Working with Self-Harm and Suicidality – CPD with Pete Holloway

Having looked forward to this seminar since it was first mooted, I found that I wanted to take a few days after attending to process the experience. It felt as though it bordered on the transformational and I believed that it was worthwhile to just allow that post-seminar glow to recede if it was going to do so?

A week on, and I have to say that it still feels as though it borders on the transformational. The shifts in perspective it generated for me by examining what self-harm might mean for clients- what and who might be being harmed and who might be doing the harming- by taking a more object relations and existential tack- were truly “lightbulb” moments for me and have already enhanced my clinical practice. The concept that the body becomes the projective tool for what might be going on in the mind; that what is going on in the psyche might be enacted in or on the body sounds simple and yet it was remarkably illuminating.

It was also extremely helpful to address the therapeutic challenges and the “institutional anxiety” that might arise around suicidailty as we work with our clients. Whether we work within an agency as part of a team or whether we are the institution itself as sole practitioners, being able to explore how to work relationally without becoming hamstrung or paralysed by potential consequences around working with such serious issues and behaviours was incredibly valuable.

Looking more closely at risk factors and approaches to risk appraisal when working with the “suicidally contemplative” was also very beneficial in terms of being able to work effectively and appropriately in these areas.

This was an amazing seminar dealing sensitively and helpfully with complex and challenging issues. Pete brought a generosity and warmth to this work which made it accessible and, well, do-able. I am SO glad I attended and have left with the gift of a deeper and more reflective way of “being” with this aspect of therapeutic work and pathways of thinking on this subject theoretically opened to me.

Pete listed some key influences on his thinking and I wonder if it might be helpful to share them:

Felicity de Zulueta: From Pain to Violence

Irvin Yalom: Existential Psychotherapy

Wilfred Bion: A Theory of Thinking

Melanie Klein: Love, Guilt and Reparation

Judith Herman: Trauma and Recovery

I know I’ll be adding these to my reading list!

By: Merri Mayers,
October 2017

We were thrilled with the excellent feedback.  20 out of 21 delegates voted 5 out of 5 on all three questions to give these overall results:

Overall assessment of event: 4.95 out of 5
Speaker: 4.95 out of 5
Value for money: 5 out of 5

Delegates feedback:

  • “You have been highly informative and have re-ignited my interest and passions in this field of mental health and therapeutic interactions.”
  • “What an excellent day – Pete has a breadth of knowledge and a great human, realistic approach to therapy”
  • “I liked the group–size, helpful to promoting an atmosphere where engagement and participation is possible.  Wonderul speaker dealing with a difficult, painful topic in a positive way that affirms the therapist’s competence.”
  • “Excellent speaker, clearly an expert; enjoyable and enlightening about a sombre and disturbing subject”
  • “Pete has been so informative, interesting, engaging and funny – so interesting.  I would definitely attend another of his courses.”

Wendy Bramham
October 2017

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Healthy Selfishness – what is it and why does it matter?

Can Therapy Make You Selfish?

Do you worry that having counselling might be indulgent or selfish? Do you fear that focusing on your own desires and needs might result in neglecting or hurting others? Lots of people who go into therapy have these fears. And the fear of selfishness is understandable given that many of us were brought up to put others first. However, I’m wondering if there is a different way to look at this issue? Perhaps there is a kind of ‘healthy selfishness’ that we can explore in therapy and which might help us get our lives in better balance?

Take journalist, Sally Brampton’s**, experience. In ‘Shoot the Damn Dog’, a brave and excellent memoir of her own suicidal depression, she recounts how a therapist told her she was abandoning herself every time she:

  • pretended she was fine when she wasn’t
  • refused to rest when she was tired
  • didn’t ask for what she needed from a person with whom she was intimate, and
  • put someone else’s needs before her own but resented doing so.

The therapist explained that Sally suffered from a failure of care; care for herself but also care from her parents who should have taught her how to take care of herself in childhood. Sally explains that as a child she unconsciously learned that it was better not to need or become attached to people or things, because anything she loved – people, dogs, houses, schools – were taken away from her. As an adult she was able to see other people’s needs but not her own, and this contributed to her serious depressive symptoms.

