Loss Blogs - Brighton and Hove Psychotherapy

May 27, 2024 by BHP Leave a Comment

Reflections on bereavement

The experience of loss and grief from bereavement are often explored in psychotherapy. Finding a way to cope and move forward, when the weight of emotion feels intense. The knowledge that life ends and how we go through the associated grief is something that is hard to prepare for. Much is written about loss and grief, but from experience some common themes do emerge.

Loss is not a straight line

How do we deal with, process and manage bereavement, loss and grief? There is evidence of stages, an indication of what one might experience and how one might cope. This is always reassuring to think that we can put structure around what can feel chaotic, especially when the emotions can feel unbearable. Being able to feel that we have some control of our emotions when we are potentially overwhelmed by them. How we think about such guidance is where the challenge lies. Loss is not a straight line. The emotions surrounding it can be complex and rarely follow any neat progression. Can we be reflective, aware of how we feel and avoid pressuring ourselves to ‘move on’? Is it possible to let the emotions happen and not feel that we have to be good at how we handle death and grief?

Loss is individual

Speaking of stages and process around loss can give structure to what is going on, but can also cause us to compare ourselves to others. Seeing that everyone moves at a different pace, for whatever reason, can be hard to manage. How do we feel when others seem to be moving on, but we feel stuck? This is the point at which the individuality of death can feel most important. Everyone experiences it in a different way and thus will grieve differently. Being aware of this and resisting comparisons with others can make us feel more able to cope and less isolated with our individual experience.

Also individual is the actual response to death. The relationships that we have to the deceased always come with a different set of emotions. One person’s extreme grief can contrast with someone else’s mild sadness. Being able to express and value whatever emotional response one has is important, and ideally every response can be heard.

Loss can feel ‘ugly’

Sadness is probably the obvious emotion that comes to mind when we think of loss. Therefore, to experience anger, frustration, annoyance, and other emotions that feel a long way from sadness, isn’t easy. I once heard it described as the ‘ugly’ side of grief. It is however quite likely that one could feel any or all of these. They are hard to make sense of and hard to share with those who are also grieving. Can we share these feelings, or do they feel too challenging to be brought up? The ‘ugly’ emotions are part of grieving, so how do we find a way to acknowledge them and not feel that we are being hurtful towards the deceased or those who are also grieving?

Loss has associations

When we talk about loss and grief, it often isn’t always about one event. To grieve is to be open to a series of emotions that might take us far from what has actually happened. Past events, personal experiences, present issues can’t be neatly separated when we experience loss. Being open to this and able to acknowledge that life events don’t happen in isolation can help to frame one’s emotional response.

Loss, grief and psychotherapy

In all these reflections the common theme is that we need the space to reflect and process loss and grief. A strong support network of family and friends can be helpful. Sometimes however such a network is hard to find or speak with and at this point talking therapy can provide that reflective space. Psychotherapy for bereavement gives the bereaved the opportunity to be reflective and open with every emotion and ultimately work through their grief.

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 –

Compulsive use of pornography

Mental health in retirement

Subjective perception, shared experience

In support of being average

Collective grief

April 1, 2024 by BHP Leave a Comment

Ageing and death

Ageing and death are two topics we find difficult to think and talk about.

Do you remember when you first realised you were a grown up? Major events like the loss of a parent signal a change in the social pecking order, and how society or the world sees us. There are moments that symbolise the start of a new phase, when we move from one stage of life to another, and age is the primary signifier. It usually happens when we are least aware of the transformation. Moving from child to adult, and young adult to adulthood, maturity and old age. As ageing adults, might we be in denial? ‘I feel the same as I did when I was twenty-five’ – is this denial or how life is experienced for most of us?

A woman remarked the other day that a young man had offered her a seat on the bus. The comment triggered her to consider what this means. Did she look as though she needed to sit down because she looked old? She was not the young woman she felt inside, but an older generation. Of course, there could be many other reasons why he gave up his seat.

How does this impact our lives and relationships? In that period of life where we are developing a career, raising a family, or supporting parents in their old age, we are so busy that we may not want or have the time to reflect on how our roles and status are changing. The encounter with the young man who gives up his seat for us triggers in our minds the reality that we are seen differently in the world than how we experience ourselves.

Rather than giving advice here, it would be useful to think about ageing with an optimistic lens, by identifying earlier on in life what is required to preserve our mental health:

avoiding isolation and loneliness
physical health and wellbeing
mental stimulation
companionship with family and friends
keeping an open mind
dealing actively with loss and grief, and
actively managing our mental health to prepare for old age.

The last point is concerned with investing in your mental health throughout your lifetime. What are your relationships like with family and friends? Are problems swept under the carpet when resentments build up over months and years? We have an emotional economy that needs building on for those latter years.

In future blog posts I will elaborate on the above topics and suggest how we can help with some of the issues. For example, joining a group where you can discuss these things with others.

Thea Beech is a Group Analyst with many years experience working in the UK and overseas. She worked as A Group Analyst in South Africa as a Lecturer at Cape Town UCT and at Kwa Zulu Natal University in Durban, lecturing on a Masters Program in Group Work. Her MA in Applied research was on Eating disorders. Her interests are in cultural diversity and trans-generational influences on the individual. Thea is available at our Brighton and Hove Practice.

Further reading by Thea Beech

The first 5 years

How do I know if I am ready to become a parent?

Our emotions are shaped by our relationships?

Group Analytic Psychotherapy – the slow open group

It is never too late to start therapy

February 26, 2024 by BHP Leave a Comment

I worked as a psychotherapist with death. Here’s what I learnt

Most psychotherapists have specific experience in one or multiple fields and one of mine happens to be death.

From 2012 to 2016, I worked at a large UK hospice as part of the clinical team supporting both patients and relatives. The work was confronting, humbling and hugely varied and it taught me a few things about death which I would like to share.

Why did I choose death?

Every psychotherapist who is well trained and has undergone their own analysis or depth psychotherapy knows that they cannot be ‘good’ at working with every patient group. None of us can be good at everything and this is especially true in the field of psychotherapy where we have our own history, traumas and blind spots. Equally, we also know not only where we are not so good, but also which challenges or pathologies we like working with and with which we get good results. For me, one of these is death.

