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A psychotherapist’s guide to surviving Christmas

For most people, Christmas is an amazing time. It takes us to a state of childlike excitement, reminding us of the cyclical nature of life as we have a chance to reminisce and relive some of our childhood dreams and experiences. The fantasy and expectation of Christmas may point to a sense of joyous family time, but to some of us the reality beyond the hollywoodish dream can sometimes be quite cruel. Far from a big happy family having a great time, Christmas can be a painful reminder of the sort of things we try to avoid along the year, like feelings of abandonment, loneliness and resentment. The seasons can also make us face unresolved interpersonal conflicts, which are often re-enacted in the centre stage of a family reunion.

It’s not a coincidence that suicide rates spike after Christmas, and that a lot of people seek the help of a psychotherapist after the festivities. It’s for this reason that I thought about compiling a simple and brief guide on how to survive 3 of the most difficult experiences I could identify that happen around Christmas. My hope is that it will help those who struggle even more around this time to think and change some of the patterns that may be happening year in, year out.

1- Loneliness: it’s very common for people to feel quite lonely around Christmas. But this loneliness is not exclusive to those who have no friends or are more recluse anyway. I believe Christmas actually accentuates the bit of loneliness we all carry within ourselves. As we see friends going home to their families, or for those who are from another country and won’t be able join their loved ones for Christmas, this can be a very lonely time indeed. But what can be done then? Well, have you considered asking some of your friends if you can join them in whatever they’re doing? A lot of people assume that everyone is busy at Christmas and that no family will want to have a stranger around, but you’ll never find out unless you ask. I have a feeling that some of us actually feel a sort of satisfaction in dwelling on how lonely we may be at this time of the year, feeling sorry for ourselves and becoming even more recluse and resentful. And in doing so we may lose the opportunity to come out and find somewhere we would be welcomed this Christmas. So it may help to acknowledge this kind of resentment, and perhaps this will bring the willingness to go out there and be bit more forward about our wish to be with someone this Christmas.

2- Abandonment: alongside feelings of loneliness, the experience of abandonment around Christmas can be quite difficult to acknowledge and deal with. Everything stops around this time, and it can feel like everyone is going somewhere else to spend time with someone else. So for those who are actually spending Christmas on their own, loneliness and abandonment go hand in hand. But it may be a good opportunity to think about how you actually feel, and if you do feel abandoned, to try and see if it reminds you of other experiences of abandonment and rejection you may have had in your life. This may help putting the abandonment aspect of Christmas into perspective, and it may help you understand how you react when you feel abandoned in other contexts of life.

3- Family conflicts: if some people dread being alone at this time of the year, others actually long for it. In the tradition of gathering the family around for Christmas, some of us are thrown into a hurricane of deeply unresolved family conflicts. The elephant in the room, things like old grudges, resentment, betrayals, hatred, etc. may be ignored for a few days, but soon enough things are likely to kick off. And much like weddings, funerals and other family reunions, Christmas can become the centre stage for the re-enactment of past battles, a failing attempt to work through issues in the wrong context. But we have to remember that families are systems, and each member plays a function in this system, like clogs in a machine. This mentality takes away the simplistic victimised way each family member may feel at times, as everyone in a family is contributing to the dynamic, be it a funcional or dysfunctional one. It amazes me to see how easily we can all slip back into old roles in a family situation. Our parents may make us feel like we are 10 years old again, or our siblings may put us down, or we may be made to feel insignificant in the family context. But how much do you feel you contribute or collude to being placed in the position and function you have in your family dynamic? And if you feel pushed or provoked, do you really have to take it all out and try to resolve it during Christmas. So perhaps it would be helpful to try and step back and think a bit before reacting in the usual way you would do. Being together with the family may also be a good opportunity to think about how you relate to others out there. Because as much as we may try to be and do the opposite of what bothers us in our family dynamics, we carry within ourselves a way of relating to others that will most likely repeat these unresolved conflicts. Whilst this may be more easily disguised in other relationships, when back with the family everything may be a bit more raw and saturated, thus harder to overlook. But try and remember that it’s highly unlikely that any family conflict will find resolution during the festivities, and that you don’t have to counter everything when you feel attacked or provoked. Like a machine, if a clog suddenly stops and reverses it will cause friction and break down. So perhaps a more easygoing approach may slow down the system and even change its direction in due time. But this requires a throughout the year kind of attention, and not just at Christmas.