Narcissim… is therapy just ‘all about me’?

Selfishness, defined by the Oxford English Dictionary as “…concerned primarily with one’s own interests, benefits, welfare, etc., regardless of others”, is not to be confused with pathological narcissism. This condition is characterized by self-inflation, grandiosity and lack of empathy, which are ways of coping with very low self-esteem. Narcissistic traits include self-serving attitudes and behaviours that exploit others. By contrast, therapy aims to help clients become less fearful and more accepting of their own feelings, which in turn fosters the capacity to build self-esteem, and relate more openly and fully to others through increased empathy, compassion and intimacy.

So, if ‘healthy selfishness’ actually promotes self-respect as well as respect for others, how can it be achieved? Our experience suggests the following:

* honest self-reflection, especially after setbacks

* taking responsibility for yourself

* self-care and self-respect

* acknowledging what you need and what brings you joy and meaning

* celebrating your achievements

* connecting with your authentic self

* learning to tolerate differences between yourself and others

What is Good-Enough Parenting?

Donald Winnicott, the famous paediatrician and psychoanalyst, coined the term ‘good-enough mother’ in 1953, and his thinking went on to become pivotal in understanding child development. If we are lucky as infants we will have had good-enough parenting; our primary care-giver will have responded to our needs and feelings, reassuring and comforting us in a fairly predictable and timely manner, and empathising with or tuning-in to our emotions. If this ‘good-enough’ parenting is available to us during our early years, we stand a chance of developing the ability to manage and care for ourselves through life’s inevitable ups and downs.

If good-enough parenting is not available, or we experience a great deal of loss or trauma, we don’t learn healthy selfishness and consequently get used to putting on a mask for the world, and living to please others. Therapy can be crucial in addressing this imbalance, helping clients learn to be their own ‘good-enough’ parent and to properly honour and care for themselves. In her book, Gift from the Sea, Anne Morrow Lindbergh, writes about the peace she found through rediscovering herself during a quiet island holiday, away from her busy life as mother to five children: “When one is a stranger to oneself then one is estranged from others too. …Only when one is connected to one’s own core is one connected to others.”

Perhaps it is only when we can consider ourselves as important that we can find peace and fulfillment? But why does it matter?

What Happens if we are not Healthily Selfish?

Anne* had been married for 18 years, and came to therapy with marital difficulties. She had always tried to please her husband, but recently he had become frustrated and withdrawn. The more she tried and failed to please him, the more Anne perceived him to be selfish.  What was really happening was that Anne was projecting her own unmet needs onto her husband, who in turn felt trapped and somewhat manipulated. Additionally, Anne had become silently resentful of her husband and had also developed stomach pains and indigestion. When her therapist commented that there didn’t seem to be “enough of her” in her life, she felt criticised and rejected. She enjoyed looking after others, she said. Surely this was a good thing? Gradually, in therapy, Anne realised that she had taken on the role of ‘pleaser’ early on in life, and whilst this gave her an identity, it made her self-worth dependent on another’s appreciation. Behind the role of helper she didn’t know who she was; she had become an empty shell.  And so had their marriage.  This pattern of relating, in an attempt to gain self-esteem, was simply no longer working.

Change came as Anne began to acknowledge her own feelings, needs and desires, and to believe she could exist in her own right. She began to develop an authentic sense of self. She started to take charge of her life, taking pressure off her husband and their marriage. The tension that was causing her indigestion also eased, because her unspoken, repressed resentment had been faced, understood and let go. Anne moved from unhealthy selflessness, to healthy selfishness.

Healthy Selfishness enables us to care for ourselves and others

Therapy promotes a ‘healthy selfishness’ which enables us to take better care of ourselves and helps us to form more satisfying relationships. It is better not only for the individual, but for all those we relate to.

We cannot take responsibility for our own happiness if we habitually or compulsively put others before ourselves. The concept of ‘healthy selfishness’ gives us permission to care for and nurture ourselves, which is particularly important if we have learnt to get love and affirmation by pleasing others. Indeed it is often those of us who protest most that therapy might be selfish, who have the greatest need of it!

