Loneliness

Therapy for Loneliness

Therapy for Loneliness in Surrey, Guildford, Farnham, Woking and surrounding areas.

Loneliness is another modern epidemic. And it doesn’t just affect the elderly but also the middle-aged and the young. Loneliness isn’t the same as being alone which may be a pleasurable and perhaps reinvigorating experience. By contrast, loneliness is associated with pain and may be present even if you have many social connections and even if you’re married or in a relationship. It’s nature’s warning signal to get into (more intimate) contact with people. That’s because we’re built to be in relationship with others. Relationships – not just romantic relationships – give meaning to life and are vital for survival.  The feeling of loneliness and chronic loneliness can be linked with significant deterioration in physical health, as well as with depression, anxiety and even suicide.

What are the signs of loneliness?

There are various symptoms – a few of them quite surprising. Among them are:

  • Wanting people around but being unable to attain that
  • A sense of social isolation or disconnectedness from people
  • A persistent yearning for closeness
  • Social anxiety
  • Even with people around, not feeling understood or cared for
  • Avoiding being alone
  • Hiding away from others
  • Making excuses, including to oneself, for avoiding human contact
  • Feeling lost and lacking direction
  • Burying oneself in work or other home activities
  • A feeling of nothingness or perhaps numbness
  • Low self-esteem or self-confidence

  • Difficulty in liking oneself or in believing that others will
  • Social isolation through mental health problems
  • Feeling depressed (in severe cases including suicidal thoughts)
  • Frequent illness
  • Shopping a lot/accumulating possessions (to fill a void)
  • Binge-watching television
  • Disrupted sleeping and tiredness but more time in bed
  • Addiction to social media
  • Excessive long, hot showers or baths (to feel ‘warm’)
  • Weight-gain
  • Having friends who feel lonely (it can be contagious)

How do I know if I’m lonely?

If you’re lonely, you may be acutely aware of it or hardly at all. You may not want to admit to loneliness but, if you’re open to the possibility, then recognizing yourself in some of the signs in the list may tell you something. There’s an explosion of online material, including loneliness tests, to help you get an idea of whether you have a problem. But most reliable of all may be speaking with your GP to get their thoughts.

What are the causes of loneliness?

The reasons for so much modern loneliness are social as well as psychological so I’ll deal with each in turn. The complexity and scale of the problem are such that I can only scratch the surface here.

Social factors

Society has changed and we’ve lost our communities and therefore an inner sense of community. Relative social isolation is the lot of many. Work and college take us away from our original families and social networks and repeated redundancies may lead to repeated moving. Divorce is more frequent so life companions are fewer. Families are getting smaller with more single parents and more only children (sometimes especially prone to loneliness). We often bring up children away from our relatives. Former centres of meeting like churches or dance halls are emptier or non-existent. The cultural impetus is towards individualism, narcissism, independence, competitiveness, withdrawal, aggression and relationships with technology rather than with people. Cars insulate us from each other.

The county of Surrey, where I’m based, is often characterised by big houses hidden up big drives, tiring commutes, exhausting jobs, partners not seen enough and neighbours not seen at all. Social media connect people but if you have two hundred friends on Facebook does that mean you have two hundred friends? There’s something about face-to-face meeting that’s uniquely enriching. Finally, simple retirement can create loneliness as can stigma through race, sexuality, gender, disability or health.

Psychological factors

Some of the psychological causes of loneliness are obvious, some less so. Bereavement, the lack of a partner and unrequited love can all be factors. The lack of someone to understand us, recognise us or simply be there in the background can be agonising. Small wonder some people fear death less than loneliness.

Other causes may be more deep-seated. For example, every toddler needs a mother or caregiver who’s safely and consistently there. In later life the quest may be for a partner to provide similar stability and enrichment, without which there can be loneliness. But if the original caregiving goes wrong, the template for a fundamental insecurity and lack of trust in oneself and in others may be laid. There may be a sense of being unloveable or not good enough in some way. Childhood experiences of hurt, lack of love, trauma, abuse, neglect, abandonment, ridicule or deception can significantly contribute to loneliness both at the time and in adult life.

So it is that many of the psychological conditions I describe on this site can have the effect either of alienating people or keeping them at a safe distance. Narcissistic, borderline or paranoid traits, for instance, may do the former while schizoid, avoidant or depressive traits may do the latter. (For borderline, paranoid, schizoid and avoidant traits, please see the personality disorders page, remembering that people can have characteristics of a condition without having a full-blown personality disorder).