I understand why – I was raised by a father who was already 60 when I was born. Throw in his fairly volatile and depressive personality, no other relatives and being moved from country to country as a kid, and I was left hypervigilant about his health.

I remember I would come home from nights out in my late teens, ears still ringing from whichever nightclub I had been in, and intently try to listen for his snoring as I passed his bedroom door on my way to bed. Sometimes it would take quite some time for my ears to pick up signs of life and during those moments my mind would anxiously imagine that he had died and I was all alone.

As it happened, despite my father’s depressive nature, his diet of sugary drinks and biscuits and his penchant for getting divorced (six times), he managed to live to 94. So much for the predictability of death!

Being reminded about death makes us anxious

This first point brings together empirical research in the field of how we cope with death anxiety – terror management theory (TMT) – and my own lived experience working as a clinician with patients who were dying.

TMT is a research field I used in my MA on this topic and the underlying premise is that we are all, at our core, terrified of death; we are, as far as we know, the only mammals who have sufficient consciousness to know we are going to die and yet, alongside this, need to somehow lead meaningful lives.

When exposed to direct or indirect reminders of death, the research shows that our anxiety levels increase exponentially and heavily influence our decisions in favour of safer, more conservative choices. It’s fascinating stuff.

My experience of working with patients versus their relatives was quite distinctly opposed, even though on the face of it, I was dealing with a similar ‘presenting issue’. Working with relatives who were either pre- or post-bereavement was often messy – there would be a lot of tears, for example – and sad, but it did not make me feel anxious. They had gone through something and I hadn’t. There was a separation between us. And the work,
however hard, was grief work, which has a trajectory.

What rendered me anxious was working with patients, which quite literally meant sitting with death. My first experience of this was in seeing a patient for an initial consultation who had resisted having any therapy for quite some time and finally decided that the time had come for him to do some work with me. He was relatively young, reasonably fit (given he had stage four cancer), middle-class and clearly a positive character. I liked him. We agreed some key areas he wished to look at and parted company planning to meet at the
same time and same place (the hospice) one week later.

A week later I arrived at my office and opened the patient record system to check on him and other patients who had been referred to me. I had been looking forward to my session with this first patient, only to read that he had died. Not only that but he had died the evening after I saw him and yet had walked out of the hospice comfortably under his own steam. This was not the plan (his nor mine) and was not supposed to happen. But it did.

Working with death is both the easiest and hardest thing to do

Grief work has been extensively written about and, if you are that way inclined, there are numerous models of how to work with grief that can be applied including the now simplistic and ubiquitous ‘Five Stages of Grief’ by Elisabeth Kübler-Ross. The models are not complicated and nor are the steps. What’s hard is being with death and the feelings that death brings up for us.

Part of my role at the hospice was to recruit and train volunteer counsellors at our yearly intake. These volunteers would go through a ten-week training programme on top of the basic clinical training they had already undergone, and did so in part to gain clinical experience and for many also because they had an interest in death.

We would generally over-recruit by 100% as invariably there would be people who would drop-out of the course for family reasons, personal reasons or a general lack of skills.

However, there was one particular week during the training when we would see the most leavers and that was week four – this happened year after year. In week three the trainees left the classroom environment for the first time and were given a tour of the hospice including the inpatient unit.

The inpatient unit in any hospice is generally where patients come to die. Nothing advertises this reality and compared to most hospitals the ward was bright, cheerful and airy with views over a beautiful garden. The trainees would see one of the empty rooms and be aware of the presence of patients behind the other closed doors. The unease was palpable. Death had become real.

By the following week we had usually had four or five counsellors leave ostensibly for ‘personal reasons’ but after four years the pattern was impossible to ignore: it is one thing to conceptualise death; quite another to be face-to-face with it.

In death there is no ‘us’ and ‘them’

Most of the issues or challenges that I work with, are not ones I have directly experienced and nor will I. I can work with addiction without having been an addict, I can work with eating disorders whilst always having had a healthy appetite and I can work with abandonment as the person doing the abandonment is not my parent.

Death is different.

There is a part of us all that lies hidden, that knows that we face the same fate and try to escape it. And we all can, at least temporarily. But, no matter how hard we try, how much money we have and how ‘good’ a person we are, we will all have to face an uncertain death. Death is ‘us’.

I am a good clinician but I have never felt the same degree of helplessness as when sitting with a patient who is dying and somehow trying to be of use as they face regrets and terror. It is extremely humbling and difficult.

Psychotherapy treatment does not always take place in a consulting room

I am psycho-analytically trained and that means that I tend to see my patients in private practice at the same place, on the same day and at the same time every week. Ongoing. I attempt to remain as consistent as I can and with most of my clinical work the relationship we build lasts many months if not years. This is not how it is working with death.

I have ‘treated’ patients by their bedside, quite frequently with nurses busting in and out of the room and yet been able to offer something.

I have given sessions that lasted little more than minutes as that was all the patient could endure before the pain or hallucinations took them away from contact with me. They were worthwhile.

One session that remains firmly embedded in my mind was with patient who was dying from a brain tumour. She was in many ways hardly recognisable as a human; she had lost her hair, her body shape, was covered in scars from operations and swollen from steroids.

I will admit it was hard to sit with her.

This patient told me about a door at the bottom of her bed that led to her sister’s beach hut in Devon where she was able to run on the beach with her sibling. She asked me if it was real. I thought about this knowing full well that her experience was, at least by way of clinical explanation, a hallucination caused by the morphine. She seemed to gain a lot of joy and peace from her ‘hallucination’ and so that is what we talked about. This was
therapeutic for her. It was a way of escaping her predicament and feeling like the master of her own life again.

Oh, and unlike the planned ending I usually co-create with my private practice patients, it was rare to have a ‘planned’ ending with a hospice patient. Whilst they would happen on occasion, the ending was usually dictated by death and I would learn of this via the digital patient record system at the start of my day.

Grieving is not complicated when the relationship is one that is secure and loving

Prior to working in this field, I had naively assumed that the closer a relationship – especially between parent and child – the more complicated and sadder would be the grieving process. This is not the case.

The complicated cases of grief were often those where parent and child were estranged and the now adult child was suddenly involved in providing care for their parent. What made the grief complicated was that it was not just the grief of the death of that parent, but the grief of never really having had the parent they wanted and needed. The death symbolised the loss of all hope that things could and would be different.

