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Trauma and disconnection

Dissociation is a term used to describe the mental process of ‘getting rid of’ painful or traumatic feelings by banishing them to a ‘nothing’ place within – for good and for bad. The paradox of dissociation is that in the process of such banishment, far from being shut down, traumatic experience can take on a life of its own. Locked away, our painful feelings are not available for processing and cannot be integrated into a coherent narrative of our history. The consequent effect is that from this place these unwanted feelings may cause us trouble, without us necessarily having any idea of where the trouble is coming from.

A small child will learn early how to dissociate in the face of overwhelming traumatic experience, as a means by which to survive and to keep trauma out of narrative memory. Should that child find themselves in therapy at some later stage in their life, it is unlikely that there will be a ‘whole’ story of what happened to them available for recovery. It is more likely that memory of traumatic experience will present as disconnected and scattered fragments. Strewn across an internal landscape these scraps of memory may still be signalling distress through here-and-now symptoms: psychological, emotional, physical and relational.

Strategies for survival

There are many ways someone who has experienced trauma might attempt to discount or disconnect from uncomfortable or distressing memories and the feelings associated with them.

Emotional numbness, self-medication, overwork, addictions or psychosomatic illness are amongst the (out of awareness) strategies that can maintain the disconnect. The trouble is that when we are unable to connect to ourselves, we will likely struggle in our connections with others, and this is what can keep the effects of early relational trauma alive. When early experience of traumatic events leads to emotional disengagement and disconnection, this system of relating is likely to be replicated in the here and now, long after the original threats have passed.

Shame

A powerful after effect lingering in the shadows of relational trauma is shame. Shame is corrosive and debilitating and when in its grip we are diminished, privately believing ourselves to be defective. When a child can’t make sense of bad feelings an obvious conclusion is ‘there’s something wrong with me.’ Dissociation and disconnection, once the only option for survival, today prevents us from accessing and integrating painful feelings. This we carry as shame; a dirty little secret that controls us from within. On the outside shame might masquerade as anxiety but it’s likely an anxiety that breeds more shame: shame about the amount of work it takes to ‘keep a lid’ on things, to present a together and coherent face to the world; shame about the habits and obsessions that keep anxiety under control; shame about being isolated; shame about interpersonal difficulties. Shame colonises a fragmented psychic landscape and hijacks our interpersonal potential.

Remembering-with

Remembering, in therapy, how bad things once felt is a significant emotional risk for the dissociated client, especially when so much energy has been spent in putting difficult experience out of sight and out of mind. The attuned, sensitive and empathic therapist will understand the magnitude of risk that a client might feel. Remembering ‘with’ is not the same as revisiting traumatic events in (gratuitous) search of catharsis. Having someone bear witness to and validate all the pain, carried for so long and all alone is transformational. It is the way that pain is transformed into grief, and in its way, grief is the opposite of dissociation. In our grieving we can integrate past and present meanings and feelings, and it is in this way that we might finally lay trauma to rest.

 

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

 

 

Further reading by Gerry Gilmartin – 

Therapy and art… an intersection

Cultivating a tolerance for uncertainty

The importance of generosity and forgiveness in a hostile world

Understanding sexual desire

Reflections on freedom and security in a turbulent year

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Why do we repeat past failures again and again?

All of us make mistakes; we wouldn’t be human if we didn’t.

But some past failures or mistakes have a habit of being repeated time and time again. These could be work related, like promising yourself that you’ll hand in an assignment ahead of time, only to leave everything to the last minute and deliver something below your best.

Alternatively, patterns of failure can repeat in more serious ways, such as making poor financial decisions like overspending or getting into debt. They can repeat in behaviours like isolating yourself from those who care for you in a time of need. They can repeat in romantic endeavours, such as continually dating people who treat you badly.

Repeating past failures has the potential to provide endless frustration, confusion, and suffering. And on the surface, it seems completely counterintuitive and unhelpful; why would anyone want to relive their failures or traumas?

It’s possible that these repeated behaviours are not random mistakes that we temporarily forget we’ve learned, but actually our unconscious mind’s way of trying to overcome and solve unresolved problems from the past.

To try to understand this further, I turn to some of the insights presented by Freud’s 1920 paper ‘Beyond the Pleasure Principle’.

Mastery and control

Freud noted that one reason we repeat past failures is an attempt to gain mastery over an original experience or trauma. So by repeating this event in a new situation, that we’re in control of, it gives us an opportunity to try again in more favourable circumstances. A chance to do better than before and master the experience, as well as feel triumph and pleasure when we survive it.

So, to understand this, let’s revisit the example of the person who leaves their assignment to the last minute. Let’s call him John. It’s possible that John had a painful childhood experience where he’d been criticised or humiliated for failing to meet expectations or perform – perhaps at home or school. These painful emotions and memories are likely to remain unprocessed and alive within him, even when he’s not aware of them. So where there’s an opportunity to re-do this experience and master the feelings associated with it, like with his work assignment, he might unconsciously recreate it through performing poorly.

Process difficult emotions

Building on the idea of mastery, Freud also discovered that sometimes we unconsciously re-create past failures or painful experiences, to give ourselves another chance at understanding the emotions we couldn’t fully process when they first happened. When an event in the present echoes a past trauma, our mind could interpret it as an opportunity to work through what was once too overwhelming to face. Our unconscious mind has a frustrating habit of prioritising resolving past challenges, over helping us to succeed in the
now.

So, going back to John, let’s suggest he struggled to learn to read as a child, making him a target for teasing and criticism from his parents or siblings. Perhaps this continued throughout his schooling, where he didn’t perform well in tests at school. At the time, John may not have had the emotional tools to fully understand or process these experiences, so the pain remained unresolved. Now, as an adult, when faced with a challenging work assignment, John unknowingly finds himself procrastinating, leading to criticism from colleagues or managers for delivering subpar work. This new experience gives him another opportunity to process the emotions he couldn’t manage or understand as a young boy.

Resistance to change

We are all at times resistant to change, even when change is preferable for us. But past experiences, both negative and positive, often seem preferable to new experiences that have the potential to be worse. The expression ‘better the devil you know’ comes to mind. By repeating a past failure, we can reconnect with familiar feelings that make sense to us, rather than expose ourselves to a vulnerable unknown.

To explore this, let’s look at the example of the person who continually seeks partners who treat them badly. Let’s call her Penelope. It’s possible that her early experience was that of being mistreated by her parents some way. Perhaps she never received attention from her father or had a mother that criticised her a lot. So when Penelope has an opportunity for connection in later life, she might seek similar relationships with others, who are likely to treat her in the same way. Despite being painful, recreating these past relationships, where she’s criticised or ignored, feels familiar and safer than being treated with kindness or respect.

Self-destructiveness

Whilst we’re all naturally driven to seek pleasure, survival and creativity, there’s also a counterforce pulling us in the opposite direction, towards aggression, destruction and self-sabotage. Depending on our temperament and past experiences, some of us have a larger capacity for self-destruction than others, which can cause us to repeat behaviours that harm us and those around us.