What can be done about loneliness?

There are numerous self-help resources and also treatments available to combat the feeling of loneliness. Analytic psychotherapy may be a valuable way of dissipating it over time. (Remember that psychotherapy probably won’t achieve rapid results because it goes into the depths to tackle problems and that does take time.)

Psychotherapy provides a regular confidential space in which to think about loneliness and to identify its origins. It may be particularly helpful if the roots are in your childhood, in which case it may be possible to work through the causes and for significant changes in you and in your life to evolve naturally.

Group therapy can be of especial benefit. Although group members don’t meet outside the group and group analysis doesn’t provide ‘friends’ in that sense, it does offer a therapeutic social setting. In that setting, relating with others can be practised, problems can be worked through and a freer, more confident and more outward-looking stance can be deeply absorbed which may then be used to build new relationships in the outside world.


Anger

Anger is a natural and essential emotion which has its origins in aggression – a basic potential in all of us.  We feel anger surfacing in the face of something being unsatisfactory – for example, if we’re deceived, insulted, threatened, attacked, treated unfairly or made to feel powerless.  Channelled appropriately, anger can push us to defend ourselves, express our needs, rectify injustices and generally make changes.

If there’s significant acting out of anger, it’s advisable as a first step to bring the behaviour under control through a period of anger management work – perhaps using Cognitive Behavioural Therapy (CBT).  PLEASE NOTE THAT I DO NOT OFFER ANGER MANAGEMENT OR CBT.

Once the anger has been brought under control, there may be a wish to proceed to a second and deeper level – exploring the underlying causes of the anger problem.  That is where the kind of analytic psychotherapy for anger offered at Guildford Therapy might be helpful.  It will usually take a good while longer than anger management/CBT because problems don’t get established in people overnight and can’t therefore be resolved overnight.  Although there can be no guarantees of success with any therapy, analytic psychotherapy does aim for deep and long-lasting change.

Given its fundamental nature and universality, anger will be somewhere present in almost all the psychological conditions that you read about on this website and in many more conditions besides.

Anger only becomes a problem when it harms us or those around us.  The instinctive way in which we express anger is through aggression but it’s not socially appropriate for anger to be vented every time we’re irritated or annoyed.  When we harness our anger and express it assertively and constructively but not aggressively we have a fair chance of getting our needs met.  But sometimes anger can become a characteristic of who we are, coming out too often or explosively or with physical violence.  Or alternatively it can be mutely buried deep within us, contributing perhaps to depression, anxiety, passive aggression or high blood pressure.  Either way, anger issues can damage us, our relationships and our work.

What are the signs of problem anger?

Some of the more common signs of a problem with anger include:

  • Involvement in fights or other physical violence
  • Frequent arguments
  • Explosive outbursts (for instance, shouting, swearing, hitting things, throwing objects, being verbally abusive)
  • An habitual impulse to lash out verbally or physically
  • Losing your temper while driving or road rage

  • Regular trouble with the authorities
  • Alcohol or drug use to stifle underlying anger
  • A rocking motion when sitting
  • A clenched jaw and teeth grinding
  • Passive aggression
  • Inward aggression

Passive aggression and inward aggression

Passive aggression is the indirect rather than direct expression of anger. It might manifest in ignoring people, being sarcastic or sulky, making cynical comments, deliberately performing tasks poorly or with thinly concealed aggression, back-biting and being excessively critical, refusing to cooperate with reasonable requests, doing work late and creating an atmosphere of latent hostility that makes others walk on eggshells.

Inward aggression, as the term implies, is anger turned inwards against the self. A person might, for example, withhold essential needs from themselves such as food or activities that could make them happy, isolate themselves from the world around them, be full of hatred for themselves, suffer from depression or engage in self-harm.

How do I know if I have a problem with anger?

It may be that if your problem is with controlling anger, you’re already aware that there’s something wrong. Others around you are very likely to be. If your problem is with buried anger, it may be less clear to you although, again, others may be well aware of it. As with many psychological difficulties, there are various online tests for problem anger. It’s usually a good idea, however, to have a conversation with a specialist, such as your doctor, in the first instance.

What are the causes of anger problems?