In secure and loving relationships, the lost loved one (often a parent) could be mourned and grieved for but it was generally something that the bereaved could do themselves and with other loved ones – I was not needed.

Hidden psychopathology surfaces when approaching death

Part of my role was to attend multi-disciplinary clinical meetings, particularly in the cases of patients who seemed to be psychologically struggling.

It was from working with these patients that I came to understand how severe psychopathology can find a place to hide throughout a lifetime and it is not until the approach of death, as more and more of the socially sanctioned hiding places are stripped away, that the patient’s real pathology surfaces.

In one case I recall working with a patient who was successful both professionally and personally and yet who was now clearly fragmenting and displaying all the signs of having a personality disorder. He had the whole clinical team running after his every whim and would present contradictory parts of himself to different team members. The result was that his internal conflict played out in the clinical team as overt conflict. It was only through helping them (and them helping me) to think through what was ‘being put into us’ that we could understand his pathology and step out of the projections. He created chaos in lieu of being able to control his life as he had done for 70-odd years, and the chaos protected him from facing death.

We can only stare at the sun for so long

Irvin Yalom, the great existential psychotherapist wrote a book on death with the title ‘Staring at the Sun’, which I believe to be an apt analogy for how we humans deal with the reality of death. Just as it is blinding and impossible to stare at the sun for any length of time, so it is with death. We can squint at it, consider it, intellectualise it, rationalise it, but we can only really be with it for a short while before it starts to overwhelm us and we must look away.

I used to leave the hospice with a skip in my step and noticed that I would generally play my music louder than usual in the car on the way home. I got curious about this and realised that I had been unconsciously playing my own little game with death which went something like ‘Ha! Today you don’t get me!’. Nothing wrong with this and if death can make us feel more alive that is a good thing. But I also recognised my own history
repeating itself stretching back to me listening at my father’s bedroom door for signs of life – ‘not today…’.

After four years I made the decision to leave palliative care and focus more on private practice. Interestingly within a couple of years the whole team I had worked with had moved on and most had also left palliative care. I think we had perhaps collectively stared at the sun long enough and turned away to instead be a little more in denial like everyone else.

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 –

What is the difference between loving and longing?

Why do we expect women to smile and not men?

Is there something wrong with me for hating Christmas?

Why do some of us feel a constant sense of dread?

February 5, 2024 by BHP 2 Comments

What is the difference between loving and longing?

Loving and longing can be frequently found in song lyrics nestled up alongside each other as though they are somehow related, however, I would suggest that psychologically they are very different and perhaps opposites, especially in the context of relationships.

To understand longing, we need to understand desire. We can only desire that which we do not have: we desire another until we have them; we desire food (have an appetite) until we eat, after which desire is replaced by satiety. Longing is related to desire but it refers to a desire that cannot be met – a sort of unrequited love.

I work with patients who find themselves in romantic relationships which are deeply frustrating and stuck and yet they cannot seem to leave. Mostly, these people do not understand why they are attracted to men or women who seem unable to meet their needs and unable to commit to anything real. These relationships, or repetitious encounters, seem to be characterised by a lot of excitement followed by a rollercoaster of other feelings but fundamentally what keeps these people stuck in a loop is longing.

Longing is a form of pseudo-desire that promises much and delivers very little. In relationships of the nature I have defined above, longing is addictive like a drug or a desert mirage that drives the thirsty traveller ever forward without the oasis ever appearing.

Is it a girl thing?

At risk of perpetuating gender stereotypes, there is a painful dance that takes place around the impossibility of intimacy that both the masculine and feminine contribute to – after all it is pretty lonely to dance without a partner.

Sex and the city and Mr Big

Anyone who is familiar with the long-running series ‘Sex and The City’ will be familiar with the storyline of Carrie and Mr Big. There is nothing particularly original about them in that it is a modern version of the woman chasing the unavailable man, and research has shown that this storyline forms the basis of most female sexual fantasies. In Sex and The City, Carrie eventually gets her man and Mr Big, in realising how much he has hurt Carrie, pursues her and they eventually marry. It’s the promise in all of these fantasies which is that as long as the girl hangs in there long enough and works hard enough, she will get her fairy-tale ending. ’50 Shades of Grey’ follows the same recipe.

Whether liberal fairy tale or modern-day blockbuster series, the principal message remains the same – hang in there long enough and you will get the love you want and deserve. In other words, longing pays off. It’s an uplifting and encouraging message but largely false.

Relationships that are defined by longing and unavailability and yet both partners cannot seem to give them up rarely end in the fairy-tale ending because that would negate the unconscious function of the longing.

The longing is a re-enactment of past abandonment or loss that has not been worked through. Sadly, romantic relationships are where we often tend to replay these painful dramas from our past and the unconscious ensures that we manage to successfully locate a co-star who will play the opposite role for us, as it corresponds with their relational traumas and loss.

And men?

Archetypally men who are ‘longed for’ are depicted as the unavailable man – think ‘Beauty and The Beast’ and you are on the right track. A man who is untamed and / or has shunned society but who with enough love can be won over and will make a great partner.

The reality of these men is that they are dealing with their own childhood losses but rather than the solution being one whereby they relentlessly hope, instead they relentlessly withdraw. They are not waiting to be loved into a good relationship, they are terrified of intimacy.

So what about love?

Well love in its psychologically mature meaning is a state in which there is mutuality of feeling in the here-and-now. In other words, love recognises the reality of the person who is in front of us, their qualities and their limitations, which is weighed up against the degree to which they can meet our needs. Let’s be clear, this is not the same as ‘falling in love’ which is a very different thing and as Freud so succinctly put it, akin to a form of psychosis as we are consumed by a delusion about the other and only see what we want to see.

Love is the ability to hold ourselves and the other in mind and have this reciprocated. Love is the ability to receive as well as give and to be present for each other’s vulnerabilities. Where love is, longing is not required.

Relinquishing longing

Longing is not really an emotion, it is rather a sentiment. Like melancholy, it has yet to develop into something that resembles a real set of emotions. Beneath longing lies grief which tells us that longing is very different to desire in that it acts in lieu of something that cannot be felt or processed.