 

Author: Wendy Bramham, Psychotherapist & Proprietor “Wendy Bramham Therapy”

*  “Anne” is a fictionalised conglomorate of clients and changed to protect confidentiality

** This article was originally written in 2015.  We were shocked and saddened to read of Sally Brampton’s apparent suicide in May 2016.

Historical Childhood Sexual Abuse

One of our newer therapists, Julie Luscombe, has spent the last year as a counsellor supporting survivors, with the Independent Inquiry into Child Sexual Abuse (IICSA).

She writes, “since the Jimmy Savile scandal, abuse survivors have felt encouraged to talk about abuse, rather than feeling silenced. Although we still hear about child abuse in the news most days, the stigma around it is lessening. However, the effects of abuse can leave some people suffering with debilitating and consuming symptoms of post-traumatic stress. When trust has been violated a person feels devalued and this can compromise self-esteem and affect all aspects of a person’s life. Traumatic memories can persist because the brain was not able to file away the traumatic memory at the time of the abuse – it was too busy trying the keep the victim safe in the abuse situation. These unresolved traumatic memories can cause a person to feel that the traumatic event is happening over and over again. Therapy can help by helping the brain properly process trauma.”

Julie Luscombe works as a qualified counsellor in our Newbury practice, with both men and women who have been abused as children and young adults. She helps them find a greater sense of safety and security, understand how to manage trauma symptoms, and start on the road to recovery. 

She also has extensive experience working with issues of domestic violence, abuse and sexual violation and has developed a training program for use by medical professionals and the police to help front-line workers understand post-traumatic stress.

Julie offers clients a safe non-judgemental place to work through this process, explore difficulties and move towards change. To have someone to talk to and work through the trauma related symptoms can alleviate distress and empower your life.

Julie Luscombe, MBACP, is a specialist counsellor in the area of trauma and sexual abuse, and a registered member of the British Association of Counselling and Psychotherapy.  

She was a counsellor, supporting survivors, with the Independent Inquiry into Child Sexual Abuse (IICSA) during 2016-2017. She also has been working at Trust House Reading for the past 3 years.

Contact Julie:  Mobile: 07469 717219 or  email: Julie.alderson67@gmail.com

View Julie’s profile

Resilience begins with owning your vulnerability – we’re all only human after all! How I got to near breaking point.

penny robertsThis is a client’s story of courage and recovery.

I always thought and was told that I was a good planner, super organised and focused. My nickname at uni was Miss Organisation and I’ve built a career in Operations a perfect fit right..?

Last year I went through a massive personal upheaval that resulted in me losing perspective and left me wondering what the hell was I doing with my life and whether I’d got it all wrong.

This period of feeling out of control and lost started in March. A stolen purse – six years living in London and the laws of averages meant it was bound to happen to me – there’s a first time for everything… right?

Then after this came the night I left another purse and all my newly replaced cards in an Uber… never to be found. Then it was a stolen rucksack and more personal and work possessions in someone else’s hands a month later. And finally leaving another purse on a train – which even the cleaners couldn’t find!

The icing on the cake was a lost train ticket, when I had no cash and cards – I was still waiting to get new cards after I lost my purse the last time – and nearly being stranded in the city.

Until this point I had NEVER lost anything in my 29 years on this planet. The universe was seriously telling me something – stop, slow down, relax!

The irony is I’d actually been doing that albeit not consciously. At times I had felt like I was nearly paralysed by the massive upheaval that had occurred in my life but I was still acting and carrying on as normal. I was out of tune with my mental wellbeing – I needed to get back in tune!

The truth

So here’s the brutal honesty that with time, my friends, family and my therapist helped me come to terms with. I was numb / out of touch with my emotions. I was grieving for a broken marriage and selling my home – losing the life I’d spent my adult years building. I was feeling totally ashamed of how things have turned out for me at the grand old age of 29 and hiding how I truly felt.