As I’ve said above, issues around anger can be present in a huge number of psychological difficulties which means that it’s impossible to give a catch-all answer to this question. In addition, psychoanalytic psychotherapy has no single overarching theory about anger. We can say some things, though, about the causes of anger problems.

Innate drives

It’s likely that some people are simply born with a stronger aggressive drive than others. This still has to be mastered, however.
I’ve mentioned that an aggressive drive is present in everyone. Just think of a hungry baby’s spectacular rage. In stressful situations and when our impulses are frustrated, we can all be catapulted back to those primitive states and feelings. Each person will control them or fail to control them depending on the success or otherwise of their emotional development in their formative years.

Parental messages

If people grow up with the parental message that acting out anger aggressively or violently is acceptable, that’s likely to influence the way they continue to behave as adults. Conversely, if the message in childhood is that anger is unacceptable, perhaps being punished, it may be driven underground. Similarly, witnessing dramatic outbursts of anger from parents can leave a child with an impression that anger is terrifying and destructive – including the child’s own anger. On the other hand, we know that a child witnessing parental violence can lead to re-enactment of the behaviour by the child.

Something missing at the centre

Another way of understanding anger problems is to see them as a kind of ‘disintegration’ of the core of oneself when problems are encountered with other people. (For what follows I’m making use of a helpful study of anger called Anger-Related Disorders, edited by Eva Feindler). Ideally, parents soothe, admire and validate children until they’ve internalized the capacity to do this for themselves when encountering criticism, frustration, failure and so on. If something goes wrong in parenting and this solidity doesn’t develop in a child, you may get ‘narcissistic’ rage when they come up against frustration and disappointment. If you like, the core self isn’t strong enough to deal with the slings and arrows of everyday life.

Something else missing at the centre

Linked to the above is the lack of another ability which may again lead to out-of-control behaviour. If all goes well, a mother reflects back to a small child his or her emotions, naming them and making sense of them for the child. If this doesn’t happen, the child can’t develop a coherent picture of their own mental states and those of others. There’s an inability to understand them, think about them and talk about them. A confusion arises about internal and external realities so the individual feels they must act out in reality what could otherwise just be imagined, thought about or talked about. Violence-prone individuals often show a confusion of reality and fantasy, thought and action, feelings and facts, body and mind, and self and other. They may act out in reality aggressive thoughts about another person.

There’s a close association between the inability to control strong emotions and the experience of trauma in childhood.

What can be done about problem anger?

As I’ve explained above, anger probably needs to be addressed on two levels.  The first aims to bring the expression of inappropriate anger under control and can best be done via anger management work – often using Cognitive Behavioural Therapy.  PLEASE NOTE THAT I DO NOT OFFER THIS.

When that has been done, a person may wish to proceed to a second level – exploring the underlying causes of the anger.  This is where analytic psychotherapy of the kind I offer may be of help.

If you know someone who has difficulties with anger and who could potentially be helped by psychotherapy for anger, please note that the person themselves would need to contact me.

It’s important to be aware that a decision to take someone into therapy will depend, along with other factors, on the severity of the problems.  Also, domestic violence is a distinct category of anger dysfunction and requires specialist treatment.


Anxiety counselling and therapy

Anxiety

Anxiety Counselling & Therapy

Anxiety Counselling in Surrey, Guildford, Farnham, Woking and surrounding areas.

Over time, anxiety counselling and therapy can reduce and even eliminate your anxiety. A difficulty with thinking about anxiety is that it manifests in different ways and has different causes. It can include generalized anxiety, social anxiety, panic attacks, phobias, obsessive-compulsive behaviour and Post-traumatic stress disorder (PTSD). Appropriate anxiety can be caused by experiences like redundancy, ageing, bullying or cancer but I’m thinking in this section about entrenched anxiety.

What are the symptoms of anxiety?

Among the most common are:

  • A sense of unease, tension, fear, doom or worry – sometimes linked to specific situations but sometimes hard to pin down
  • The feelings may be uncontrollable, intrusive, obsessive and out of proportion to a given situation
  • Restlessness, tension and being on edge
  • Irritability
  • Sleep problems
  • Difficulty concentrating

  • Fatigue
  • Loss of confidence
  • Muscle tension
  • Difficulty breathing
  • Sweating
  • Racing heartbeat

As I’ve said, anxiety is also linked to panic attacks, phobias, obsessive-compulsive behaviour and PTSD.