Sex and The City Finale

In the show, Carrie and Mr Big get married and live happily ever after which is exactly as it should be in a fairy tale. In real life, a painful relating pattern such as this can really only end happily if both parties are willing to do the work (therapy) and discover why exactly they are both so addicted to longing and being longed for. Then and only then can the grieving begin.

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

Is there a Good Way to break up with Someone?

Can Self Help become an Identity?

Can psychotherapy help narcissists?

Are we becoming more narcissistic?

December 25, 2023 by BHP Leave a Comment

Is there something wrong with me for hating Christmas?

Everybody loves Christmas. That’s a fact. At least if you watch how it is portrayed by the media and subscribe to the collective mania of ‘preparing for the big day’……….

Of course, the reality is that many of us find Christmas difficult and for some it can feel unbearable. We have the statistics for this – the Samaritans charity experiences its highest call volume over the so-called festive period, suicide rates increase and mental health professionals such as myself experience an uptick in enquiries.

Why is this?

I have written blogs and contributed to articles in the press on the reality of Christmas for many people and yet despite my small efforts and those of many others in my field, there remains a taboo around acknowledging how hard this time of year can be for many people, and an expectation that we will all somehow collude with the manic hysteria of turning the day into some sort of magical experience that eradicates both the memory and the reality of complex family dynamics.

In my view, Christmas should really only be magical for one group of people and that is children. It is a developmental experience to believe in the unbelievable and children are not only susceptible to this but also have an interesting way of denying reality even when it is staring them in the face. I think this is part of the ordinary process of slowly coming to terms with both the reality of the world and our lack of control over it. However, aside from children, there is no benefit to adults in believing there is anything magical about Christmas or any other day.

Having spent many years working with the bereaved, I am acutely aware that after a bereavement, it is the anniversary dates in the first year following the death of a loved one that can be most difficult – the first birthday, the first wedding anniversary and the first Christmas. And it is often these anniversary dates that continue to bring forth the loss for many years to come.

All Families are Psychotic

All Families are Psychotic is the title of a book by acclaimed Canadian novelist, Douglas Coupland, and whilst I do not take it literally, the human condition and the meaninglessness of life is most certainly a theme in Coupland’s work.

And whilst I am not seeking to minimise psychosis, there is something somewhat delusional about how the collective (society) colludes and invites merger around the fantasy that all is well in the family and ‘there’s nothing to see here’. This, for me, is akin to the child’s magical approach to Christmas and it’s unhelpful.

For the member(s) of such a family who feel frustrated and lonely with the lack of true connection, which I define as the ability of each member of the family to bring their needs into the mix and negotiate together, this invitation or expectation to collude can feel especially alienating and, combined with external pressures, can make them feel wrong.

Now of course there are plenty of families where the relationships are based on mutuality and love and they may also enjoy Christmas. However, the paradox here is that because the relationships are real, there is no need to whip everyone up into a manic state of hysteria around just how perfect the day is – the day can be good enough and each member of the family can have their own experience.

Christmas is not magical but it is powerful

Of all the anniversary dates that can bring forth unresolved or simply painful grief, Christmas is especially powerful for two reasons: firstly, there is a collective expectation placed upon the day that somehow it has the power to heal rifts and paper over grievances – which it does not have; and secondly, for many adults of conflictual families, historically much of the conflict would have come to the surface at Christmas.

Children growing up in homes where there is not enough money to create the ‘fairy-tale’ Christmas, where there is only one parent, where extended family do not feature, or where their parents are in conflict, all have the propensity to carry these feelings forward with them, only to find themselves revisiting them as a Ghost of Christmas Past each year.

What can you do if you find the day tough?

Even if those around you – and the collective is absolute on this – don’t or can’t acknowledge that the day is tough for you, or that you are having feelings other than ‘joy’, it does not mean that you are wrong.

Acknowledge in advance to yourself that it is a difficult day.
Consider whether you have someone you can trust with your feelings who will be able to accept them without attacking you or abandoning you.
Accept that you have your reasons for disliking Christmas.
Consider in advance of the day what you want from Christmas – even if this in an ideal world. Begin there and then work with what you are choosing or have to do.
Remember that it is only a day and that it will pass.

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

Why do some of us feel a constant sense of dread?

Is there a good way to break up with someone?

Can self care become an identity?

Can psychotherapy help narcissists?

Are we becoming more narcissistic?

November 27, 2023 by BHP Leave a Comment

Is there a good way to break up with someone?

Breaking up with someone is hard to do. Often we feel a degree of ambivalence about our own emotions and our instinct is to both find the easiest and fastest way of ‘just ending it’.

Whilst this may seem seductive, the easiest and fastest way is often more likely to cause conflict and to leave us feeling ‘unresolved’ about the ending.

I believe that it is possible to end a meaningful relationship with another whilst holding ourselves in mind and essentially being ‘selfish’. I often refer to being ‘selfish’ (with a small ‘s’) in my consulting room as being the act of first and foremost holding ourselves in mind whilst not dismissing another’s experience.

Even good things must end

The first step in holding ourselves in mind is to bring an end to the relationship. If you have made up your mind then this represents a ‘hard boundary’ and is not one that can be negotiated.

The second step is to think about how you want to feel after the break-up. This is another step in being selfish in that you are thinking about your own sense of integrity and self esteem. If you are ending a relationship with someone you have cared about and the ending is a ‘no fault ending’ then it is unlikely you will feel good about yourself if you simply ‘ghost’ them.

Accepting different emotions

If your partner is not expecting the relationship to end, it is likely they will have a very different emotional response to the news than yours. Whilst this may feel uncomfortable, it is entirely natural and providing they do not verbally or physically attack you nor try and make you feel responsible for their emotions, they are allowed to have their emotional experience.

I would suggest that relationship endings should always be done in person and in private. It can be tempting to create distance when initiating a break up – such as ending things via text message – but this is far more likely to cause a ‘messy’ ending than by meeting with the person. By meeting in private it gives you both the opportunity to say what needs to be said and importantly feelings to be felt, without the discomfort of strangers witnessing your relationship coming to an end.

When we are uncomfortable about delivering a message that may hurt another, we can have the tendency to try and ‘soften the blow’ by using gentler language, however, this can backfire as the person receiving our message may hear this as a sign of hope and fail to recognise that the relationship is truly over. Clarity is ultimately kinder to you and your partner.