This was not how I thought my life would turn out – but had you asked me what I thought my life would be like I couldn’t have articulated it to you. I knew I wasn’t the first person to go through this – and I sure as hell knew I wasn’t going to be the last but honestly that didn’t help me at the time.

Where to begin…

It’s tough – bloody tough admitting when you’ve not got your shit together. I felt like I was losing face by admitting I had depression – I was ashamed. If I could have hibernated at this point I would have!

What I very gradually realised over time though was that the more I talked about my depression the more I normalised it for me. I felt like I was building my own understanding of what I was going through – the tears lessened as I gained courage.

My work, friends, family and therapist were all supportive. I’ve consciously chosen to write my support network in this order – from personally who I thought would be hardest to talk to, to easiest to talk to- as I am shocked by how even conversations I thought would be tough weren’t as bad as I envisaged.

If you don’t own your vulnerability in all sectors of your life then you won’t build your resilience and support network. I was, and am, blessed with an amazing support network. Having just started a new job when this all “went down” it could have resulted in a sudden ending but it didn’t! They listened, were accommodating and genuinely cared.

Stability with my work routine was important for me and gave me a weekly focus. My friends showed me bucket loads of compassion and were there for me even when I didn’t know how to articulate how I felt. My family were beyond amazing – they helped me focus on the joy of the now (beach trips and time with my nephews spring to mind in particular) as well as planning for fun times ahead.

I’m writing this post from Chile – a dream two week adventure by myself that during dark times I thought I might not have the courage to do. What a difference a year makes!

Small steps lead to big rewards. Honesty and open communications breeds positive changes and inspiration from sometimes the strangest of places and experiences!

2017 is my year of fun! A year for me to own to positively take steps to create the life I deserve. 2016 helped me understand the challenges and heartbreak that life can throw at you from time to time. The lessons from 2016 have helped me become more resillient they’ve made me stronger and aware of how important it is to look after my mental health just as much as I look after my physical health.

I truly believe that to experience life’s true highs sometimes you need to experience it’s lows. And to really get the learnings and build resilience from such experiences you need to own them and get used to being vulnerable – it’s tough but it can be done!

The afterword

Writing and reflecting on my experience of depression briefly makes it seem a hell of a lot calmer than the turbulent time I went through. For me a combination of medical and therapeutic support has worked. Everyone is different and experiences are personal. The commonality in finding a path out is human connection – everything starts by talking and being vulnerable….

The Ups and Downs of Therapy; a client’s story

The thing I liked about my therapist when we first met was that she seemed different from me – the last thing I wanted was to talk to someone similar. The relationship would be different from anything I had experienced: it was the first time I had discussed my life intimately with another person.

 

The idea of ‘difference’ became the key to approaching therapy. Sessions were an opportunity to experiment with different ways of thinking, without relying on reason or analysis. Instead, I would talk about whatever popped into my head at the time – no matter how irrelevant it seemed – and see where it led.

 

My first fear was that I would sabotage therapy, probably by convincing myself that it had been going on too long. To counter this, rule number one was that there would be no time-limit: if it took years, it took years and I wouldn’t leave until it felt good to do so.

 

The second fear was that I would develop an attachment to my therapist that would become painful, so the boundaries of the relationship were very important. I determined not to cross these boundaries under any circumstances: no contact between sessions, no trying to discover personal information. The therapy room would become a bubble, although, as I later discovered, there was a downside to this.

 

As therapy progressed, the word ‘instinct’ kept cropping up, and I began to realise how powerful the unconscious mind is, and that it is often right. Understanding my past behaviour in this context – that a lot of it was actually self-preservation – was a huge relief. I began to trust my instinct more as a guide through the process.

 

Self-expression was surprisingly hard. I found the spoken word incredibly limiting and the habit of editing myself as I went along didn’t help. A lot of the time it felt as if I was talking around a feeling, but couldn’t be completely accurate – I just didn’t have the language. Images were very helpful in this respect. If I couldn’t describe a feeling I would imagine it as a scene or a story and describe that instead. In fact, the further away we got from the literal, and the closer we got to symbols, stories and art, the more satisfying and truthful the conversations felt.