How do I know if I suffer from anxiety?

There are quite a few websites providing tests for anxiety. It’s worth being aware, though, that diagnosing oneself can be misleading. It’s always a good idea to talk to a specialist and your doctor is a good first port of call. Symptoms may also emanate from more than one cause or from a different cause.

If you have some of the symptoms in the list and if they persist or are recurrent, it may be that you are suffering from anxiety. Other indications can include the need for frequent reassurance, being overly alert, finding it hard to relax, trembling, nausea, digestive problems and lightheadedness.

What are the causes of anxiety?

Anxiety-related conditions are diverse and have diverse causes. There’s probably something different going on in a person who feels trapped at cocktail parties and one who’s obsessively hoarding large quantities of garden furniture. Or one who constantly worries. But there are common denominators. There’s some evidence of a biological element in anxiety. And at the psychological level the universal factor is a perceived looming threat to safety – perhaps quite unconscious.

Threats in childhood

For example, the threat may originally have been an overwhelming event or events in the distant past that menaced a person with total disintegration. Instances could include a traumatic birth or an intimidating, even terrifying, parent. Challenging situations in later life can threaten, at a level beyond awareness, to re-immerse the person in a flood of the original annihilating feelings – hence the difficulty or impossibility of mastering them in the present. In psychotherapy, the aim is to find and heal as far as possible the original emotions.

Or the original threat may have been about experiences of separation from a parent, in which case the emotions, while threatening a less total destruction, can still be terrifying: a dread of aloneness and a yawning feeling that one is empty.

Or else the original threat may have been connected with punishment for unacceptable longings. This time there may be no menace of being destroyed but instead a deep guilt and an anticipation of retribution.

For instance

The quality of the early relationship with one’s parents (or other major caregivers) is pivotal here. An example might be of parents who are not attuned to what their child needs at a particular stage of their development. They may be either too present – for instance, a mother who over-protects and offers ‘smother love’ – or not present enough – for instance, a mother who is neglectful.

In either situation, a child might not be able to develop the necessary mechanisms to control their anxiety. In the first case, that’s because the mother constantly protects the child from anxiety and deprives them of the chance to experience anxiety-provoking situations in safe doses and build up a tolerance to them. (In addition, the very fact of stunting a child’s natural drive to stand on their own two feet can provoke anxiety). In the second case, anxiety might take root through the child being ignored and uncontained fear being allowed to spiral out of control. A mother needs to take a child’s fear, ‘process’ it and reassure the child that everything’s all right.

Depending on their severity, such situations can lead to major anxiety linked to one’s fundamental sense of safety and existence.

What can be done about anxiety?

There are different approaches for treating anxiety, including analytic psychotherapy. Bear in mind that psychotherapy usually doesn’t offer rapid change and that, as with most types of therapy, successful treatment can’t be guaranteed. Psychotherapy goes to the roots of conditions (often unconscious) and working with these takes time. But therapy does aim for long-lasting effects. It’s sometimes the case that, where appropriate, people find psychotherapy easier if they are on medication prescribed by their GP.

Other pages which may be of interest

For more information about Depression
For information on Anger
See our blog post about stress: All stressed up and nowhere to go


Narcissism

Narcissism Counselling & Therapy

Narcissism Counselling in Surrey, Guildford, Farnham, Woking & surrounding areas.

Narcissism is one of the primary conditions of our time and has even been labelled an epidemic. Individual narcissism is being fed by our narcissistic culture with its emphasis on self-promotion and hyper-individualism exemplified in selfies, talent shows, cosmetic surgery and the ‘me’ in social media.

What are the symptoms of narcissism?

Narcissism ranges from moderate traits to a full-blown personality disorder (see personality disorders page) so the symptoms also vary in degree. Some of the most frequent are:

  • A hunger for recognition and admiration
  • A haughty, grandiose sense of self-importance
  • Self-admiration and self-absorption
  • A sense of superiority and an expectation that this will be recognized, perhaps without commensurate achievements
  • A sense of being special and possibly of being understandable only by a few
  • A sense of entitlement – ie expecting preferential treatment or automatic compliance from others
  • A need for an audience
  • Fantasies about power, success, brilliance, fame, beauty or the perfect partner

  • An inflated view of oneself sometimes alternating with feelings of inferiority and insecurity
  • A lack of empathy with others and difficulty in achieving emotional intimacy
  • Devaluing others
  • Using, controlling, bullying, manipulating or exploiting others who may only be perceived as extensions of oneself and who may be dropped when they have served their purpose
  • Feelings of envy and a desire to counteract them by arousing envy in others – eg by some special talent, physical attribute or possession
  • A fear of dependency on others
  • A heightened sensitivity to criticism and shame

How do I know if I suffer from narcissism?