Being compassionate does not mean staying when you want to go

You can empathise with your partner’s feelings of shock, hurt, disappointment and sadness without backtracking on your decision or making yourself ‘wrong’. Remember, they are entitled to their emotions and you are entitled to yours.

I would recommend being boundaried with the time you spend delivering the message and thinking about where the balance lies between delivering what you have to say compassionately and sacrificing your needs. Perhaps plan in advance how long you will spend talking to your (ex) partner before leaving and creating some distance.

If your partner is able and willing to have a dialogue with you then you can discuss how you will approach letting your sider family and social circle know about the break-up and agree a narrative you both can adopt.

If possible, cut off all contact following the break-up, so as to allow space to grieve and start to move on. You can think about this in advance of your meeting and I would suggest that a minimum of a few months can be a helpful period of time to grieve some of the rawer feelings.

Let’s be friends…

Don’t commit to being ‘friends’ at the break-up. Whilst this again may feel seductive, neither of you know how you will feel about the other once the dust has settled and you have grieved. You may be able to be friends or you may not. The romantic relationship needs to first come to an end and only in time will you know whether any form of platonic relationship is possible.

Recognise that even though it is you who has initiated the break-up, this does not mean that you will not feel grief and need to give yourself time to let go of the relationship and your now ex-partner. Getting used to the ‘space’ left in our lives after a break up – a shift emotionally from ‘we’ to ‘me’ – can take time and feel uncomfortable. The inclination can be to ‘fill’ that space with dating, however, this rarely works out well and is a way of avoiding the grieving process.

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

Can Self-Help become an identity?

Can psychotherapy help narcissists?

Are we becoming more narcissistic?

What is narcissism?

The medicalisation of mental distress

April 10, 2023 by BHP Leave a Comment

The end

Just as what goes up must come down, so whatever begins must end.

Each of us comes to deal with this existential reality imposed on our own lives and all the living beings that we care for. As truly relational creatures we humans encounter the inescapable fact of death in those who die before us and we experience the pain of loss and bereavement.

And grief work itself is a common reason for people to seek therapeutic support. But whether it is through debilitating loss, or one of the many other reasons that spur people to commit to regular therapy, it is a fact that once therapy has begun, an ending of some sort will surely follow in the fullness of time.

Indeed the business of deciding when and how to end therapy is not straightforward.

Aspects that might make it easier to recognise when work is coming to an end can sit within the very beginnings of the work. Sometimes we go to therapy with a higher level of self knowledge about where our difficulties lie. With the help of our chosen therapist we can identify a working goal that will help us to recognise desirable change and a means of measuring how we will know when this has been achieved.

Through this means an ending may well present itself. In some senses this work might be likened to sailing whilst keeping the shoreline always in view.

Perhaps more often than not though, we can approach therapy with a less clear picture of who we are in our lives at that particular point in time, maybe even feeling unsure about quite what is ailing us or why.

In this case the beginnings of therapy can require a willingness to tolerate uncertainty. To deepen our self awareness, we might contract with our therapist to explore more deeply how we are in the world and this might come with a commitment to developing skills for new ways of being. We might compare this approach with setting sail beyond coastal waters to the open sea in search of new horizons.

When client and therapist first meet one question swirls for each of them: how is this for me to meet in relationship with this new person? And when the time comes to end therapy the question’s twin will arrive: how is this for me to end my relationship with this person I have known? An attuning therapist will process both these questions in the service of her client. For the client these valuable questions offer a way to better understand themselves and to evaluate any differences they experience in who they were back then at the beginning and who they feel they are now, at ‘the end’.

Much has been written about endings in therapy in terms of how this might relate to the ways in which both client and therapist have processed loss and bereavement in their own lives. Some family systems therapists have proposed that we can conceive other contexts to finishing therapeutic work than (1) ‘ending as loss’. Their framings suggest to me some useful additional questions for both client and therapist to consider:

• Ending as cure: does the client feel ‘better’ in relation to the way they originally felt ‘bad’?
• Ending as transition: how has this therapy supported the client to grow developmentally?
• Ending as release: does either client or therapist feel relief in this ending and if so, what might this mean?
• Ending as metamorphosis: how have both client and therapist changed through this relationship?

Reviewing these questions here reminds me of the vital importance of beginnings and endings in shaping the content of therapy and the emerging relationship between practitioner and client. Thus therapeutic beginnings and endings always invite our special attention.

As it is ultimately the client who decides to finish in therapy one final question becomes theirs alone: having begun, how much time and space will I allow myself to end?

Chris Horton is a registered member of the British Association for Counselling & Psychotherapy (BACP) and a psychotherapeutic counsellor with experience in a diverse range of occupational settings.

Further reading by Chris Horton –

I’m the problem – It’s me!

Making sense of our multiple selves

Let’s not go round again – how we repeat ourselves!

Out of Sight, Out of Mind

Resources –

Fredman G. & Dalal C. (1998) Ending discourses: implications for relationships and action in therapy. 1
Human Systems: The Journal of Systemic Consultation & Management. Vol 9 (Issue 1)

January 2, 2023 by Brighton & Hove Psychotherapy Leave a Comment

New Year’s Resolutions – why change might be so difficult

The start of a new year feels like a good time to make resolutions to change your life. Cut down on drinking, learn something new, be more efficient, be kinder, be more sociable or get fit.

Gym memberships regularly peak in January, increasing by 10%-20% but how many of those new memberships are used? According to research by Fridge Raiders, published in the Daily Mail in March 2019, 23% of Britons have gym memberships but only 12% use them often. They estimate that more than 4 billion pounds a year is wasted on unused gym memberships.

The reasons given for the 50 percent who did not attend regularly or at all, were to do with feeling self-conscious or intimidated, thinking that everyone was watching, finding repetitive activity boring and not knowing how to use the gym equipment. These could be valid reasons but Robert Kegan and Lisa Laskow Lahey think it goes deeper. They ask why do we stick with the status quo when we are unhappy or unwell and know that change will make us feel better or even make us live longer? Kegan and Lahey have been researching the resistance to change for many years. In their book Immunity to Change (2009) they discovered that strongly held values, often unconscious, prevented both collective and individual change.

The most quoted finding from their studies comes from interviews with patients with heart disease who were told they must change their habits around eating, drinking, smoking and exercise and take their medication otherwise they would die. Kegan and Lahey found that only one in seven was able to make the necessary changes. Making further enquiries they discovered that although patients recognised the imperative of their doctor’s advice there were deep seated beliefs that contradicted their desire to get well.