So for those who are unfortunate to have a bad time during Christmas, it may also present itself as an opportunity to reassess what’s not working and to change things around, in the hope that next year things will be better. Psychotherapy can support people in this process.

 

Allan Gois – Psychotherapist EC1 – Psicologo Brasileiro em Londres – Psicoterapia en Espanol Londres

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The problem of help (Part II) – ‘The experience of help’

Experience HelpLast week I wrote about the problem of help in psychoanalytic psychotherapy. I mentioned how the idea of help in this context differs from simply removing the symptoms and the problems, and how help in psychoanalytic psychotherapy involves the process of finding out the meaning underneath the suffering, which will promote understanding, development and transformation. All well and good.

But a question still remained for me, one that comes back every so often both in my work as a psychotherapist and in my experience of myself being on the couch as a patient. Yes, psychotherapists and analysts do go through the process of being a patient for many years, and this is an essential part of becoming a therapist. Maybe I’ll write about that on another occasion. This week the question I wanted to address relates to the how it really feels to be helped.

You see, it’s not easy being a patient in psychotherapy. Although one might expect that being helped and supported in therapy will only bring the relief and sense of wellbeing one wishes for, the emotional experience of help is an intense one, often giving rise to feelings that can be difficult to recognise and work through. I would say that this is not only true for what happens in psychotherapy, but to any experience of asking for and receiving help in any relationship.

And that is the key word for us to tackle the question of how it feels to be helped: relationship. Everything that takes place in psychotherapy happens in the context of a relationship, a therapeutic one, but intense nonetheless. It is in the relationship with the therapist that the patient will, often inadvertently, repeat and re-enact the way they relate to others in life. Feelings and unconscious dynamics will then take place, which the therapist will help the patient recognise and understand. So how the person experiences the psychotherapist attempting and managing to help them should not differ so much from how it feels to be helped in other relationships. And to understand the dynamics of help is to become more able to give and receive help when needed.

But what sort of emotional experience does help bring about? If it’s not straightforward soothing and relief, what else is there to be felt? I’ll list but a few:

1- Vulnerability: to experience help is to face vulnerability. When we are hurting, physically or mentally, we will do all we can to protect our vulnerable spots. In this sense, it can be very difficult to trust others and let them through the defence to look after our wounds. So the person who wants to be helped must face vulnerability, which can be very anxiety provoking.

2- Dependence: to be helped is to experience dependence. Some people avoid dependence like Dracula runs away from the cross. To depend on another person is to submit to their disposition and ability to help. This can be a difficult experience, as it makes us vulnerable to be disappointed and frustrated. We bring within ourselves an innate mistrust, maybe mirroring some of the times when we felt that those we depended on to look after us failed to do so. But to receive help from another person is to have to submit and face such dependence. There is no other way.

3- Envy: the experience of help can bring out feelings of envy. When people need help they may often feel depleted, on the opposite side of self-sufficiency. There is an assumption that the helping other then possesses what they need to be ok, whatever form it takes. This disparity between one who feels empty and the other who has what they need may give rise to unconscious feelings of envy. This is not uncommon in the experience of psychotherapy, as the patient comes with their difficulties and they expect the therapist to have what they need to get better. So often the patient will feel that the psychotherapist is withholding from them what they need to be well again, to feel immediate relief, and this stirs up feelings of anger and envy. So to be helped is to have to come to terms with our own greed and envy, as we submit and depend on the other for help.

4- Frustration: to be helped is to be susceptible to experience frustration and disappointment. When we ask for help we are to an extent surrendering our self-sufficiency and depending on another person’s capacity and willingness to help us. This makes us open to experience frustration and disappointment if the help doesn’t come when we want it, or in the way we want it. This also happens often in psychoanalytic psychotherapy, as I explained on last week’s post. If we want to be helped, be it in psychotherapy or in other contexts of life, we must face the possibility of frustration and disappointment.

You may have noticed that the aspects mentioned above relate to a narcissistic blow that takes place when a person asks and receives help. To be helped is accept and, to a degree, surrender our narcissistic defences, becoming vulnerable, dependent and sometimes envious, willing to face possible frustration and disappointment.