There are all kinds of online tests for narcissism, some based on the Narcissistic Personality Inventory – widely used in social psychological research. You need to bear in mind, however, that attempts to diagnose yourself – or indeed others – can be problematic. It may be more helpful to talk to a specialist. Your doctor can be a good starting point. But if you recognize quite a few of the symptoms in the list and if they are causing difficulties, it may be that narcissistic tendencies are at work to some extent or other.

What are the causes of narcissism?

As I’ve mentioned, narcissism can range from fairly modest characteristics to its more serious manifestation in narcissistic personality disorder. The latter may cause problems in many areas of life including work, relationships, education and finance. There’s also the category of malignant narcissism where narcissistic personality disorder is mixed with anti-social features, very high levels of aggression, sadism and paranoid traits. Underlying all these, however, there seem to be some common experiences deriving from childhood. As always, they will vary in severity. Otto Kernberg has done major work on the causes of narcissism and I’ve made use of it in what follows.

Coldness and aggression

Often the child’s home environment is superficially well-organized with apparently good parenting. But beneath the surface the parents may actually be cold and covertly aggressive, although the aggression may not be expressed in words. The child may experience callousness, indifference and spitefulness.

Unsurprisingly, the overall effect will be for a child to feel that they are unloved or unlovable. A sense of hunger for love, plus rage, emptiness and worthlessness may follow. It’s not surprising that envy of those who have had more authentic experiences of love can also develop, along with the compulsion to create compensatory envy and admiration in other people. Some of these feelings may be beyond conscious awareness.

‘Trophy’ children

It’s not uncommon for such children to be ‘trophies’ – that is, valued not for who they are but for what they do (for instance, their musical or sporting achievements) and for what function they have for their parents. The children are being used just as they may later use others. The message that one is highly valued but largely for an accomplishment or role is confusing. And it may drive a child’s real feelings (particularly hostile or selfish ones) underground for fear of them being censured in the family.

When a child is criticized every time they fail to bring reflected glory to their parents, the shaming message may be conveyed that they’re somehow not good enough. Similarly, over-indulgent parents who applaud their children indiscriminately may instil in them not only an awareness of permanently being judged but also a deep intuition that the lavish praise is false and that they are somehow fraudulent.

What can be done about narcissism?

Analytic psychotherapy is often used to treat narcissism. Because it endeavours to tackle the condition at a deep level, it’s long-term work. As always with therapy, a successful outcome can’t be promised but the aim is for lasting change.

It’s important to note that the level of severity of a person’s symptoms would determine whether or not I took them into therapy.

If you know someone who you think might have narcissistic tendencies and could potentially benefit from psychotherapy, it’s helpful to be aware that the person themselves would need to contact me. This can be difficult because people suffering from narcissism often don’t think that there’s anything wrong. Sometimes it’s only as a result of feeling depressed through recent experiences of criticism, rejection or failed relationships that they contact a therapist. That’s not uncommon in later life when difficulty coping with the ageing process may be an additional factor.

What I have said above applies, of course, if you yourself feel you may have narcissistic characteristics. They can be hard to recognize in oneself and the possibility of them can be hard to acknowledge.

Other pages which may be of interest

For more information about Individual Psychotherapy
For more information on Depression


Personality Disorder

Personality Disorder Counselling & Therapy

Personality Counselling in Surrey, Guildford, Farnham, Woking and surrounding areas.

Personality refers to the patterns that make up how we think, feel and behave towards the world. In a personality disorder, the ways in which a person thinks, deals with their feelings and behaves cause significant distress to themselves or others in many aspects of their life – for example, at work or in relationships. The person’s symptoms will be long-standing and enduring – in other words, probably dating from late childhood or adolescence and extremely hard for them to change. Quite often people have more than one personality disorder and may struggle with other mental health problems such as depression or substance abuse. Personality disorders may be caused by a mixture of upbringing, genetics and biology. It’s not uncommon for people to have experienced fear or distress in childhood through abuse in one form or another.