A composite example would be a man who said that cutting down on food and drink and taking medication for ‘old people’ would make him feel he was old and weak. This challenged his idea of himself as a competent man in the midst of a productive life. Beneath this was his fear of becoming incapacitated and dying that brought back memories of his father’s illness and death. At a deep level the fears that prevented him taking care of himself were the very things that were likely to happen to him if did not change his habits.

There are many other examples in their book. Another composite example would be a manager who wanted to be more collaborative and involve his team in decision-making. Until he participated in the research he did not realise how much his fear of being a weak leader prevented him from being open to the ideas of others. This feeling stemmed from the unspoken culture of ‘you must be strong otherwise you won’t survive’ in the family he grew up in and was an integral belief about himself. When he could recognise this belief and its negative impact he was able to ask for support to change and eventually become a better and happier leader.

Kegan and Lahey’s research helps us understand why it might be so hard to change our habits to improve our lives. They offer an alternative to castigating ourselves for our indiscipline and lack of commitment and, I think, suggest that we begin by being kind to ourselves and curious.

References –

https://www.dailymail.co.uk/news/article-6765171/Britons-spend-4-billion-year-unused-gym-memberships-new-survey-reveals.html

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.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

September 27, 2021 by BHP Leave a Comment

Space: The Final Frontier of Manic Defence

As a boy I was fascinated by space travel. I remember being glued to the television set with awe as the Space Shuttle blasted off into space back in the early 80s – I was born after the epic Apollo programme came to an end and was just the right age to appreciate the engineering accomplishments in launching the Shuttle, without having fully lost my sense of wonder and amazement at the idea of man (and woman) going into space.

In recent years and months it seems a new type of space race has emerged – one that for me lacks much of the romance of the Apollo and even the Shuttle programme and instead halls of something very different indeed. I am referring to the race which seems to be be the vanity project of three of the richest (one middle-aged, and two bordering on elderly) men – Bezos, Branson and Musk.

What drives them?

Well, I am a good psychotherapist but cannot mind read. Nonetheless, there is some commonality between the three which I shall cover further on in this piece. What we can easily derive is that what drives these men has very little in common with the values and ideologies behind the original space race between The United States and The former Soviet Union.

The original space race was about many things but none more so than an affirmation of superiority over the other. Superiority in the space race meant, symbolically, superiority as a culture. Why does this matter? Culture, it can be argued from an existential perspective, is fundamentally religious in nature in that it provides us all with a mechanism be become ‘heroic’ and belong. Culture, whether the so called ‘primitive cultures’ of the world through to the now globally dominant Western culture all have three things in common : a story of how we got here, rules on how to behave whilst we are here and lastly, and perhaps most importantly, a story of what happens after we die. This is ostensibly why ever war ever fought is a war of one culture against another or, put more purely, one religion against another whether Christianity versus Islam or Communism versus Capitalism (or Freedom, as the Americans like to call it).

Bezos, Branson and Musk all share the reality that they have immense and almost infinite wealth. However, whilst this wealth is currently propelling them towards space like modern day space cowboys (a reference to Bezos’ cowboy hat attire after his space trip), they share something even more concrete than their wealth and it is something they share with the rest of us: no matter how wealthy, they are hurtling towards their own finitude (death) just like the rest of us and this renders them anxious.

Existential anxiety

Existentialists have long argued that to feel anxious is to be human; that our very being is defined by a knowing anxiety as we are, as far as we can discern, the only species on the planet who has such a profound awareness of our being that we also know we are going to die. This is unbearable for us and so we invent ways in which to stave off death anxiety – back to the raison d’être of culture.

Bezos, Branson and Musk all live on the same planet as the rest of us mere (financial) mortals – a planet that is reaching its limits on almost every level: we are fast running out of space, clean air, clean water and temperature ranges that provide liveable conditions for us and our animal cousins.

However, to engage with this is deeply anxiety provoking, not just for billionaires but for all of us and to contemplate the planet’s finitude is to be reminded of our own finitude.

A flight from death

Imagine how much good could be done with the combined wealth of these three individuals on this planet: third world debt could be resolved, huge investment created in renewables, diseases eradicated and so on. However to do this it would mean living within the constraints of reality – within the context of finitude. It would mean that each of these men would have to accept that despite their billions, they are mere mortals who are going to die.

Manic defence

A manic defence is a process (unconscious) that humans employ to distract themselves from uncomfortable truths, thoughts and feelings. It is, if you wish, the polar opposite of depression, where one is consumed by negative thoughts and feelings and nothing possible can be accessed.

It is a normal developmental process for infants to pass from a state of denial and splitting to the depressive position whereby reality, with all its disappointments, can be tolerated – not the same as clinical depression.

Whilst the latest wave of space travel is couched as progressive and future orientated by each of these billionaires, in reality what seems to be emerging is simply an expensive and highly polluting contest from see whom has the biggest ego (or other appendage if one is to reference the phallic shape of Bezos’ rocket ship). And what are they offering the world? The ‘opportunity’ for others who are wealthy, but slightly less so, to invest in this egotistical immortality project by becoming ‘space tourists’.

The little boy in me dreamt of space and the idea of being a space tourist. I now am firmly (and uncomfortably) rooted in the reality in accepting my own finitude and that of the planet we all share. Perhaps if the three protagonists in question had spent just a little of their fortune on a curiosity in exploring their inner ‘space’, they would be more able to tolerate actual reality themselves and rather than resorting to mania to defend against existential angst, find culturally heroic ways of making a difference and leaving their mark.

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

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

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

April 12, 2021 by BHP 4 Comments

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?

January 27, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Loss

You can hold yourself back from the sufferings of the world, that is something you are free to do and it accords with your nature, but perhaps this very holding back is the one suffering you could avoid.”? Franz Kafka

Loss is a feature in almost every encounter we experience as psychotherapists. It’s a common part of being human. In this article, we will look at what loss is and what we can do with it.

What Is Loss?

Loss is a term we use to describe many experiences and not just death. Although bereavement is what we associate with loss, more everyday losses that we experience include loss of identity, the loss of childhood experiences, the loss of friendships or relationships or simply the loss you feel from a change in situations. Loss can be experienced in a range of different ways, and if not properly processed, it can have a profound impact on your life and mental well-being.