Let’s link this back to Penelope. We all want and need people in our lives that love and care about us. But with her parental experience growing up, she didn’t get this feeling. Being criticised and ignored became her understanding of normal and safe. This might have caused her to take on the belief that she didn’t deserve to have others care about her. So when she’s in a situation where she needs support and care, she pushes others away, re-enacting her experience with her family in a self-sabotaging way.

Breaking the cycle

Unfortunately, repeating past failures is rarely a good strategy for stopping these cycles from happening again. It could be seen as an outdated method our brains use to cope with unprocessed and overwhelming past experiences. However, there are ways to break the cycle, one being long-term psychotherapy.

The work of psychotherapy is to identify these negative patterns of behaviour and look to understand what is being repeated and why it’s unresolved. Through processing these memories and emotions in a safe environment, within a reliable therapeutic relationship, we can attempt to build self-awareness, stop repeating the past and create a future where more healthy choices are possible.

 

Joseph Bailey is a psychodynamic psychotherapist, offering analytic therapy to individual adults in Brighton and Hove. He is registered with both the British Psychoanalytic Council (BPC) and the British Association for Counselling and Psychotherapy (BACP). Joseph is available at our Brighton & Hove Practice and online.

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Trauma and the use of pornography

I explored the use of pornography and its presence in society in previous blog. In thinking about pornography, there is the question of why some people might become habitual users. What part might childhood trauma play in the development of compulsive use of pornography?

Trauma, attachment and anxiety

The experience of trauma in formative years can have a marked impact on the individual when they become sexually active and might be using pornography. Trauma can take various forms and can lead to feelings of difficulty expressing emotions and in forming close relationships.

The connection between trauma and the difficulty in forming close relationships, originates in how the child who experiences trauma is related to. The experience that the caregivers are not able to hear and support the child in expressing and exploring their emotions, shapes the child’s sense of the bond that exists between them. When this bond, or attachment, is not good and secure, the child feels that they are not worthy of care, love and attention and of being ‘attached’. This is when they learn that close relations are not reliable and so are to be avoided. In the sexually active adult, the expression of this may well be that sexual intimacy feels difficult.

The vulnerability that is present when being sexually intimate can feel overwhelming and make such encounters difficult, if not impossible. The desire is there, but the anxiety that it induces makes it something to be avoided.

Pornography: the reliable relationship

Looking at the adult who has experienced trauma in childhood and finds close relationships difficult, how might we conceptualise their relationship with pornography? Against the background of trauma and the resulting poor attachment do we seek out reliable relationships? Looking for something that meets the need for sexual intimacy, yet doesn’t have associated anxiety about that comes with closeness?

Pornography could be seen to meet that need. It is intimate, yet it is impersonal. One can be sexually potent, engaged and satisfied without the anxiety that closeness brings. Pornography becomes the reliable and safe relationship. It meets the demands of libidinous urges, without demanding more of the individual. The use of
pornography also relates with the feelings of low self-esteem, that this might be the only form of sexual interaction that the individual deserves. Feelings of guilt, shame and unworthiness all get acted out in the use of pornography. It is secretive, private, personal and can controlled by the user. Pornography ultimately becomes the way in which anxiety is managed.

Psychotherapy and pornography

When thinking about the compulsive use of pornography from a therapeutic perspective, we are considering both the idea that its use can be a choice, but also exploring the origins of the compulsion. Can we be curious about what has happened in the past? How experiences that might have been traumatic and disruptive to the attachment to others, shaped the relationship with pornography. The capacity to imagine oneself as someone who can make choices around the use of pornography and feel more able to be form intimate relationships. All of this is present when working with the compulsion to use pornography and in helping the client to change their relationship with it.

 

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

 

Further reading by David Work –

Reflections on bereavement

Compulsive use of pornography

Mental health in retirement

Subjective perception, shared experience

In support of being average

Collective grief

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When a solution is not the answer

Often people come to therapy in some kind of emotional pain. This might be acute or chronic or both. Understandably, they want to feel better. Sometimes, for some, this desire can feel very urgent. Reassuringly, many people find their distress dissipates with surprising speed almost as soon as they start therapy. Bringing your upset to someone who can listen and engage with it attentively and compassionately can impact quickly as a pain relief. Work can then begin in untangling the difficulties that have led to the painful situation the person finds themselves in.

For some, however, the pain stirs up so much anxiety (or, high levels of anxiety are driving it, or both) that it feels difficult to allow this process to take its course. In my experience this dynamic often manifests as a desire for solutions above all other help. These ‘solutions’ can often be seen, consciously or unconsciously, as a means of getting rid of feelings that are deeply lodged internally. What almost always accompanies the desire for a solution is the desire for it to be speedy. The ‘solution’ in this sense seems to be a quick fix that side-steps painful feelings and thoughts. Often, it seems, it is experiences and memories from the past that must be avoided.

It is of course true that some people do come with problems that can be and are addressed in a short time frame. For example, an acute experience, such as a bereavement or other kind of adult trauma, can often be simply and quickly contained and processed, providing that there is no underlying complexity created by earlier losses or traumas. Or, some people come to therapy for help with a difficult dilemma or needing help in making sense of things as they go through an upsetting experience, such as a break-up or redundancy. For young people, learning how and when to assert independence is very important and so short-term therapy, for many, can be the best intervention at this life stage. There are many, many examples where short-term work*, that has a clear aim, is the most appropriate help to offer.

However, there are also many examples where it is not.

When someone approaches me as a psychotherapist, I initially assess what they might need and if I am able to help. A key factor in working this out is deciding what seem to be the underlying traumas and complexity to their issue/s. I also ask myself to what extent (or not) is their current problem a symptom of something deeper and more complicated and/or part of an emotional pattern. Thinking about these elements contributes to my assessment about whether the problem/s may be addressed in a short time frame or may need longer term help. Sometimes, of course, I will misjudge or something changes and a long-term piece of work finds a natural conclusion early on or in short-term therapy, something emerges which indicates longer term help is needed.

Earlier in this blog I described how I see wanting a solution through therapy as potentially a defence against painful feelings. There are also other ways it is problematic. Firstly, it supposes a neatness to life that is rarely borne out. This is very much the case where emotional and relational problems are concerned. Secondly, most therapies centre on a journey of some form around self-discovery and exploration, and this process is an essential aspect of the work. Skipping steps and jumping ahead to a solution is not only often impossible but can be countertherapeutic and counterproductive.

Many of us live in a world where it has become increasingly possible to find solutions to problems quickly and this has become a valued aspect of our modern life. This has perhaps normalised an expectation that our emotional lives and difficulties should be dealt with the same immediacy and solution focus. This is of course also understandable when those problems leave us feeling distressed and overwhelmed. Some difficulties can be met within shorter time frames but, in many cases, they are manifestations of deeper, complicated and longstanding difficulties and trauma. At these times, finding a quick solution is not the answer.

