Citypsychotherapy

Anxiety denotes a whole range of affects and phenomenon. Those include panic attacks, vertigo, a general sense of worry, uncertainty and doubts regarding which direction to take in life. Bodily phenomena often include breathlessness, palpitations, muscle tension, fatigue, dizziness, sweating and tremor. If we can never be sure of the reasons behind our feeling, say, happy or sad (happiness can cause sadness or guilt) anxiety has an overwhelming certitude attached to it – it is real, something in front of which all words and categories fail. Anxiety happens when our place in the world and how we used to see ourselves in it suddenly changes, when we can no longer rely on the Other and use his desire as a compass to orient ourselves in relation to it. Instead, we are left suspended in a moment where we no longer know where our place is, and a future where we will never be able to refind ourselves. For the existentialist philosopher Jean-Paul Sartre, anxiety is evidence of our freedom. For Jacques Lacan there exists a relationship between anxiety and desire. Anxiety is a way of sustaining desire when the object is missing and, conversely, desire is a remedy for anxiety, something easier to bear than anxiety itself. Psychoanalytic Psychotherapy approaches it from the fundamental notion of an absolute loss, a ‘lack of a lack’ and sees desire as its remedy.

Do you find yourself eating or sleeping too much or too little? That you are pulling away from people and activities because of low or no energy? Some of us may feel like nothing matters anymore. We are left confused, isolated, angry, worried or scared, perhaps even having suicidal thoughts. In those cases where all seems well and ‘perfect’ this feeling of disillusionment is quite baffling to understand. One way of looking at depression is as a force or movement driving our lives. Like a heart that has stopped beating, depression marks a stop to this vital movement. Given the set of circumstances and how long things have been kept this way unaddressed, it may be challenging for some to regard this issue as worth investigating. Often placated by feelings of shame we tend to fall back on the basic assumption that us alone can change our situation. Unsurprisingly, questions of anger, frustration and isolation are often central to the experience of depression. In Psychoanalytic Psychotherapy, I approach this issue with the view to reintroducing a movement using the element of surprise.

Relationship fall-outs are expressions of a toxic form of aggressivity between partners. Typical signs include living in tension and mutual rejection, jealousy, passive aggressivity, denial and in some instances verbal or even physical abuse.For example in the act of blaming the other personal criticism is expelled by projecting it onto the other. Referring himself to the master-slave dialectic by the German philosopher Hegel (1807) Lacan argues that a fraught relationship is ‘imaginary‘ in nature, a life and death struggle for ‘pure prestige‘. In this context the other is seen as a rival, whose elimination seems to be the safest option. Generally speaking, aggressive attacks are a form of response indicating that one’s defense mechanism is somehow stuck in overdrive. The ego is felt to be under constant attacks and threatens to collapse. Those are moment of great vulnerability and risk in which retaliation is seen as an attempt to protect oneself against the anxiety that the threat of disintegration immediately poses.Jealousy is experienced when the ego concludes that the other with whom one is competing has the advantage. Feelings of jealousy reflect the desire to have this advantageous position for oneself, and the wish to eradicate this frustrating other.Psychoanalytic Psychotherapy sees working with issues in relationships as one of ‘un-knotting’ the multiple threads that have led to this situation. Its goal is to try and dislodge the frozen and stereotyped perceptions and evaluations at play.

One avenue of exploration may for instance include exploring those significant previous relationships in the patient’s life.

Anger may be categorised as any forms of violence expressed towards others or oneself in self-harm. In the former, symptoms of anger include bullying, threatening people, persecuting, insulting, pushing or shoving, using power to oppress, shouting or playing on people’s weaknesses.Psychoanalysis regards anger as a ‘passage à l’acte’: a form of ‘acting out’ with no control. We become violent when the Real has come to possess such a grip on us that the fictional character we had created of ourselves to contain it breaks down. However paradoxical this may sound, Psychoanalysis Psychotherapy understands anger as a form of ‘deadly enjoyment‘ which, in its final analysis, expresses nothing other than a rejection of what is felt to be a threat to one’s sense of integrity. For Freud, hate and anger are more ancient feelings than love. In this context, the clinical work consists of using language as a way to make something of this anger. The exercise of symbolisation realised in therapy may well be initially experienced as somehow exacerbating this feeling further, but should in due time transform itself into some useful and creative productions.

