Tag Archives: therapy

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

Advertisements

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.

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

Working in Therapy with Adolescents and Young People: What is different? Key points of understanding.

On 25th April, a group of 16 therapists of varying disciplines and experience attended a seminar presented by Professor Stephen Briggs (whose books include: Working with Adolescents and Young Adults: A contemporary psychodynamic approach (2008).

We had had the opportunity to download 26 of his slides which offered a framework for the discussions.

In the process of working with this age group, we understand that we have to do things differently from our work with child and adult populations, outlined as follows:

THERAPEUTIC STANCE:

  • Providing a combined containing and exploring space..(containing anxieties and exploring meaning).   This combines taking in the feelings, making sense and feeding back whilst ‘holding’ urgency and anxiety.  Also, enabling the young person to tolerate the ups and downs, extremes of excitement and depression;  facilitating feelings of overwhelm and omnipotence, and taking these things seriously.
  • Being ‘adolescent-centred’..trying to understand the adolescent ‘world view’, without making assumptions about the adolescent’s knowledge or experience of the therapy process.  This includes noticing how quickly adolescents can change and how stuck they can be in the developmental process. The therapist is required to take on the ‘in-between-ness’ of the client, moving responsively between more adult/more childlike states as they occur.  Working with the ‘yes’ adolescent and the ‘no’ adolescent.

WORKING WITH DEPENDENCY:

  • Stephen Briggs explored the delicate issues around the adolescent’s potentially fragile sense of independence where the offer is to share with the therapist what is his, what can he share? What does the therapist need to know; what can be private and acknowledged as private?
  • The therapist needs to work out what the adolescent can and can’t bear, adapting to the fragile sense of separateness from parental figures, his aloneness in the world and the responsibility of his own thoughts and actions.

BECOMING A SUBJECT IN ADOLESCENCE:

  • ‘Being subject to’:  things happening, re-enactments and repeated patterns through change…(puberty, relationships, peer groups).
  • ‘Being subject of’: something that’s going on emotionally and rationally – relating to experience, learning from experience.
  • ‘Becoming a subject’ – the process of gaining ownership..new adult, sexual body, ownership of one’s own thoughts. Ownership of drives, sensations, impulses, feeling and powers. With ownership of bodily changes comes both power and the power to enact. Power relationships evoke different capacity to enact thoughts and feelings.
  • Increased separateness from parental figures at the above levels.
  • From neuroscience, we’re told that with brain development, the slowest capacity to develop is the capacity to reflect.
  • For Separation and Individuation at one end of the axis and Regression on the other, there are transverse opposites:

Self -esteem and competence.   Vs.  Fear of failure
States of mind (subject to).          Vs. Subject of
Power.                                              Vs. Dependence
Life.                                                   Vs. Death

So the binaries in the adolescent process are:
– Excitement v Loss
– Love v Hate
– Life v Death
– Online v Offline
– Powerful v Dependent
– Competence v Fear of Failure

The retreat from death can lead to omnipotence and/or the need not to fit in with convention.  Online/offline ambivalence engenders both omnipotence (with the provision of answers to problems) and the defeat of omnipotence (when the adolescent can’t solve the problem).

An example:
Exploring on line = securely attached
Looking for ‘belonging’ online = less securely attached.

These are part of the dichotomies to be held in mind through the therapeutic intervention in adolescent work.

We had a further three case studies to consider, discuss and apply the learning from the presentation as well as from our own experiences.

WORKING WITH TRANSFERENCE AND COUNTER-TRANSFERENCE:

In the transference:

  • drawing attention to connections between the social world and the therapeutic relationship.
  • making formulations about relatedness, maternal and paternal transference.

In the counter-transferential space:

  • what are we picking up as therapists of the adolescent feelings? What feelings are we evoking?
  • what about me is getting in the way of this work?

So what is both going on in the therapist and what from the adolescent is stirring up feelings in the therapist?  Much of the rich discussion from the case studies surfaced transference and counter-transference explorations.

Appropriately we talked of endings, particularly from the last case study where breaks in the therapy and missed sessions brought important material for therapeutic thought.

Stephen said ‘there is always something about separation with adolescents…in the therapeutic relationship, we replay through separation from the therapist, those other issues of separation’. ‘We are introducing the adolescent to him or herself’.

By: Angy Man, March 2017

“Opening the Hidden Door; Working with Dreams in Therapy” – Matthew Harwood, 24 September 2016

dreams-seminar-2016

Matthew Harwood at Wendy Bramham Therapy seminar

I attended this seminar because of my training and experience in Deep Memory Process with Roger Woolger, and also because throughout my life I have had dreams that I remember vividly and have tried to make sense of.

Having gone through the day’s seminar with Matthew Harwood, a Jungian Analyst, it is a pleasure for me to write a few words about it.

The seminar was perfectly constructed so that on whatever level your training or experience, you could get something out of it.  Matthew performed his role with skill and humour and we all learned a method of how to look at dreams – both for ourselves and for our clients.  I personally think that dreamwork is an extremely important way of understanding where you are and what could be the next steps forward. And what a relief not to have to take notes, as Matthew had plenty of handouts!

I wish the best to Matthew Harwood and his important work.

By: Elly Nickson, Chartered Physiotherapist

Participant Feedback:
Quality of Speaker: 5 out of 5 unanimously from all 17 delegates! This is exceptional and never achieved before.
Overall assessment of event: 4.94 out of 5

Delegate comments:
“I have been to other dream workshops but I am going away feeling I have learnt more than I have done before!!”
“As usual, event top notch”
“Excellent attention to detail. Good sense of cohesion around group and speaaker”
“The events are always good and well organised”
“Nice setting with plenty of space. Matthew is an excellent speaker. Overall excellent”
“Full and informative day”
“Well done as usual”

 

Seminar on Sex Addiction with Karen Lloyd, 18 June 2016

Karen Lloyd, an accredited psychosexual psychotherapist and certified sexual addiction therapist, gave us a full day of insight and knowledge on the quite misunderstood and challenging subject of sex addiction.

Karen Lloyd with Wendy Bramham

Karen Lloyd with Wendy Bramham

We learnt that people with sexual addiction do not have fun, that it is not related to a sexual orientation, neither is it connected to sexual fetishes or paraphilias. Sexual addiction is not the same as sexual offending.

We thought about the many words we might use to describe a person with sexual addiction problems and that they are mostly negative. Shame is the most acutely felt emotion and trained therapists work mainly with supporting and helping their clients to manage their feelings of shame.

Karen helped us to understand how she and her fellow trained therapists work with clients and gave us lots of detail on the complexities of working in this specialist field. It is a “process addiction” and the primary driver for sexual addicts is for mood altering purposes. We thought about some similarities in how alcohol addiction is now managed, for example providing support groups as a powerful and effective technique.

Karen spent the 2nd half of the day focusing on how she and her colleagues help the partner of a sexual addict and how isolating and shameful the discovery of a partner’s sexual addiction can be.Seminar sex addiction 2016

The seminar was interactive and well paced, packed with information and insight and very much a taster of how to work with this very challenging subject.

By : Jo Turner, June 2016

We are pleased with the delegates’ average feedback scores as follows:
Overall assessment of event: 4.89 out of 5
Speaker: 4.5 out of 5
Value for money: 4.89 out of 5

Comments from delegates:
“Fantastic delivery of the course by Karen, very insightful and interesting”
“Excellent value”
“Karen’s experience, warmth and knowledge made it easy to engage and enjoy the seminar”
“Very relaxed, intimate and cosy to share”