* I define short-term work as anything between four to six weeks and three months.

 

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 –

When a solution is not the answer

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

A new psychotherapy group

 

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‘The Wisdom of Trauma’ a film by Gabor Maté – A Critical Review

Both the name, Gabor Maté, and the word, trauma, have become synonymous and ubiquitous in recent years.

Dr. Maté is a Hungarian born physician and author of ‘In The Realm of The Hungry Ghosts’, which was first published back in 2008 and offered a compassionate and insightful understanding of addiction as a response to trauma. Since then Dr Maté has steadily risen to fame as an addiction and trauma expert. He has now released a documentary film entitled ‘The Wisdom of Trauma’, which was brought to my attention by a couple of my clients. I decided to watch it.

The film follows Dr Maté on his journey of defining trauma, most specifically, childhood developmental trauma (CPTSD) and covers his work and learnings from treating street addicts in Vancouver’s Downtown Eastside.

As a mental health professional and clinician, I am all in favour of any well-researched productions that aim to highlight the impact of CPTSD, educate the masses and ideally bring about change at a societal level in how we conceptualise trauma and treatment. I therefore had high hopes for Dr Maté’s oeuvre. Sadly, as the film progressed, I became increasingly uneasy with the content and was ultimately left with the impression that the film was more about glorifying Dr Maté and his self-professed ‘new’ trauma informed approach to treating trauma, than a piece of work aimed at bringing together the teachings and learnings of many clinicians over the years on whose shoulders Dr Maté, like the rest of us, stand (see Alan Shore, Babette Rothschild, Pat Ogden, Steven Porges, Antonio Damasio, Daniel Siegel to name a few).

There is a powerful sequence in the film filmed in a prison where Fritzi Horstman, founder of the Compassion Prison Project, undertakes some meaningful work with inmates based on the ACE principles (see Adverse Childhood Experiences study 1995 – 1997, conducted by Kaiser Permanente). The work of the Compassion Prison Project is clearly meaningful, research based and healing, however, the link between this project and Gabor Maté remained at best utterly unclear and secondly, there was no reference to the original ACE study and the importance of it so viewers were left in the dark around context and thus perhaps invited to imagine that this was somehow connected to Dr Mate. To be clear, the ACE study has nothing to do with Dr Maté.

As the film progresses, Dr Maté moves into sharing his experiences of healing through the use of psychedelics, namely Ayahuasca, with footage shown of a ceremony taking place in Peru. The study of psychedelics and their possible use in treating mental health problems is in its absolute infancy and the research being conducted is done so in strictly controlled environments where participants combine the use of medical doses of psychedelics with psychotherapy – no mention was made of this. Whilst promising in specific clinical settings (as opposed to the Peruvian rain forest) and for specific applications, psychedelics can potentially do more harm than good,
particularly for patients with weak egos or personality disorders. There also remain valid questions about the long-term benefits of psychedelics in treating trauma, with most studies showing that symptoms tend to return over time once psychedelic use was suspended (generally 6 months to a year).

There is then a sequence wherein a man in his early 50’s with a stage 4 prostate cancer diagnosis appears to enter into remission through therapy with Dr Maté with the implied cause of his previously terminal illness being put down to trauma. I am a clinician who profoundly believes in the body-mind connection as have many more learned clinicians before me (see Winnicott and psyche-soma integration), however, whilst our emotions are experienced through the body and the ACE study has shown correlation between adverse childhood experiences and illness,
correlation is not the same as causation.

Finally, there are numerous sequences where Dr Maté is conducting his own brand of ‘trauma informed therapy’ which he suggests is in some way unique and the way to heal trauma. And yet again, trauma informed therapy is neither a new phenomenon nor something that has been invented by Dr Maté; indeed, any well-trained and experienced psychotherapist who works with trauma (and we all do), should be educated in understanding the presentation and defensive structures around CPTSD.

The message of the documentary – a trauma informed approach to healing society as a whole – is a positive one and yet despite his profile, I was disappointed to see how Dr Maté fails to engage and influence policy makers, educators, physicians and mental health professionals and actively seems to undermine his own message through an irresponsible focus on psychedelics, terminal illness being healed through trauma talk-therapy and a guru-esque approach to practicing his own therapeutic approach.

The sad reality of relational trauma is that it occurred in relationship and so can only be treated and worked through in relationship. And working through is not necessarily the same as ‘healing’.  Good psychotherapy is painful and slow and the main reason it takes time is because the traumatised part of the patient (client) needs to overcome resistance and form a dependent relationship on their therapist; thus the client dictates the speed of therapy.

The Wisdom of Trauma seemed to me to subscribe to an all too common narrative of recent years – there is a ‘fix’ for everything and it can be quick. This is not my experience of working with trauma and nor is it that of my clients, many whom learn to live with their trauma rather than somehow leave it behind. Perhaps a better title would have simple been: ‘The Wisdom of Gabor Maté’ as the documentary was essentially about him and his views, despite the enormous work in this field undertaken by the likes of Freud, Winnicot, Bowlby etc., all the way through to ordinary psychotherapists like myself and all my ‘ordinary’ colleagues.

 

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

 

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.

 

Further reading by Mark Vahrmeyer

‘The Wisdom of Trauma’ a film by Gabor Maté – A Critical Review

Do Psychotherapists Need to Love Their Clients?

Unexpressed emotions will never die

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

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Unexpressed emotions will never die

‘Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways’. This quote, widely attributed to Freud, is both simple and profound in context. 

With this statement, Freud (if they are indeed his words) is defining one of the pillars of psycho-analysis and psychotherapy – to uncover repressed and unconscious memories and provide a relationship in which those ‘traumas’ can be expressed through language and contact. From this perspective it remains academic as to whether or not Freud did indeed utter these words – we know from his writings that he believed them.

Let’s delve deeper into this statement. What evidence is there that unexpressed emotions don’t die? After all, is the passage of time not a great healer as the popular expression goes?

We know that unexpressed emotions don’t die because otherwise people with traumas would simply recover and live contented and fulfilling lives.  Instead we know that this is not the case and trauma gets ‘stuck’. 

And with regards to the glib statement that ‘time heals’, this is only true when feelings can be expressed – losses grieved – and reality come to terms with. Otherwise the past will continue to repeat itself in unconscious ways in the present. After all, the unconscious has no concept of time. 

How do unexpressed emotions come forth?

Unexpressed emotions – in other words emotions that cannot be acknowledged for fear of their impact on the psyche – express through a variety of means and present in an infinite number of actual behaviours or presentations. For me it brings to mind a quote from a Woody Allen movie where a character (played by Allen) says ‘I never get angry …. I grow a tumour instead’. 