 

Going to therapy for a long period, it was inevitable that some subjects would be discussed many times. This wasn’t a problem, but I was aware that each time we repeated a subject, I would describe a set of feelings that were different to what I had said before. Thankfully my therapist didn’t point this out, although I have no doubt that she noticed the contradiction. The question is, why did this happen when I was trying to be honest? The best answer I can come up with is that I was just saying what needed to be said on that particular day. This pattern of repetition/contradiction did lead to some answers that you could call ‘truth’,  but the answers seemed less important than the process of finding them.

 

One of the more unnerving sensations was the feeling that life was on hold. In the midst of the therapy bubble, most of my time was spent looking forward to the next session or thinking about the previous one. The outside world felt less important. If it had ended at this point I suspect it would have been pretty devastating and knowing that I was dependent made me nervous. It was a leap of faith to trust that one day I would feel differently. Until then, the frequency of the sessions gave me enough security to keep going.

 

But the relationship between therapy and my life in the outside world was something I struggled with. Whenever we discussed making a change, I had all the reasons not to do it. This inability to connect therapy and life felt frustrating at the time. Looking back, I probably didn’t realise how much was shifting around in my unconscious. Every so often change would rise to the surface and I would suddenly decide to do something completely out of character. Eventually I learnt that I didn’t have to force the change to happen, I just had to be open to it.

 

I think one of the great misconceptions about therapy is that it’s all about the moment of catharsis. That the right question will lead to a huge outpouring of emotion and then everything will be better. I never had that experience – therapy was more complicated and difficult than that, but also more rewarding. I certainly don’t think of it as getting things out of my system: I have more in my system now than when I started.

 

The decision to stop was surprisingly easy. It just felt right. Life wasn’t perfect but I had the strength to deal with it. As the end approached I knew how important it was to end well, to walk out the door without regret.

 

People who know me well say the change has been enormous. They are probably right, but it’s a difficult thing to see objectively. Superficially, life hasn’t changed that much, but there has been a fundamental shift in how I react to things. My stress and anxiety levels are certainly much lower, I’ve become more open to taking risks, and more patient with other people.

 

My life now is messier, dirtier, happier, angrier, faster, less predictable and more confusing than it has ever been. For the first time it feels like there aren’t enough hours in the day for everything I want to do. But I do what I can and don’t worry about the rest. So far that seems to be working.

 

Written anonymously by a client in 2015

The Psychology of Violent Extremism

Since the last newsletter where violent extremism was discussed, there have been a number of further acts of violence within the UK.  Thinking about what drives people to engage in such behaviour has become more pertinent.  Dr Hannah FarrAlongside this it also feels important that we think about how we talk to our young people about these acts, especially after the suicide bomber at the Ariana Grande concert, where many young people were involved.  At the end of this piece I will provide details outlining where to find information on trauma, how to support people who have been through a traumatic experience and how to talk to young people about what has been happening in their world.  However, I want to start by presenting some of the psychological research which has tried to develop a profile of someone who becomes involved in extremism.

Psychological research into those who carry out acts of violent extremism has been somewhat minimal to date.  However, there are some characteristics which have been identified and provide us with some insight into what drives a person to join these groups.  It is suggested that those young men (I will focus on men here as they are the majority in these groups) who feel marginalised and unrepresented in places of authority e.g. the government, and who perceive an injustice are more likely to join an extremist group.  They appear to be searching for a sense of belonging, connectedness and affiliation (Silke, 2008), which they don’t feel they get elsewhere in society or their community.  It is suggested that they feel uncertain about themselves and their world (Bonim, 2014) and seek danger and excitement as a way of giving their life meaning.  They feel they are unable to make changes in any other way than through extreme and unconventional means (Saucier et al., 2009).  They believe they represent a broader victimised group who need someone to stand up for them (Horgan, 2017).  Motivation, ideology and social process all come together to play a role in the radicalisation of men who join extremist groups.  Understanding this interplay is the first step towards developing policies to intervene (Kruglanski et al., 2014), it may also be important for society to understand and play a role in expressing concerns about possible extremism in their communities.

