive psychology is concerned not with how to transform, for example, -8 to -2 but with how to bring +2 to +8’.[1]

So, what might be the emotional equivalents of cleaning your teeth or keeping active be?  There are lots of ideas that can be helpful, and some will suit certain people more than others.  It is worth trying out a few different ideas to see what works well for you.  Using a planner can help, to ensure that you are regularly and frequently doing something specifically to have a positive impact on your emotional wellbeing.  It’s good to have a mixture of things across a week, including things that bring you pleasure and things that bring a sense of satisfaction or accomplishment. 

The list below includes different ideas and strategies drawn from Positive Psychology, and other areas of psychology:

  • Engaging in physical activity
  • Noticing your strengths
  • Actively relaxing – this could be using imagery, or a progressive muscle relaxation
  • Random acts of kindness
  • Spending time engaging in hobbies
  • Spending time with, and investing in close relationships
  • Completing the ‘Three good things’ exercise; every night for a week spend some time to identify and write down three things that were good about the day and notice your role in them
  • Thinking about someone you are grateful to or for, and telling them about it
  • Spending some time paying attention to the present moment (Mindfulness)

Later this year I will be running a series of workshops along with a physiotherapist, looking at tips for having a healthy body and healthy mind which will go further into the topics discussed in this blog.

Dr Emma Stevens, HCPC Registered, is an experienced Clinical Psychologist. She has an integrative approach drawing on Cognitive Behavioural, Systemic and Psychodynamic models, as well as Attachment Theory. Emma sees individuals primarily for sort-term work. Emma is available at our Lewes Practice.

[1] Positive Psychology in a Nutshell, 2nd edition.  Boniwell, I. (2008).

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