Some of what we see as clinicians with clients who are defending against expressing difficult feelings can be: 

Acting out – Engaging in behaviours that are destructive to self and or others the reasons for which the client is often unaware of; 

Mania – Frantically ‘doing’ to avoid being in touch with one’s inner world; 

Depression – A pervasive deadness and inability to be in touch with desire as a result of emotions  being unexpressed. Being dead is preferable to feeling; 

Repetition compulsion – The compulsion to repeat an event or behaviour over and over again without an ability to clearly think about and consider why that may be; 

Reaction formation – A defence against the anxiety produced by feelings towards something causing the person to over-compensate in the opposite direction – an example would be someone terrified of death who engages in dangerous sports or activities; 

Mental illness – This is a catch all phrase, a product of the medicalisation of psychiatry whereby clusters of ‘symptoms’ are given different diagnoses. Essentially, mental health diagnosis or not, the work remains the same. And psychosis can be seen as the mind protecting itself from unbearable feelings and emotions by ‘going mad’. 

Somatic (body) symptoms – Back to the Woody Allen quote – in lieu of feeling, many of us develop physical ‘pains’ far less dramatic than tumours, but chronic nonetheless. Examples could be  gastro-intestinal problems (IBS), migraines or other more obscure symptoms. 

Dissociation – We all dissociate, which broadly means to ‘zone out’, however dissociation can manifest in powerful and extreme ways whereby the person ‘splits’ their mind akin to ‘the left hand  not knowing what the right hand is doing’, however rather than it being about one hand not knowing what the other is doing, it is in reality one hand not knowing what is BEING DONE to the other. 

And this list is by no means exhaustive or conclusive. 

Expression vs repression – living vs dying 

Expression of emotion is essential, however, cruelly paradoxically, those who have needed to repress have done so because there has not been a sufficiently available adult (in chronological as well as psychological terms) to be in relationship with. This is the role of the therapeutic relationship. 

Without titrated expression of emotion – I am no fan of new-age catharsis – and done in the context of relationship, living is simply not possible; only existence is possible where the client is at the mercy of powerful unconscious forces and exposed to their repressed emotions coming forth later in uglier ways. 

Grieving is part of living 

Grieving is extremely painful – whether that is grieving a loss in the present, or grieving the loss of what never was. However, without grieving we cannot feel alive – we cannot be born. 

Being born in the biological sense means leaving the safety of the womb, but also the ‘nothingness’ of the womb. In the womb we cannot experience reality other that filtered through our mothers. And so it is psychologically too – being born through psychotherapy means to face losses and bear reality, however painful that may be, and through that to come alive. If loss can be borne then desire for life can emerge and emerge it will. 

Psychotherapy is about expressing what has previously been inexpressible and it is in the context of the therapeutic relationship and encounter using language that this takes place: language gives trauma shape and form.

 

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

 

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.

 

Further ready by Mark Vahrmeyer –

What is the purpose of intimate relationships?

Why ‘Cancel Culture’ is about the inability to tolerate difference

The Phenomenon of ‘Manifesting – The Law of Attraction’ and the inability to tolerate reality

Why does the difference between counselling and psychotherapy matter?

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Understanding Sexual Fantasy

The exploration of sexual preference and fantasy in therapy can be a portal to our inner psychological landscape. Unlocking the unconscious logic of sexual fantasy is one way of casting  a light on our internal world and of understanding the emotional and psychological difficulties that may have prompted us to seek therapy in the first instance.

Our sexual scripts are formed in infancy, long before the onset of mature sexual desire. Our early attachment experiences and the familial and cultural context into which we are born inform the psychological maps and templates for being (in the world) to which we both consciously and unconsciously refer as we develop and grow. We are evolutionarily wired and sensitively attuned to the moods and feeling states of our caregivers absorbing them all through a process of psychological osmosis.

The conflict of growing up

Whilst our lust and capacity for pleasure (according to the Freudian account) are instinctual, the road to pleasure is more often than not a complicated one. We are likely to experience myriad obstacles along the way (many that will later inform our sexual fantasies) guilt, shame, fear, rejection may all stand in the way of our experience of pleasure. We all (consciously or otherwise) feel guilty about something. Life is fraught with conflict – and from the get go. The conflict (for example) between our attachment to our families and to the developmental imperative to grow up, individuate and leave them is fraught with guilt and worry. We bring these unresolved and largely unconscious conflicts into our erotic lives.

The creativity of fantasy

The child of a depressed parent may grow up with a powerful sensitivity to and identification with the sadness of others. It may be hard for such an individual to fully connect to their own aliveness and vitality as sexual excitement is fundamentally incompatible with depression. In the imaginative realm of fantasy such an individual may be released from the burden of caring by populating their fantasies with dynamic carefree people, aroused, excited and turned on. It is not hard to understand, in this scenario, that when everyone is having a great time (and no one is depressed)  the fantasy serves as a creative permission to connect, without guilt or shame to one’s own desire.

An antidote to trauma

Many sexual fantasies can seem puzzling and hard to understand. One person’s turn on is another’s turn off after all. Arousal for some may come through being tied up and whipped, another’s from phone sex, group sex, sex with a stranger(s), etc, etc. All are plots of desire, many are attempts to draw on and transform past trauma. When someone is cruel or aggressive  in their sexual fantasy or practice it is not because they are inherently sadistic but rather that they are trying to solve a problem. It may be useful and illuminating to consider and understand why the normal pursuit of pleasure may require a particular imaginative scenario in order to be safely experienced.

Empathy and ruthlessness are important aspects of a healthy sexual relationship. Too much empathy (for the other) may be a dampener to our own desire and too much ruthlessness may render sex mechanical and devoid of emotion. Sexual fantasies can be attempts to counteract or transform beliefs and feelings that may interfere with sexual arousal and can provide an elegant ( if not always politically correct) solution to the problems of ruthlessness , guilt and shame.

When we  understand our sexuality we understand ourselves.

 

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

 

Further reading by Gerry Gilmartin

Fear and hope in the time of Covid

Relationships, networks and connections

Paying attention to stress

Why does empathy matter?

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Termination and endings in Psychotherapy

We have just celebrated the ending of the year, welcoming in a New Year. It provides a shared / collective opportunity to reflect on the past, think ahead to the future. Likewise, psychotherapy invites us to think about the past, how it contributes to who we are, what is important to us, how the past can provide an understanding of previously unconscious material that has been repressed in order for us to reconcile the past and choose what is taken into the future.

This segmentation of time helps to contain a complex worldview. I suggest the break or holiday from psychotherapy offers us a chance to reflect on how we manage our internal world in the absence of the secure base represented by the clinical setting. The break provides an opportunity to see how we feel without the weekly hour or hour and a half in the session or group.

How important are endings in psychotherapy?

The therapeutic alliance between the therapist and the client provides a safe, secure and consistent base for attachment to a reliable figure for working through trauma. Childhood experiences of adult caregivers, depicted most vividly in fairytales of giants and powerful forces that impact on our emotional security; in adulthood leave traces of emotional trauma that can distort our judgment of reality haunting us as adults. Trauma inhibits the development of neurological pathways that lead to self-regulation of emotional states. Attachment styles will influence how we react to stresses in the environment, the challenge of psychotherapy is to find a way of reaching our fears and understanding how these shape our lives. The biological changes in the brain required to establish new pathways takes time and can leave us feeling confused and bewildered.