How communities can play a role in expressing concerns about suspicious behaviour has also been an ongoing discussion especially after an attack.  Dando (2017) stated that when it comes to ‘pointing the finger at a neighbour or friend’ when they are suspicious of their values/beliefs/behaviour the impact may be too great.  She considers the impact of a reduction in community police officers, as it may be that a rapport between communities and police could encourage people to have more of the difficult conversations.  ‘When people feel socially and economically excluded, and when groups feel marginalised they tend to look inwards rather than outwards’.

Violent extremism effects us all, either directly as a victim or family/friend member of a victim; even as a family member/friend of the perpetrator; as an observer and member of a community or as a parent (carer) trying to explain to a child what is happening in their world, whilst trying to make sense of it yourself.  These experiences are traumatic and leave us with questions and difficult emotions, so I have attached some links to websites which may help to provide some support.

By: Dr Hannah Farr, Clinical Psychologist
July 2017

Dr Hannah Farr works at Wendy Bramham Therapy on Thursday mornings in Marlborough.

Links

http://www.huffingtonpost.co.uk/2016/03/23/how-to-talk-to-children-about-terrorism_n_8580612.html

  • Helping children understand their responses to difficult news stories

http://www.bbc.co.uk/newsround/13865002

 

Loneliness – no longer a silent epidemic

Loneliness has crept up on us as a silent epidemic and is now regarded as a public health issue affecting our wellbeing and shortening our lives.

Traditionally, we think of loneliness affecting only the elderly or the sick.  Today it is indiscriminate and affects the young, the old, the single, the married, the working, and the retired.  Apparently, we are all increasingly susceptible.

So why are we so lonely?

Loneliness is a feeling of social and emotional disconnection. It is not a direct consequence of being alone. We can feel lonely in a crowd.  It is true that the rise of virtual online relationships, our culture of independence, our frenetic busyness and our increasingly mobile workforce can make us feel more disconnected. But social isolation is not the same as loneliness.

We are often afraid to admit our loneliness because we believe we will be judged as unlovable and unlovely .

How does this cycle of loneliness work?

When we are lonely, we tend to perceive things more negatively and more pessimistically. We make more judgements and more assumptions. These assumptions are often along the lines of everyone else being happier, busier, more popular, more loved, and more sociable than we can ever hope to be.

We become more and more defensive and withdraw rather than engage. Our internal story tells us that ‘everyone else is happy and connected and no one wants to bother with me.’ The story goes round and round in our heads and we end up sabotaging any opportunity for connection by pushing people away.

So what can we do about our loneliness?

We can start by making a connection with ourselves. Notice first how defensiveness feels in your body, notice where it sits, and how it drives you. Name it, describe it and breathe into it. Expand the space around it. Befriend it, it’s ok, it’s yours.

Notice any change when you engage with someone in a shop, or whilst walking the dog. Look for the feeling of opening up and warming up a little. It’s often the smallest incidents that give us the first feelings of change.

Get to know the story in your head. Notice how it drives you further away from others. Notice your negative assumptions. Then by contrast, notice what giving people the benefit of the doubt feels like.

In her book Daring Greatly, Brene Brown suggests that when we allow ourselves to be seen, when we share our vulnerabilities, we connect with others. In turn, they feel able to be themselves and connect with us. Her definition of connection is ‘ the energy that exists between people when they feel seen, heard, and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.’
So let’s start by connecting with ourselves. By seeing ourselves, hearing ourselves and valuing ourselves without judgment.  Remember that there are thousands of people experiencing this same feeling at this very moment, you are not alone. Then reach out, from the strength you’ve derived, one small step at a time, to connect with others – chances are, they’ll be hugely grateful.

By: Lisa Stevenson MNCS(accred) MNCP(accred)

Lisa is a qualified and experienced couples and relationship therapist at our Marlborough practice.

You can contact her directly by mobile:  07873 871059  or email:  lisa@vitalconnections.co.uk

website:  http://www.vitalconnections.co.uk