How do I know if I have a personality disorder?

There’s a lot of material on the internet which may give you an initial idea about personality disorders. Because diagnosing yourself (for example, doing a personality disorder ‘test’) can be unreliable, however, it’s always advisable to talk to a specialist. Your GP can be a helpful starting point in this.

Below are brief details of some of the more common types of personality disorder: borderline, narcissistic, histrionic, schizoid, obsessive compulsive, avoidant and dependent. Although I have drawn from many sources, including my own clinical experience, I have made particular use of the work of Otto Kernberg and of Nancy McWilliams in her book, Psychoanalytic Diagnosis.

Borderline personality disorder

More women than men suffer from borderline personality disorder (BPD). A person with the condition may swing between a fear of being abandoned by others and a fear of being engulfed. They may have unstable moods and difficulty in containing emotions including anger. They can shift rapidly from very good to very bad feelings about another person and shift rapidly too in how they see themselves. There may be feelings of boredom and emptiness and sometimes episodes of dissociation – ie periods of ‘lost’ time, trance-like states and forgetfulness. The person may be reckless and do things on impulse such as self-harming or attempting suicide. There can also be a pattern of unstable and intense relationships.

The causes of BPD are complex and often include childhood loss, trauma and abuse – physical, emotional (including neglect) or sexual. The experiences may have been overwhelming, unbearable or terrifying and may have rendered the child powerless and unable to process what they were feeling. A parent may have switched between being caring and being quite the opposite, making it impossible to develop a stable, integrated sense of self and others. Another factor may have been a mother who discouraged a small child’s natural drive towards independence and self-assertiveness and instead encouraged clinging behaviour. The child then grew up feeling safe in regressed, dependent relationships but which also threaten to engulf her or him. Aloneness, on the other hand, brings an anguished sense of abandonment.

Narcissistic personality disorder

Narcissistic personality disorder is characterized by a grandiose sense of one’s own importance and superiority, a feeling of being special, a craving for admiration, a sense of entitlement, a lack of empathy, strong envy, fantasies of power and success, the misuse and exploitation of others and a heightened sensitivity to criticism and shame. For more information, please see the separate page on narcissism.

Histrionic personality disorder

Histrionic personality disorder affects more women than men. People who have it tend to be over-dramatic, attention-seeking, intense, risk-taking, suggestible, anxious and seductive. They may be preoccupied with their appearance and have strong emotions which change quickly.

Often they may feel deep down like small, frightened children in a world of powerful adults. Their original family experiences may have led them to believe that females are weak and unimportant and that men are strong, exciting and dangerous. To master anxiety, they may run towards what they fear (behaving seductively with men, for example). They dramatize what they say because they don’t expect to be listened to as an adult. Much of this behaviour is unconscious.

Schizoid personality disorder

Those suffering from schizoid personality disorder usually keep away from emotional involvement with others. They may prefer their own company and have little interest in sex or intimacy. Some feel that relationships interfere with their freedom and they can appear detached, emotionally cold, overly intellectual and aloof. They’re often introspective with a complex inner world of fantasy.

One frequently finds that schizoid people have had impinging, overinvolved parenting which was perhaps combined with impatience and criticism. There may also have been contradictory communications. It’s not surprising that withdrawal was a solution. Alternatively, some children have had neglectful and lonely upbringings which set the pattern for the future.

Obsessive compulsive personality disorder

Individuals with obsessive compulsive disorder may exhibit hoarding behaviour, need to keep everything under control, be rigid, detailed and rule and routine-bound, dislike change, become anxious when mistakes are made, have unrealistically high standards, expect disaster when things aren’t perfect, be judgemental and sensitive to criticism, have obsessional thoughts and be excessively cautious.

The parents or caregivers of these people may have been over-controlling, stern or authoritarian, condemning not only ‘unacceptable’ behaviour but even thoughts and feelings. They may have induced guilt in a child or shame. The child may grow up with a tension between rage at being controlled and fear and shame about being punished. These feelings are buried beyond awareness. The person may keep things that way by talking about what they think rather than what they feel.