In certain situations we may find it almost impossible to act, and instead react as if feeling self-conscious and unable to act in a natural way. Symptoms of inhibition include reticence, procrastination (delaying), reserve, wariness, reluctance, discomfort, hesitancy, nerves, nervousness.The experience of inhibition can be transitory, for instance in a surprise accident from which we eventually recover, or last some extended period of time while bringing with it feelings of isolation and anger. From another person’s perspective, it may look as if nothing is really going on. In fact, being quiet may even be encouraged and seen as a positive personality trait (especially for men), that is, until eventually some violence is done and personal ties are cut. Symptoms of inhibition include fear; being hyper sensitive to the other’s reactions; feelings of being disconnected or dissociation. In therapy, it may be useful to invoke the place and presence of the Other with its omnipotence. In Psychoanalytic Psychotherapy it is essential to help patients try to remember anything that could have been felt as particularly traumatic. It may also be useful to explore the various relationships the patient had with this so-called ‘omnipotent Other’.

Issues of self-confidence and/or self-esteem include shyness, embarrassment, unease, reserve, apprehension and feelings of insecurity.As a derivative of the experience of inhibition, issues of self-confidence can be usefully regarded in therapy as revolving around the notion of power, the perceived lack of which is based on an image (the ego) which is in fact deceptive. This is not to say that feeling of low self-confidence is not real. This ‘hole in the mirror‘ can have a significant impact on one’s life if left unattended. The society we live in demands that we continuously show self-confidence. The work undertaken in Psychoanalytic Psychotherapy includes encouraging patients to describe their significant relationships and identify those specific descriptions that have an alienating influence in their lives. The aim in therapy is also to help patients identify with what works for them; the Sinthome.

Moods can oscillate more or less suddenly between extremes of euphoria and a sense of invulnerability (in some cases with spending habits getting out of control) morbid, self-deprecating and suicidal thoughts.The clinical work consists primarily in first trying to achieve some form of stability, then to reduce or ‘average’ the gaps between highs and lows. Explorations to this effect are encouraged by helping patients provide some detailed descriptions of their life experience, but also to help them remember if any significant events had occurred in their past, the things they may have heard being said while growing up.The desire or willingness to become curious about those moods swings, the time at which they appear, what makes them suddenly turn into their opposites, what, if anything, could be associated when those are at their peaks, are also critical ingredients in the work Psychoanalytic Psychotherapy.

Addictions are usually recognised in experiences of dependency, craving, habit, weakness, compulsion, fixation or enslavement.From a psychoanalytical perspective addictions are regarded as a type of ‘self-medication’: a method used to evade everyday suffering. Intoxication affords not just an immediate relief from pain, it also provides a feeling of independence from the external world. At any time the addict can withdraw from the pressure of reality and find refuge in a world of his own.Addiction with intoxicating substances may draw to it an enormous amount of resources, physical and financial, potentially leaving the sufferer totally depleted or, as popular language would have it, ‘wasted’.The looming danger with addictions of this sort, besides the obvious risks to one’s health, include some potentially long-lasting changes in the person’s view of himself or herself. “I would no longer be ‘me’ without it”; “I am expected to keep achieving and could not do this without it” are only a few typical accounts therapists hear in their clinic. The combination of using substances as painkillers or as a means to sustain a particular lifestyle in which one is trapped makes it a formidable symptom to treat. The work may seem arduous, if not impossible at first, but this would be to underestimate the power of words. The patient’s understanding of the notion of ‘belief’, as well as what may have been seen and heard at the time in the past, are essential avenues to explore within Psychoanalytic Psychotherapy.

Impotence or obsessive thoughts of a sexual nature, porn addiction or excessive masturbation unavoidably distract from having an intimate relationship.To make sense of this situation, the other may conclude that he or she is no longer attractive, that some extramarital affairs must be going on or that the other must have fallen out of love altogether. In any case, the end is devastating in the emotional distance this lack of intimacy create. Conversely, sex may be taking place not because of any sexual desire per se, but solely with the purpose to sustain this emotional bond.In Psychoanalytic Psychotherapy the French psychoanalyst Jacques Lacan claimed that ‘there is no such thing as a sexual rapport’. If each of us have our own and very specific way to reach sexual gratification, then how can we ever be exactly ‘on the same page’ with each other?Now what may also be at play for some men is an anxiety about being ‘swallowed up‘, being under the stress to perform. At times some inhibition may take place because of something felt to be too close for comfort.