Neuroscience has given us a greater understanding of the effects of child hood trauma’s and a method of working that bring about changes in how we process feelings and thoughts.

Through our interactions in the therapeutic setting, either individual or group, enables us to experience /observe our defenses at work in a safe and containing space/ in the individual session or through the group matrix of interactions. This results in a re-working of the internal working model originally created to cope with trauma to enable change to occur. We begin to integrate more adaptive responses to our emotions and feelings. To gain mastery over long held ways of relating, the internalized working model that shaped our attachment style is revised.

What part then do breaks and endings play in this process? Jeremy Holmes suggests that different attachment styles require different approaches to endings. (See paper European Psychotherapy on termination of psychotherapy /psychoanalysis)

I suggest that some knowledge of the theory is useful to clients like a comforting diagnosis helps people feel more in control. It is what mindfulness can do for all of us used in the service of our need for regulation during times of heightened arousal / stress.

Whenever we make an attachment be it to a therapist, a working environment or an intimate relationship we are faced with separation. This is why falling is love is so disorientating; the object of our love leaves us fearing loss, jealousy, envy etc. etc. If our love is reciprocated then we are both preoccupied with one another. It becomes a joke when the love struck people are in a group of friends and only have eyes for each other.

So attachment and separation are present and unavoidable; we are social beings who seek closeness and intimacy throughout our lives. (The exception is when we are preparing for the end of life.)

Ending a relationship or needing to adjust to changes in others in our lives such as our children going from being a child to an adult requires an ability to face the often painful and difficult process of change.

Breaks in therapy offer an opportunity to try out our internalized therapeutic capacity for self-regulation. Ending therapy or a good ending requires work on understanding the capacity we have to deal with life outside of the safety and security of the therapeutic alliance.

 

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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How body stability creates psychic stability

There is No Such Thing as a Baby

I frequently blog about the importance about including the body in the process of psychotherapy and how the unconscious resides in the body.  However, unlike many ‘body psychotherapists,’ I believe that the involvement of the body is more profound than identifying the presence of the body in the process. Let me explain using one of Donald Winnicott’s most famous quotes, “There is no such thing as a baby.”

Winnicott famously made this statement in 1947. On face value, it may seem somewhat absurd. After all, we have all seen babies and know they exist. However, the reality is far more complicated, because every baby that any one of us has ever seen is only visible because it is in a relationship with its primary carer (which for simplicity, I shall refer to as its mother).

A baby cannot exist alone but is essentially part of a relationship.  Babies exist in an absolute state of dependence, such that the infant (the word is taken from the Latin – ‘infans’ – not able to speak) has no knowledge of maternal care, as this would require the knowledge of ‘an other’ providing the care.  The baby therefore is essentially indivisible from its mother and thus cannot exist in its own right.  The infant’s experience relies on the mother’s ability to merge with, and adapt to, her baby.  Therefore, whenever we see a baby, we actually see a baby, its mother, the relationship between the two and also the wider social context within which that baby lives and has come to be.

There is No Such Thing as a Body

The same principle can be applied to a body.  There is no such thing as a body in its own right.  A body is created, shaped, moulded and exists within the relationship that the mother of the owner of the body has had with it.  In other words, the body and how it is experienced by the person in the body is contingent on the relationship that the baby has with the mother and the wider environment. This then dictates the relationship that the owner of said body, has with him or herself (if any.)

Why Does the Body Matter?

Psychotherapy is about many things, but one of the primary tenets is that it is a relationship within which the client/patient can, through relating to the therapist, establish a relationship with themselves. Having a relationship with ourselves includes having a relationship with our body. However, I believe that too many psychotherapists assume that such a relationship is necessarily experienced as helpful by the client at the outset of therapy, or even possible.

The Body as an Enemy

If we come to inhabit, or embody, our bodies through the relationship with our mothers and the wider social context, and our mothers were abusive to us, then the experience of our body can be one of ambivalence (‘I don’t really care about my body”) through to experiencing the body as dangerous, attacking or not our own.

Examples of where internalised abuse/hatred is expressed towards the body include cutting and burning the skin through to anorexia and bulimia, to name a few.

Risk of Trauma

Assuming a pre-existing, or even conceptually possible positive relationship between a client and their body on the part of the psychotherapist is naive. At worst, it risks re-traumatising the client.

If, for the client, all that is bad resides in their body, then they need to slowly find a way to ‘meet’ their body in a different context and to tentatively form a different relationship with their body – to reclaim it from the ‘bad’ parent. The therapeutic process involves creating a different relationship with ourselves, one in which we are able to leave the echoes of past formative relationships behind. At the very least, we need to learn to think about ourselves as players in those stories in a different way. In the same way, we need to learn to relate to our body as our own and as our friend, guide and an integral part of us.

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

Body psychotherapy

What is attachment and why does it matter?

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On Affect Regulation

The term ‘affect regulation’ is one that I have written about previously and one that is increasingly used in the world of applied psychology and neuroscience. It can be a very useful term for bringing together psychology, biology and in explaining why good psychotherapy works, so read on!

What is regulation?

We all regulate (manage) the environment around us moment to moment. A good example of this is how we may regulate the temperature in a room by either opening a window or turning up the thermostat.

When we feel overwhelmed by our emotions, we become dysregulated. It is interesting that the language we use often reflects our experience of how we experience nature or bodies when we witness this dysregulation taking place. “She blew her top.” “He became hot and bothered.” “She went weak at the knees.” “She exploded with anger.”

Imagine a sunny warm afternoon, and you are relaxing in a nice safe place. If you don’t like the sun, imagine an environment where you feel contented and calm. There are no worries or stressors and life is good. In this state, you are likely to be regulated and in a state of ‘rest and digest’. However, as we all know, calmness is transitory, and soon a stressor will appear on the horizon. An irate relative calls, we realise we have lost our keys somewhere on our walk, our partner says something we experience as hurtful – the list is endless.

In this moment, our arousal levels increase. Arousal simply refers to the wide range of physiological, emotional and psychological changes that happen when our attention is drawn to a stressor that we perceive as something that needs dealing with. In this moment, we have moved from ‘rest and digest’ into a state of alertness.

Just as a room temperature on a micro level is never static, so our arousal levels are also never static. Whatever we think about, see, hear, smell, taste or imagine creates a change to our physiology on a moment by moment basis.

If our arousal starts to become too heightened, we can shift into a ‘fight or flight state’ (or freeze/fold state) where our thinking brain quite simply goes offline and we feel overwhelmed.

Being in a fight or flight state is useful if we are about to be attacked by a sabre-toothed tiger. However, in most day to day situations and interactions, it is simply unhelpful and can be damaging to ourselves and others.

Affect regulation is therefore the understanding and practical implementation of how we manage our emotions in the face of an ever-changing inner and outer environment.

