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July 12, 2021 by BHP 18 Comments

‘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

Filed Under: Mark Vahrmeyer, Mental Health, Psychotherapy Tagged With: complex trauma, Gabor Maté, The Wisdom of Trauma, Trauma

April 12, 2021 by BHP 4 Comments

Unexpressed emotions will never die

Short sharp, to the point and written by Freud. His full quote is ‘Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways’. What does he mean and is he right? 

With this statement Freud is defining on 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. 

What evidence is there that unexpressed emotions don’t die, after all, is 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?

Filed Under: Loss, Mark Vahrmeyer, Mental Health, Relationships Tagged With: Depression, Emotions, Trauma

November 23, 2020 by BHP Leave a Comment

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?

Face to Face and Online Therapy Help Available Now

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Filed Under: Gerry Gilmartin, Relationships, Sexuality Tagged With: Relationships, sexuality, Trauma

March 2, 2020 by Brighton & Hove Psychotherapy Leave a Comment

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.

 

Thea Beech is a UKCP registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst.  Her work in psychodynamic psychotherapy spans 20 years in the NHS and for the last 10 years overseas in South Africa.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

What is a Psychotherapy Group?

Group Psychotherapy: The Octopus and the Group – what do they have in common?

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Filed Under: Gender, Relationships, Thea Beech Tagged With: group psychotherapy, relationship, Trauma

April 9, 2018 by Brighton & Hove Psychotherapy Leave a Comment

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?

Face to Face and Online Therapy Help Available Now

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Filed Under: Mark Vahrmeyer, Relationships, Spirituality Tagged With: attachment, Emotions, mind and body, Psychotherapy, Trauma

May 23, 2016 by Brighton & Hove Psychotherapy 3 Comments

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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Filed Under: Mark Vahrmeyer, Mental Health, Neuroscience Tagged With: affect regulation, Psychotherapy, PTSD, Trauma

May 16, 2016 by Brighton & Hove Psychotherapy Leave a Comment

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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Filed Under: Mark Vahrmeyer, Psychotherapy Tagged With: memory, PTSD, somatic memory, Trauma

March 14, 2016 by Brighton & Hove Psychotherapy 2 Comments

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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Filed Under: Attachment, Mark Vahrmeyer, Psychotherapy Tagged With: Attachment Styles, Neuroscience, Psychotherapy, Trauma

February 22, 2016 by Brighton & Hove Psychotherapy Leave a Comment

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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Filed Under: Mark Vahrmeyer, Psychotherapy Tagged With: anger, Psychotherapy, Trauma

January 29, 2016 by Brighton & Hove Psychotherapy 1 Comment

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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Filed Under: Psychotherapy, Sam Jahara Tagged With: Psychotherapy, PTSD, Trauma

July 28, 2015 by Brighton & Hove Psychotherapy 1 Comment

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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Filed Under: Brighton and Hove Psychotherapy, Mental Health, Psychotherapy, Sam Jahara Tagged With: abuse, Dissociation, hypervigilance, Trauma

December 28, 2013 by Brighton & Hove Psychotherapy Leave a Comment

Energy Psychotherapy

The concept of energy psychotherapy may be unfamiliar to most and easily dismissed as something ‘new age’ sounding.  However, in reality, working with body energy to heal trauma is neither a new concept, nor one that is apart from mainstream clinical psychotherapy.

First off, what is energy psychotherapy?  In brief, it is a directive method of working with the mind and body simultaneously with the goal of healing blockages caused by traumatic experiences.  It is referred to as energy psychotherapy as the parts of the body where trauma gets ‘stuck’ or blocked are the energy circuits referred to in Chinese medicine – meridians and in Hinduism – chakras.

So what exactly is trauma and how does it affect us?  Trauma is defined as being damage to an individual’s psyche which comes about from a severely distressing event.  Trauma can be a single event, or a repeated or enduring event but what they all have in common is that the individual’s ability to cope – to process and make sense of the experience – is completely overwhelmed.  The problem with trauma is that until it is resolved, it tends to repeat itself either through a direct re-experiencing of the original traumatic event, or through more psychosomatic symptoms such as panic attacks, insomnia and anxiety.  In short, trauma can be debilitating.

In traditional psychotherapy, it is only the mind and emotional system that gets activated.  In energy psychotherapy, the mind, emotional system, body and energy system are all activated which can lead to significant resolution of trauma in a relatively short period of time.  The NHS currently endorses psychological treatments derived from more complex theories of energy psychotherapy with good results.  These include EMDR, EFT and TFT.  However, whilst each of these approaches can be helpful, none are as profound a way of working to systematically clear trauma as energy psychotherapy.

Energy psychotherapy, in the form of AIT – Advanced Integrative Therapy – is offered through Brighton and Hove Psychotherapy.  AIT is a method of working available solely to clinical psychologists and psychotherapists, which is non-intrusive and gentle.  It has been shown to both greatly reduce trauma related symptoms and help resolve the deeply seated unconscious trauma that is triggering these symptoms.

Mark Vahrmeyer

 

                                                                                                Image by Sam Jahara

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Filed Under: Brighton and Hove Psychotherapy, Mark Vahrmeyer, Mental Health, Psychotherapy Tagged With: Advanced Integrative Therapy, Energy Psychotherapy, Trauma

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