How To Cope with Loss

Experiencing a loss can make you feel like you have a lack of control. It’s therefore helpful to look at the things you do have control over and do things to make you feel more in control. Breaking things down into smaller, more manageable pieces ensures you don’t overwhelm yourself. For example, maintaining a routine and slowly introducing smaller goals can give you a sense of purpose.

Therapy is also a great tool for working through your loss, whatever that loss may be.

How Therapy Can Help With Loss

Talking to a professional psychotherapist can help you understand your feelings of loss and support you in overcoming them. As therapists, we reflect mentally through our own experiences and mirror them onto our clients, so they feel understood. Grief and loss cause pain, and this must be managed to ensure a healthy life.

This reflective process helps clients understand what they are doing to manage their grief. We’re not here to judge, but to bring awareness to it so it can be looked at more in-depth. Over time, through exploration of these survival strategies, the frightening experience of grief will pass. Sometimes, a loss must be examined from different angles to be able to move forward.

As therapists, we don’t judge. We provide a safe, calm space to listen to you. We understand that people who have experienced loss have so much going on in their lives and can struggle to make sense of it. We help you reflect on what is happening and help you to navigate through it.

Darian Leader’s book, The New Black, revisits Freud’s concepts of Mourning and Melancholia and explores the more subtle experience of loss and argues that modern life holds pressure to treat loss with medication. However, this adjusts the chemicals within the brain which has led to complex and unconscious causes of depression. Although drugs can be helpful, they rarely resolve the underlying cause of loss and depression.

Leader while praising Freud’s new thinking about depression, argues that he misses a vital element of mourning, its communal aspect and looks at various cultures and how they share the process of mourning.

In the book, Darian Leader argues that Freud missed a vital element in mourning: its communal aspect. In different cultures, many share the process of mourning, and mourning should be shared whether it’s a death or more everyday loss.

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.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

February 18, 2019 by Brighton & Hove Psychotherapy 1 Comment

A Nation divided

During Brexit, there was a lot of talk about how it divided our country. So we thought we would discuss how humans are divided and how Psychotherapy can ease some of the conflicts we have with ourselves and others. A personal ‘split’ can happen when we think or act in a way that doesn’t align with our beliefs.

In this quote, Freud describes how these splits can be repressed, by quoting Nietzsche’s phrase: –

“I did that’ says my memory; ‘I cannot have done that’, says my pride and refuses to yield. Finally – memory gives way.”

What Does it Mean to Have a Split?

Experiencing an emotional split isn’t always a bad thing. A split can be a way to manage feelings that can’t be properly managed at the time. So our mind represses it. However, the repression never goes away, and it will try and come out in some other way like displaced anger or depression.

An example of this is the conflicting feelings of love and hate for those we are close to. The feelings of anger and hurt towards a person are hard to express when we also feel love towards them, as we don’t want to hurt or lose them. Although we may not show certain emotions towards our loved ones, the feelings are still there and may come out in other ways through road rage to arguing with co-workers and even shouting at the TV.

When we feel these conflicts, it can be easy to dislike these parts of ourselves and push them aside. However, it’s important you work through these conflicts with therapy, as otherwise you may experience side effects that result in damaged relationships.

How Therapy Can Help

A therapist works with their client to uncover these conflicts in a safe, non-shaming and understanding environment. The client should feel they can honestly express themselves to their therapist which, in turn, will reduce the negative effects on their own life,

During therapy, a therapist will explore these conflicts without judgement. It is through this work a therapist can understand the emotions and whether they have been enabled by well-meaning friends and family.

As Carl Jung said:

“One does not become enlightened by imagining figures of light, but by making the darkness conscious.”

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.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

July 24, 2017 by Brighton & Hove Psychotherapy Leave a Comment

Grief – how to grieve?

Grief is often referred to in the context of intense feelings experienced with the loss of a loved one. The loss we experience is often caused through death. Grief is, therefore, synonymous with bereavement.

This, however, is nowhere near the whole story. In order to know how to grieve, we need to understand grief.

When we are told that someone is grieving, we may assume they are feeling intensely sad. Although this is often true, grief is comprised of a multitude of emotions, and sadness is only one. One of the early pioneers of grief work (yes, there is such a thing), was Elizabeth Kübler-Ross. She suggested grieving was an active process that required a “working through of emotions” broken down into five core groups: denial, anger, bargaining, depression and acceptance. Sadness would fall into the ‘depression’ group in this model.

Since Kübler-Ross, plenty of other models have been proposed. All of these have added something to the field. I will not directly elaborate on these in this blog, but further information can be found on the Internet.

Grief is, therefore, an umbrella term for a whole host of emotions, and it is a verb. It is something that we must allow ourselves to experience and actively engage with.

Why should I grieve?

Emotions exist within us, whether we consciously acknowledge them or not. Where we are unable to feel them (through repression, which is always unconscious) these emotions will often express themselves as a conversion reaction. They will be expressed through the body such as in aches and pains. They may be expressed through even more obscure symptoms, such as a loss of physical movement.

Where we are aware that we are feeling grief, but actively suppress the feeling, emotions are likely to manifest as anxiety or depressive symptoms, which can persist for years.

Thus, there is no escaping it, grief must be felt and ridden out, like a storm. To complicate things further, it is not a linear process. We might have felt anger (perhaps with our loved one for leaving us) and moved onto bargaining (“If only I had done more for them…”) However, this does not mean that we will not return to anger again. And again…

We must grieve because we need to acknowledge what we feel. If we do not (because we can’t or won’t) things get complicated.

How do I grieve?

Grieving (in the context of bereavement) used to be a socially prescribed activity which was both acknowledged by the wider community and defined as a process. Those who were bereaved would often wear symbols of their grief – black clothes or a black armband. Within their community, it was acknowledged that they would be grieving for a set period of time, often a year. This practice has largely been lost in northern Europe. However, in southern Europe, it remains common in more traditional communities to see widows wearing black for the remainder of their lives.

Religion

Love it or hate it, the one thing religion gave (or gives) us is a powerful story of what happens after we die. From the Vikings with Valhalla to the Christians and Heaven, the concept of an afterlife can bring great solace to loved ones who are left behind. The loss of socially prescribed ways of mourning, combined with a loss of religious beliefs, has made grieving more difficult.