However, the process of help in psychotherapy doesn’t leave the person in such a state. This narcissistic blow is part of the process, and slowly the patient starts realising that help is an interaction, an exchange between two fallible and incomplete human beings. This will then translate to other realms of relationships, where the person will be able to find equilibrium between narcissism and depletion, between self-sufficiency and unhealthy dependence.

 

 

 

Allan Gois – London City PsychotherapistPsicologo Londres – Psicologo Espanol Londres

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The problem of help in psychoanalytic psychotherapy

As a psychotherapist I am part of what is called a helping profession. This includes doctors, nurses, physiotherapists, social workers, therapists and all those who are committed to help people develop and work through physical, psychological, intellectual and emotional problems, aiming for their wellbeing.

Psychoanalytic psychotherapy however is a peculiar helping profession, as the help someone will receive may be very different from what they wished for in the first place. I’ll explain.

I see a wide range of people in my psychotherapy practice in London, coming from all sorts of cultural, social and ethnical backgrounds. Many seek help in the middle of a crisis, some reaping the consequences of the aftermath. I see people suffering from depression, obsessive-compulsive symptoms, stress, acute anxiety, panic attacks, you name it. So it’s fair enough to assume that what every person wishes for is to get rid of what has been making them suffer. In this sense, help would consist in removing whatever symptom, issue or problem that brought the person to seek my help as a psychotherapist. Fair enough, it’s a reasonable thing to wish for.

However, a psychological or emotional problem, be it a symptom or patterns of behaving and relating to others, is not a foreign entity like a virus or bacteria, nor something that can be surgically removed like a growth or an abscess. Psychoanalytically speaking, everything that happens in the the mind and translates into everyday life is part of a complex construction of ways in which we organise our internal world, as we attempt to deal with some difficult aspects of ourselves and of life. This includes the way we handle our destructive impulses, our innate capacity for hurting ourselves and those we love and how we deal with painful experiences in life, things like frustration, disappointment, guilt and loss.

People often decide to seek the help of a psychotherapist when the way they lived their lives so far becomes unbearable, or when they realise they can no longer sustain a healthy balanced life in regards to how they feel, behave and relate to others. A lot of it has do to with the collapse of this complex mental structure that was put in place to deal with the undesirable and unbearable experiences we all face in life, be them internal or external. Nonetheless, the help that people often wish for when they first come is to actually be taken back to the place they were before the crisis, before they were debilitated by their struggle. As a psychotherapist I then meet (break) this expectation by helping the person realise that the way they were before is actually what led them to collapse in the first place.

Every symptom, conflict and difficulty that people seek help in psychoanalytic psychotherapy is there for a reason, and they all have a function and a meaning. They offer an important opportunity for the person to find out more about themselves, in how they behave, feel and relate to others. In this way the suffering that someone needs help with is not there to be simply gotten rid of or removed through a magical psychological surgery, but to be understood and worked through in the context of the therapeutic relationship. In doing so, the symptom or destructive pattern loses its functions and gives ways for the person to organise their internal world in a less defended and more conscious way.

So the help offered in psychoanalytic psychotherapy really comes through the painful process of discovering the meaning underneath the suffering, which will promote understanding, development and transformation. When what is unconscious surfaces to the conscious mind and is contained in the process of psychotherapy, the person can then become free to live a more integrated life. This unexpected help is long-lasting, as opposed to the short-lived illusion that one can simply get rid of symptoms and bypass the struggles in life without having to deal with them.

 

 

 

 

 

 

 

 

Allan Gois – Psychotherapist London CityPsicólogo Brasileiro em Londres

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What happens in a consultation (assessment) for psychoanalytic psychotherapy?

People often assume that when they go see a psychotherapist for the first time, they are already in treatment. However, soon enough the person will learn that before the therapy starts, a consultation takes place in order to assess the needs of the person and help them think, together with the therapist, whether psychotherapy can in fact help them with whatever problems they need to work through.

There are important questions that both therapist and patient need to ask themselves before embarking in the psychotherapeutic process. And this is why an initial consultation for psychotherapy is so important. The consultation is not only for therapist and client to have a sense of each other and to see if empathy and connection springs, but most importantly for the client to have a feeling of how the future therapy will unfold, and if he or she has enough resources to endure mental pain, uncertainty and unsettling feelings and the necessary robustness to face some disturbing aspects we all have within ourselves without breaking down.