How do we learn it?

In simplistic terms, we learn to regulate our emotions by our primary caregiver teaching us to do this. They literally help us make sense of our emotions by using their own nervous system to tune into ours and give form, shape and language to our experience. This is often our mother, as she will generally have the strongest and most frequent physical bond with us when we are very young, such as when we are breast-feeding. However, fathers have an equally important role to play in this process.

Time after time, our sense are flooded as infants by strong physiological responses which we have no capacity to make sense of. Time after time, our primary caregiver will soothe us, name the motion, witness our experience and normalise our response. Ideally, anyway.

Why does it matter?

Nobody enjoys living under the feeling of ‘being on edge’ all the time, or the opposite, of feeling bored, apathetic and ‘switched off.’

Both of the above states of being, although seemingly opposite, are in fact highly stressful states of being that put our minds, hormone systems, bodies and immune systems under enormous stress, just like we cannot ‘rest and digest’ when overly aroused.

Ongoing dysregulation does not only occur through poor attunement as a child (emotional neglect). It can also be the result of trauma characterised by PTSD.  However, research has shown that those people who lack the ability to healthily regulate their emotions are more prone to PTSD in later life (van de Kolk)

Types of regulation

Broadly speaking, there are two ways we regulate ourselves: we auto-regulate, and we regulate our emotional state interpersonally.

Auto-regulation is the ability to self-soothe; the ability to hold onto a thinking mind as arousal levels start to increase, to ‘think things through’ and then take action, rather than being at the mercy of our reactions. Examples of self-soothing techniques in the moment include mentalisation (holding onto that all important thinking mind) taking a deep breath, walking away from situations that are not in our best interest, through to engaging with external behaviours and activities such as yoga, going to the gym, meditation and lifestyle choices such as diet and good sleep hygiene.

Auto-regulation can also include a whole host of dysfunctional behaviours which, rather than stemming from taking action as a result of using our thinking minds, fall into the categories of reactions – a flight from emotions – such as addictions or narcolepsy (falling asleep when under emotional stress).

Interpersonal regulation is the most sophisticated forms of regulation and it involves using our thinking mind (from auto-regulation) to seek out other human beings with whom to share our emotions. All humans are wired for connection and while we can, and must, learn to auto-regulate in healthy ways, the fact of the matter is that our nervous system needs the nervous system of others in order to down-regulate our emotional state. Put simply, human beings are hard-wired for relationships and need these relationships in order to feel calm and content. This is arguably the fundamental principle as to why we pair-bond.

Why do some people find mindful auto-regulation and inter-personal regulation hard? Perhaps it is because it becomes very hard to hold ourselves in mind when the one person who should have helped us to learn to regulate our emotions could not do that. This makes auto-regulation hard to do. If that primary carer could not do it for us, why would we trust that anybody else can?

 How does psychotherapy help regulation?

Good psychotherapy starts with helping clients to make healthier choices in auto-regulation. This all helps to bring down chronic stress levels and forms the foundation of bringing that thinking mind online – the beginnings of the process of mentalisation.

However, the real goal of therapy is to help clients to grow their minds and find – perhaps for the first time – safety in a relationship where they can entrust their precious mind and nervous system to be seen, witnessed, validated and ultimately regulated by the mind and nervous system of their psychotherapist.

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

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Remembering in order to forget

It is not unusual for prospective or current clients in psychotherapy to ask, “What is the point of me remembering that and feeling sad, upset, angry (insert whichever uncomfortable emotion comes to mind)?” And even when not posed directly, the question plays in the unconscious through resistance in the therapy and a quick shift of content or a dissociation from emotions that are coming up.

Remembering to forget lies at the heart of psychotherapy, and it is no coincidence that, like so much in the world of therapy, it is a statement with more than a hint of the paradoxical to it. After all, how can remembering possibly lead to us forgetting? Perhaps the answer, or one of the answers, to how this paradox unfolds lies in why we often seem destined to repeat the past in our lives – a key factor in what often brings clients to therapy.

The past repeats – particularly in our relationship to ourselves and others – until we become conscious of our past; our unconscious drives us until it is brought into consciousness. One way of thinking about this is that as we travel through life, we all collect trauma (with a small ‘t’.) Trauma is shapeless and formless, yet, once again paradoxically, it takes a substantial hold and can exert significant influence over our lives. Trauma, or the effects of it, also reside in the unconscious – the body.

Therapy is about giving shape, form and language to trauma – whether that is trauma with a small ‘t’, or more substantial trauma in the shape of single incident PTSD or Complex Childhood Developmental Trauma. We give shape, form and language to our trauma by listening to the communication of our unconscious which uses symbolism, repetitive behaviour and the body to communicate to us.

This is why we need to remember.  We remember so that we can bring our emotional being back into contact with the sensations, emotions and feelings that were evoked when the event we are remembering occurred.  Our emotional system is not linear or logical: when we remember, we feel what we felt at the time.

What good is it to feel what we once felt?

It is only though the remembering of the felt sense – the somatic memory – that we can allow our emotions to express themselves in the way they could not at the time of the original event or experience. And unexpressed emotions do not go away, they simply find other ways of telling us that we are hurting.

Psychotherapy is about feeling those unexpressed emotions – giving shape, form and language to them – and allowing ourselves to feel without becoming overwhelmed.

How do we know the outcome will be different this time around?

We may find we are defended against remembering as, after all, it did not make us feel better when we felt the pain the first time around. The art of feeling, whilst staying present with the here and now as well as being attuned to and witnessed by a psychotherapist is where the potential for change resides.

And so it is through a grounded and gentle approach to being witnessed and validated in our process of remembering that we can process our trauma and finally allow ourselves to forget the need for unconscious reminders that dominate our lives. Remembering to forget thus ceases to simply be a paradox and instead becomes a road to freedom.

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

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What is attachment and why does it matter?

Attachment theory is something I draw on a lot in my practice.  However, unlike psycho-analytic theory, the concepts are relatively simple. Simply put, attachment theory describes how we respond to relationships.

There are broadly four different styles (or, as I prefer to think of them – adaptations) of attachment: secure; avoidant, ambivalent; and disorganised.  Briefly, they are defined as follows:

Secure individuals are people who received ‘good enough’ parenting (Winnicott) and feel they are able to navigate life without unnecessarily reacting to emotions and either becoming overwhelmed (fight) or dissociating (freeze).  They are also people who, generally, feel like they can get their needs met in relationships and for whom intimacy is possible.  Bar some later trauma in life, securely attached individuals rarely present for therapy.

Avoidant (adapted) individuals are those of us who feel that relationships are inherently unsafe and that they cannot rely on the other.  They have a tendency to keep people at arm’s length, especially when they experience a relational stressor.  To cope, they may make themselves unavailable to their partner (through other commitments) and avoid being vulnerable.

Ambivalent (adapted) individuals struggle with the internal conflict of wanting intimacy and thus moving into relationships quite quickly, only then to slam on the brakes when they perceive an attachment disruption.  They feel trapped (under stress) between wanting closeness but pulling away for fear of being hurt.