Psychotherapy is an opportunity for you to talk safely in a confidential place about your life and all that may be confusing, painful or uncomfortable. The therapist is someone who is academically trained to listen attentively so as to help you cope better.

Therapy is a process which is personal. Going through painful experiences may feel as if things are worse than when you started. In the long-run however therapy should help you feeling better. If it doesn’t after a while you should let your therapist know that things are not improving.

Apart from rare occasions where a single session is enough it usually takes a number of sessions before therapy starts to make a difference.

No. Because everyone is different (therapist included) everyone will feel the therapeutic process differently. Some therapy are successful, others are less. The relationship with the therapist is central to any progress.

It is important that you find a therapist you find yourself comfortable with, which could mean that you want to search for someone who is aware of your cultural background. Having said this it should not matter for the therapist.

No. There exists different methods and approaches in therapy and you might want to discuss the various modalities with your therapist so as to be sure his or her way of working will be all right with you.

Many different types of therapy are available. However it is often found that your relationship with the therapist is central to the progress of therapy.

Sometimes only one session is enough to feel better. However, as the therapy progress it may be the case that sessions continue over several weeks or months. It is common practice after 6 or 12 sessions to review how therapy is going for you, and discuss whether you feel it is important for you to continue or not.

Sessions usually last fifty minutes to one hour. However it is also the case that some modalities extend or shorten this time

Usually people see their therapist once a week. However this frequency can change if you wish a more intense therapy. This should be made clear from the start in the initial session with your therapist.

The following are a list of recommended questions, however do also ask your therapist any others that you think of: – How many sessions will I have? – What type of therapy do you offer? – How much will it cost? – What happens if I miss a session? – What happens if I want to take a holiday, will I still have to pay? – Will the counselling be confidential? – Will you make notes during the session, and if so, what happens to these? – Can I contact my therapist in between sessions?

The initial assessment is a chance for you to ask about the qualifications the therapist has and whether he or she is a member of a professional body such as: – The British Association for Counselling and Psychotherapy – The United Kingdom Council for Psychotherapy – The British Psychological Society You might also want to check whether the therapist has any experience and/or training in any particular area of concern important to you.

Trust your first impressions. If might just be that after a few minutes you feel you can trust the therapist and that you are comfortable talking. If on the other hand you feel not quite at ease, you may want to reconsider your choice of therapist.

If after several sessions you don’t like your therapist you may want to address the matter with him or her. This might just be part of the therapeutic process iself (transference). If after a while there is still a real and long lasting discomfort then you may wish to consider seeking another therapist.

If you feel that after a while there doesn’t seem to be any difference for you, it is important that you discuss this with your therapist. If then nothing changes then you may wish to go to another therapist.

400-450 hours college-based therapy training is the number of hours BACP recommends as a minimum. You may want to ask your therapist for the details of their qualifications. Don’t hesitate to ask questions. If you still feel unsure, do contact the therapist’s professional body in order to verify their qualifications.

Currently there is no legal requirement for therapists to be licensed. However, it is wise to choose a therapist who is a member of a professional body and who is insured to practice.

If after a while you would like to end therapy it is preferable that you first discuss it with your therapist in order to bring things to a clean end. If this seems too difficult to do face to face, you may want to give notice of wishing to end therapy in writing. Please do bear in mind any agreement you made at the beginning of therapy with regards to ending sessions.

It is important that you discuss this when you make your agreement with your therapist at the start of therapy. Because the rooms I am using require me to be charged on an ongoing basis unless in exceptional circumstances I am charging for missed sessions.

This is important to clarify this at your initial session with your chosen therapist. For reasons related to hiring the rooms I personally expect payment for missed sessions including holidays.

What is being shared in therapy is confidential to the extent that it will not be reported to anyone except a supervisor who, for the protection of the client also offers his or her own interpretations and make sure no harm is being done. In other circumstances however, if there appears to be a serious risk of harm to you or to others the therapist should inform you of his or her intention in dealing with this situation. This is usually done with your permission. These circumstances should be explained to you at the beginning of your therapy.

What you tell your therapist is entirely up to you.

Therapists usually ask to have your doctor’s contact details in case they feel there is a serious risk of harm to you.

This is not encouraged. The therapy is for you and is safe because what you talk about is explored in depth between you and your therapist. If there are communication difficulties, it would of course be understandable to have an interpreter in the room. If you feel you would rather be with other people in therapy you may consider group therapy.