A consultation for psychoanalytic psychotherapy happens over a few sessions (normally between 2-4 encounters), and this is so there is enough time for the therapist and client to have a feel of how they work together. It is also an opportunity for the psychotherapist to gauge the mental state of the client and to decide if psychotherapy or counselling is the best approach, if the help the therapist has to offer is enough for the needs of the client.

So I’ve put together a list of elements that are considered in the process of assessment for psychotherapy:

1- Connection. In the consultation stage both patient and therapist will get to know each other a bit better and feel if there is a connection there. This is important so the pair will know if they feel comfortable enough to work together. This connection has to do with empathy and trust. It is normal to be anxious in the beginning though, and it can happen that this connection will take place over time. Nonetheless, the therapeutic relationship is the springboard on where the therapy takes place, and so the connection between psychotherapist and patient is an essential question to be regarded and thought about. It is important though to go through the whole process before making any decision. The consultation is an ideal place to discuss any particular feelings or reactions that the patient might be experiencing in the here-and-now of the meeting, and this will help the pair to think about how it is to work together.

2- Information. During the consultation the patient will be free to share whatever information they feel relevant to help the psychotherapist understand what brought them to seek help. The therapist may ask a few questions to clarify and further explore what the person is sharing. Some of the information gathered throughout the assessment should include: personal history, family history, illnesses (mental or physical) history, current and past relationships, relationship with parents and siblings, work and living circumstances, etc. This list is not exhaustive, and the more information the better. The consultation is also an opportunity to clarify any queries in relation to the psychotherapy process.

3- Mental state. An experienced psychotherapist will be able to gauge the mental state of the person through the consultation stage. It is important to assess if the person has enough mental robustness to dig deep without breaking down or falling apart. If there is a possibility that psychotherapy will harm the patient, it is a golden rule that it should not be pursued. Psychotherapy can be a painful and unsettling process, so if in the assessment the therapist perceives that the person is in risk of fragmenting or becoming too unstable, it is better not to pursue the treatment.

4- The treatment x the needs. Following from point 3, through the consultation the psychotherapist will discern whether what they can offer is enough to contain and meet the needs of the patient. Whilst once or twice-a-week therapy is suitable for many people, sometimes a patient may need not only more intense work, but also the involvement and care of other professionals (i.e. psychiatrists, GP’s). It is important to recognise whether what the therapist can offer is enough to contain the patient, and so this question must be thought about in the consultation process.

5- Trial therapy. A consultation is also a sort of trial therapy. The psychotherapist will make interventions and interpretations and see how the patient reacts to them. This is to gauge the level of insight and see what the client does with the therapist’s interventions. This aspect of an assessment is quite important, as both client and therapist will be able to have a sense of how the future treatment will feel like.

6- Diagnosis. Although psychotherapists will not deliver a medical diagnosis, he/she should be able to identify aspects related to whatever mental illness a client may present. Having said that, some patients will come to therapy without a clear need for it, perhaps pursuing greater self-awareness or because they want to undergo something specific and need some support for that. Nevertheless, in the assessment stage the therapist will be able to see some personality traits and dynamics of the mind, and use that to help the client identify their needs when in therapy.

7- Objectives. It is quite common that the objectives (or needs for therapy) worked on in the assessment stage will change or be lapidated over the course of the therapy. Many times what we think to be the current demand for therapy will happen to be but an expression of a deeper struggle in the mind. Part of the consultation is to talk about objectives and needs, but it is important to keep an open mind for the more unconscious demands of the mind.

It is clear that a good consultation is paramount for a good therapy to develop. I hope the points above helped to clarify what happens in an assessment or consultation for psychoanalytic psychotherapy.

Psychotherapy is a great commitment, but one with great benefits.

 

 

 

 

Allan Gois – Psychoanalytic Psychotherapist in the City of London

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London City Psychotherapist new website

I’m delighted to announce a new website for my practice: London City Psychotherapist.

My traditional website – http://www.allangois.co.uk/ – will be up and running alongside, as I intend to keep them both.

Have a look and let me know what you think.

 

 

 

 

 

 

 

Allan Gois – Psychoanalytic PsychotherapistPsychotherapist London City