Disorganised (adapted) individuals are people who have experienced significant childhood developmental trauma and have more than likely been born to mothers who have also been traumatised at a relatively young age.  They are people who struggle enormously to contain (in the body) their feelings and to make sense of them (mentalise).  Relationships for people with a disorganised attachment adaptation are fraught with threats, intensity and chaos.  It is likely that individuals presenting with this attachment adaptation as their predominant style may have a personality disorder.  And, yet, personality disorders can be treated too, under the right clinical conditions.

Misconceptions

As is often the case with models and classifications, people can believe that they have one attachment style and that this is fixed. Whilst we may have developed a default adaptation in relating, this adaptation only surfaces when we are under stress. Let me explain:

Imagine you are with another with whom a budding relationship is developing. You are both relaxed and sitting in the sun in a place that both makes you feel safe and comfortable.  There are no stressors present – alcohol, drugs, conflicting conversations, other people who may threaten your relationship, etc. In this context, irrespective of what your default adaptation may be, you will most probably be in a state of secure attachment.  That is, in a secure relationship with yourself and the other.  This is really critical to understand, as it means that even in those of us who have experienced significant childhood developmental trauma and attachment disruption, the propensity to feel securely attached resides in us all and can be built upon in the therapeutic work.

Neuroscience and neuroendocrinology

What makes attachment particularly interesting is that it requires a focus on mind–body integration, as all emotions originate in the body (see my blog on the pyramid of change) and we need a mind to help us make sense of what we are feeling.

Theoretically, attachment principles can be applied to any psychotherapy ‘model’. as long as the emphasis is on helping the client understand what they are sensing in their body; what this feeling is telling them; how to contain it; how to make sense of it.

However, attachment theory is coming to the fore of psychotherapy thinking around change that happens as the principles of healthy attachment are being evidenced through neuroscience findings.

Neuroscience is showing that when we are securely attached, we are able to feel our emotions without becoming overwhelmed and reacting.  And it is showing how our fear centre of the brains (the limbic system) can become primed to react at the slightest perceived danger.

Neuroendocrinology – the study of brain and body (hormone system) integration is showing us that secure attachment is a state of optimal health in both the brain and the body. In brief, to be in a state of insecure attachment leads to higher stress hormones being present in the body; lower immunity; higher anxiety; and less ability to mentalise.

Mind-body integration in attachment reparation

How do attachment adaptations come about? Why would one child generally be considered securely attached and another a variant of insecure? The answer to this is complex. However, two variables stand out above all others, and those are how much the child was attuned to as an infant (particularly pre-verbal) and how much the child was encouraged to be themselves in the relationship with their primary caregivers.

It is these two variables that stand relational psychotherapy is a very strong position to repair attachment trauma – to re-parent the client.

The role of the therapist is therefore to help the client understand what they are sensing and feeling in their body and what feeling that translates to: a variant of the five core emotions of joy; anger; fear; sadness; and disgust.

The therapist is then there to work with the client in remaining present to the feelings in their body – avoiding overwhelming or dissociation – so that little by little the client learns to navigate their universe of emotions.  And how does all of the above happen?  Through careful attunement – nervous system to nervous system; body to body; mind to mind – and through validation of what the client discovers they feel.

Secure attachment is the goal of therapy for a healthy mind; healthy emotional system; healthy immune and endocrinology system; and healthy relationship patterns (intimacy with self and other).  Sounds like a good goal to me!

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

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Anger Management: Often Mismanaged

Anger management is a common term used in working with clients with anger issues.  Even Hollywood has capitalised on the term as a title for a movie, which unsurprisingly was directed at a largely male audience.

At Brighton and Hove Psychotherapy we offer work on ‘anger management’, however, what this actually comprises may well be quite different to other clinicians, so read on:

What is anger?

Anger is one of the most important emotions we can feel.  It gets a bad rap with nobody wanting to be labelled as ‘angry’ – it is much more endearing to be sees as a ‘happy’ or ‘content’ person.  However, it is impossible to feel happy or content without feeling anger.

Before we get into what anger is, it may be useful to revisit the basics of how feelings like anger come about.  In an earlier blog entitled ‘The Pyramid of Change in Psychotherapy’, I described just this.  In brief, we are all ‘embodied’ being, meaning we are one with our bodies and our bodies are constantly feeding us data through sensations, changes in our physiology, changes in sensation, right down to the tiniest change in cellular structure.  Our physiology translates to our emotions, which is literally our physiology ‘in-motion’.  Groups or clusters of emotions are feelings which in turn lead to the generation of our thoughts, in turn embodied in our behaviour which gives us the external results we experience.

So, anger is a physiological response to a real or perceived external stimuli.  Most of us experience anger as tension or tightness in our core.  Anger in its most profound and pure form is our body saying ‘no’ and is a response to a boundary violation (real or perceived).  The greater the boundary violation, the greater the anger.

Therefore, anger is vital to us in knowing what is right or wrong for us moment by moment.  It enables us to define, communicate, protect and if necessary, fight for our boundaries.

I don’t want to be an angry person!

Nobody is any one kind of person.  Folks who are labelled as ‘angry people’ and generally hyper-vigilant and feel unsafe in the world.  They are either enraged, or waiting to be.

‘Angry people’ have generally learnt that they are not allowed to relate is a healthy way and to communicate their boundaries knowing that their wishes will be respected.

The healthy expression of anger became dangerous to ‘angry people’ growing up and they either had to swallow their anger (hold it in their body) or use rage to have some sense of safety.

Where we have had to protect our caregivers from anger – where it has been unsafe to say ‘no’ – we often end up holding a lot of anger.

Anger vs rage

Anger, like all other emotions, is a feeling that tells us something is not OK for us.  It may be a request by somebody, it may be someone trying to break into our house or it may be something as subtle as somebody standing too close to us.  Thus anger can be broken down into subtle nuances of frustration, irritation, annoyance through to feeling livid.

Anger always holds the other person in mind.  It is a feeling where we are able to state ‘no’ empathically.  We do not need to be abusive or defensive in stating no, and we don’t need to be responsible for the other.

Rage, on the other hand, whilst unpleasant to be on the receiving end of, comes from a place of powerlessness.  It is anger that could not be expressed healthily.  There may be times when rage is appropriate but in a relatively safe world, these times are rare.

Anger is a guy thing

Hopefully it is now clear that anger is vital to all of us for good emotional, psychological and physical health.

Both genders can carry unhealthy anger, however, how it manifests may be different and lead to the misnomer that men struggle with anger management.  Whilst I have come across plenty of ‘angry women’ and ‘depressed men’, it is not uncommon for men to express rage externally and for women to internalise it and take it out on themselves.  They are both experiencing anger and ‘mismanaging it’.