Meaning making

A universal task in coming to terms with grief is to find some sense of meaning within it, and to weave this together into a narrative. We are no longer provided with cultural narratives in the way that we once were. This then becomes something that we need to do ourselves.

Why is grief hard for some people?

When I embarked on my own professional psychotherapy career, working directly with dying patients and their relatives, I imagined that the loss of the deceased would be felt most acutely where relationships had been close, connected and happy. However, the inverse was true. Where relationships had been difficult, strained, or even devoid of contact for long periods of time, the bereaved would often struggle to process the loss far more. This occurred particularly where the relationship was between a parent and their (adult) child.

The reason for this lies in attachment and in how we learn, through attachment, to feel. For those of us lucky enough to grow up in homes where there is no abuse or neglect, and no unexpected losses, we find it relatively easy to move in and out of relationship – to say ‘hello’ and ‘goodbye’. With the security of the relationship comes an ability to feel emotions and make sense of what is being felt. Thus, the process of grieving, whilst hard, is something that can be actively undertaken.

In some parent/child relationships, the child has been significantly disappointed by the parent in the past. Parental neglect and/or abuse can lead to an accumulation of unacknowledged earlier losses in the relationship. In these cases, the final physical loss of the parent can make it very hard to come to terms with the enormity of all the losses that person represents. The loss is not only of the relationship and person, but also of hope. If the relationship between parent and child was strained or difficult, it is likely the bereaved will be poor at navigating his or her emotional states. This makes grieving terrifying, at best, or unthinkable, at worst.

Grieving is normal

As a clinician, I get a lot of fulfilment in helping clients to grieve. It is different from any other presenting issue they bring to me. Grief is the universal leveller. We will all experience it at some point in our lives. The way out and through grief is always the same – we have to feel the full range of emotions that our grief brings up.

Grief is not a mental health condition, and yet many people become stuck with their grief. When this happens, the secondary symptoms can mutate into more complex conditions such as anxiety, clinical depression and panic attacks.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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Face to Face and Online Therapy Help Available Now

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Depression counselling

One way of thinking about depression is that it is a prolonged state of feeling hopeless and often lacking any desire whatsoever. Depression can range from mild to severe and can feel debilitating even in milder forms. Whilst the causes of depression may often not be obvious, therapy works to uncover and process unacknowledged emotions that may be feeling the depression. In fact, often the depression we feel is caused by earlier losses during our life, where the feelings at the time could not be felt and therefore become stuck. To discuss your situation with one of our psychotherapists, get in touch today.

What causes depression?

The causes of depression are usually multiple and differ from individual to individual. Common causes include: physical illness, issues dating back to childhood, current life circumstances, hormonal imbalances, poor diet and lifestyle, misuse of alcohol and/or drugs, and relationship difficulties, to name a few.

Common signs and symptoms

Symptoms can range from mild to severe. Some common symptoms are:

Tiredness
Withdrawal
Enduring and prolonged sadness
Feeling helpless and hopeless
Lack of pleasure and enjoyment
Loss of self-confidence and feelings of worthlessness
Difficulty concentrating
Anxiety
Sleeping problems
Loss of sex drive and or appetite
Suicidal thoughts and self-harm

Psychotherapy of depression

When working with depression, we first try and establish what may be the underlying cause of those symptoms, which clustered together, feel like depression. For example, grief, such as that experienced after a significant bereavement, can feel very much like depression and clinically meets all the symptoms. However, the big difference is that it is completely normal to feel ‘depressed’ after the loss of someone we love, whereas it is not beneficial to feel unable to engage with the world for prolonged periods of time when there is no obvious cause.

As depression counsellors our job is to gently understand the many factors in a client’s life that may be contributing to their overwhelming feelings of sadness and then to help them to find a language to understand and process the feelings from the past or present. This may also involve an enquiry into the lifestyle factors that may be impacting or making the symptoms worse, and work with the client towards change.

Frequently asked questions

What is depression? Read more

How do I know if I am suffering with depression? Read more Depression varies from person to person, however, a good starting point is to consider whether the feelings of prolonged sadness and heaviness are linked to an event or not. For example, it is common to feel feelings similar to depression when grieving, however in this context, these feelings are appropriate and not depression. We all have ‘down days’ however, if you are struggling to engage with life and feel hopeless and these feelings continue for some weeks then you may be struggling with depression.

What happens in a first session? Read more The first session with one of our practitioners is an opportunity for you both to work out whether you feel able to work together. Your psychotherapist or psychologist will likely ask you various questions relating to what has brought you and explain the process of therapy to you. The first session is a two-way process where you have the opportunity to ask questions and to decide whether you feel ‘safe enough’ working with your therapist.

How do I find a psychotherapist of psychologist I want to work with? Read more At Brighton and Hove Psychotherapy, we have two physical practices, one in Hove and one in Lewes, where we offer a full range of psychological therapies. On our website you can view each profile of our associates and contact them directly using the form on their profile page. You can also use our handy search function to find the right practitioner for your needs.

How long will it take for me to see a psychologist or psychotherapist? Read more

How can I get in touch with you? Read more You can contact our practitioners directly via the contact forms on their profile pages. They will then reply to you directly.

What age groups of clients do you work with? Read more We have psychotherapists and psychologists trained to work with every age group from infants through to adults.

Do you offer evening and/or weekend sessions? Read more We offer sessions every day of the week including on Saturdays and sessions are available into the evening.

What are your fees? Read more Our fees are set by each practitioner depending on the type of therapy. For individual psychotherapy or clinical psychology our fees range from £60 – £90 per session. For couple therapy our fees range from £70 – £100 per session.

Is there parking near your Hove and Lewes practices? Read more Both our Hove and Lewes practices are centrally located close to train stations, bus routes and with on-street parking.

For more information on depression counselling across Brighton and Hove or to find out how we can help with the treatment of depression, get in touch with us today. At Brighton and Hove Psychotherapy, we have two physical practices, one in Hove and one in Lewes, where we offer a full range of psychological therapies. On our website, you can view each profile of our associates and contact them directly using the form on their profile page. You can also use our handy search function to find the right practitioner for your needs.

We also offer online therapy for depression.

All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.

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