Anger: The Therapy Room Taboo

Too many counsellors and psychotherapists are scared of anger.  Particularly that of men.  This is in part because men can at times express their anger inappropriately and may in part be because many therapists are women who may not wish to be on the receiving end of a man’s anger.  Many male therapists don’t either for that matter.

Too often anger gets ‘misdiagnosed’ as either covering up sadness, or simply presents as dissociation (cut-offness) or depression.  Working with sadness and depression is important but through working with the anger, the client can start to feel empowered in a healthy way.

Good counsellors and psychotherapists are able to attune to clients and work in the therapeutic alliance through establishing a safe relationship and calming the clients fear system.  This is great, but it is only half the work.

Anger stemming from childhood developmental trauma (complex trauma) or PTSD, must be felt and worked through.  Clients need to first learn what physical sensations are their anger embodied and then learn to feel them in their body and stay present with them.

Pendulating through anger

All our emotions either increase or decrease our arousal levels.  Anger increases our arousal; calm decreases our arousal level.  Alongside this, every emotion is either moving us towards producing growth hormone and having healthy immunity or towards pumping stress hormones such as cortisol into our system (low immunity).

We also experience a journey with each emotion.  We feel an activation: so with anger a slight tension, an increase in heart-rate; some shallower breathing and a narrowing of our field of vision.  The challenge is for the therapist to teach the client to remain connected and curious about how they ‘do’ anger in their body and to stay present with the feeling until it subsides (and it will).  This is called pendulation.  More on this in another blog.

So, rather than anger management being about disconnecting from feelings of anger through dissociation or forcing a change in emotion through the body, anger management is learning to work in recognising anger as it manifests; to work through unexpressed anger relating to past trauma and to develop a healthy relationship with anger going forward.

Mark Vahrmeyer

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Trauma and Recovery

Judith Herman (1992), writes:

“Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning”

Although Herman’s book was written more than twenty years ago, and findings in neuroscience have given psychotherapists a rich body of information to work with since, I summarize here three of the core symptoms of Post-traumatic Stress Disorder (PTSD), followed by three stages of recovery from trauma explored in her book “Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror”.

1. Hyperarousal/ Hypervigilance

This is a state of permanent alert after a traumatic event as if danger is constantly around the corner. Common factors include: startle reactions, psychosomatic symptoms, irritability, aggressive behaviour, nightmares and poor sleep, arising from the chronic arousal of the autonomic nervous system (ANS).

For instance, in case of soldiers returning from war, when they are eventually removed from the stressful and threatening environment the anxiety initially recedes. However, after a while the psychological symptoms persists and cannot be integrated into a life of safety and security.

2. Intrusion

This entails reliving the traumatic event as if it was happening in the present. “It is as if time stops at the moment of trauma” (1992, p. 37). This manifests in the form of flashbacks, recurring dreams and vivid emotional memories triggered by reminders of the event (s).

“Traumatic memories lack verbal narrative and context; rather, they are encoded in the form of vivid sensations and images.” (1992, p.38)

3. Constriction

Also called numbing or a state of hyperarousal. “Perception may be numbed or distorted, with partial anaesthesia or the loss of particular sensations. […] The person may feel as though the event is not happening to her, as though she is observing from outside her body […]” (1992, p.43).

Numbness happens either through a psychological dissociative state or is also chemically induced with the help of drugs and alcohol.
Although dissociation can be a useful survival mechanism during a traumatic event, it becomes a barrier to relating with self and others after the event has passed.

Steps to Recovery

 

A Healing Relationship

Disempowerment and disconnection from others is central to traumatic experiences. Therefore, it is vital that healing occurs within a trusting and empowering therapeutic relationship, and with the support of significant others wherever possible.

“Recovery can take place only within the context of relationships; it cannot occur in isolation” (p.134).

Herman (1992) describes three main stages of recovery from trauma, which I list below. However, as therapists, we bear in mind that recovery isn’t necessarily a linear process, and treatment plans are used more as a helpful guide rather than something to strictly adhere to. In addition, every therapeutic work is tailored to the individual’s unique circumstances. Each stage may take days, weeks or months and be revisited again and again over the course not only of therapy but of one’s life.

1. Safety

The first stage of recovery entails naming the problem and normalizing common symptoms. Once the issue is identified, treatment can begin.

In the therapeutic work it is important to begin restoring control by establishing safety: “Survivors feel unsafe in their bodies. Their emotions and their thinking feel out of control. They also feel unsafe in relation to other people” (p.160).

Establishing safety begins through learning to regain control of the body by focusing on restoration of the natural biological rhythms (attending to health needs, medication, diet, exercise, sleep, relaxation, etc.), and gradually moves toward gaining control of the environment (engaging caring others, living situation, finances, self-protection, etc.).

2. Remembrance and Mourning

“In the second stage of recovery, the survivor tells the story of the trauma” (p.175). In therapeutic terms it is called ‘trauma debriefing’. It is a work of reconstruction and reintegration of memories into the person’s life. The therapist acts as a witness and ally in whose presence the unspeakable can be spoken.

Trauma debriefing needs to be carefully and sensitively negotiated between therapist and client, making sure the client remains within a ‘window of tolerance’ (Ogden, Minton & Pain 2006) between hyper- (agitation) and hypo-arousal (numbness).

Trauma inevitably involves loss. The mourning of those losses is both vital and one of the most challenging steps of recovery. This is because grieving is a complex process, varying in degree depending on circumstances. However, without mourning healing is unlikely to take place.

3. Reconnection

“Having come to terms with the traumatic past, the survivor faces the task of creating a future” (p.196).

Whereas in the first stage of recovery survivors focus mainly on establishing safety by creating an environment which is protective, the third stage may entail engaging with the world and facing their circumstances head on. In some cases this will involve accusing or confronting others who were either directly involved with the abuse or stood by.

This stage also involves reconciling with (and forgiving) oneself by means of developing desire and initiative. Survivors slowly recognize and begin to let go of negative aspects in themselves that were formed as a result of the trauma.

This process involves self-compassion, self-respect, and working toward renewing trust in others.

This isn’t to say that there is ever a final resolution to traumatic experiences. Life circumstances and events may bring back familiar feelings experienced before the start of treatment. As previously said, the course of recovery is not linear. The various stages are revisited, each time with renewed integration and strength.

Sam Jahara is a UKCP Registered Psychotherapist and Certified Transactional Analyst.

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Trauma

My heart is racing and I feel constantly under threat,
even though there is nothing to fear.

Emotionally it is like I’m in a war zone, ready to defend or attack,
even though it’s peaceful here.

I look over my shoulder,
tense up with certain sounds.
I’m scared for my life
and for the life of those whom I love,
even though it’s safe here.

I want to be able to forget and relax,
I wish I could enjoy life more.
I long for my mind to be quieter
and to engage with the small pleasures in life.

I want to stay in my body
and not leave it behind

I wish I could think clearly,
love more,
fear less,
smile often,
play lots,
breathe…

I dream of the day when I will be free.

 

This poem is dedicated to all of those who live with the effects of past trauma everyday.

Sam Jahara

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