Compulsive actions (for instance, cleaning or shopping) may have the unconscious meaning of magical rituals to atone for guilty, aggressive thoughts. Acting compulsively may also be linked to a need to leap into action to avoid making a considered choice – a choice which could be wrong and risk guilt or shame. Similarly obsessive procrastination has the effect of putting off a choice. Paradoxically all the rigid behaviours may also conceal a wish to be irresponsible, messy and rebellious.

Avoidant personality disorder

An avoidant personality disorder means that someone may avoid social activity, feel socially inferior, have few or no friends or intimate relationships, worry about being ‘found out’, rejected or embarrassed, feel constantly tense and anxious and avoid risk. Unlike schizoid people, they are less likely to appear emotionally cold but rather they crave the relationships they can’t achieve.

The person’s parenting may have included absence, rejection or disciplinarian and controlling attitudes. The child’s confidence may have been undermined or not built up, leaving a fear of failure. Experiences of rejection by peers may have compounded things, along with other shaming experiences in social settings. The latter may have caused feelings of being out of control which, in turn, may symbolize wider fears of loss of control if frightening aggressive or sexual feelings were let out. As so often, much of this is likely to be happening at a level beyond conscious awareness.

Sometimes parenting which obstructs a child’s drive to separate emotionally and make his or her own way in life can also stunt the development of confidence. An interesting paradox may be that the fear of social rejection may cover a fear of actually being accepted with perceived risks of becoming dependent, controlled or trapped in committed relationships – which may already have been experienced in childhood. Similarly, fear of failure may mask a fear of being successful with the unfamiliarity and responsibilities that could entail.

Dependent personality disorder

People with a dependent personality disorder tend to be passive, allowing others to take responsibility for decision-making in their lives and requiring considerable help and reassurance if making decisions themselves. They may accede too easily to the wishes of other people even when those wishes feel wrong or uncomfortable, perhaps for fear of harming the relationship. They may struggle to make perfectly reasonable demands and have a sense of weakness, neediness, incompetence or helplessness. They may find it hard generally to function without support, lack confidence and view others as being much more capable. They may fear being left to fend for themselves.

Children learn, mature and become independent through experimentation. Two different parenting styles may work against this and create continuing dependency. Authoritarian parenting may prevent a child engaging in trial-and-error learning and growing in a sense of potency. Conversely, over-protective parenting which prevents a child’s natural emotional separation can do the same and habituate them to functioning only with the support and guidance of people who are experienced as stronger and more able. If the child is then also mocked by peers for incompetence and immaturity, that may reinforce the belief that life can only be successfully navigated by leaning on others rather than by trusting in one’s own resources. Anxious parenting may also make the fear of failure frightening and block the discovery that failure can be survived and learnt from.

What can be done to help with personality disorders?

A variety of treatments are available for personality disorders, including analytic psychotherapy. Sometimes another form of therapy, for example Cognitive Behavioural Therapy (CBT) or Dialectical Behaviour Therapy (DBT), may be required first in order to bring symptoms and behaviours under control.
When it comes to personality disorders there are no quick fixes. Certainly analytic psychotherapy is a gradual process often requiring quite lengthy work to get results. Although a successful outcome can’t be guaranteed, psychotherapy does have as its goal moderate but long-lasting change.

It’s important to be aware that whether or not I take someone into therapy will depend, among other things, on the level of their symptoms. If they are severe, more specialized help, for example provided by the NHS, would be more beneficial. GPs are always a good place to start in finding the right way forward and there are also local support groups, online support communities (including some specifically for people who self-harm), websites, blogs and self-help books.

Other pages which may be of interest

For more information about Anxiety
For information on Anger
For information on Narcissism and Depression
See our blog posts: All Stressed up and Nowhere to go and The Right Brain For You


Relationship Problems

Therapy for Relationship Problems

Therapy for Relationship Problems Guildford, Surrey, Farnham, Woking & surrounding areas.

When people talk about relationship problems, they’re often referring to issues affecting a relationship with a partner. But obviously relationship difficulties can also be with (other) family members, work colleagues, friends or general acquaintances. Whatever the case, few would dispute that relationships are a central part of human life and can bring us some of our deepest experiences of fulfilment or misery. As you’ll see below, relationships are also at the heart of analytic psychotherapy.

What are the commonest problems in relationships?

Some of the most frequent relationship difficulties centre around:

  • Trust
  • Communication
  • Mutual respect, attentiveness and consideration
  • Infidelity
  • Sexual problems
  • Prolonged stress, traumatic events, illness
  • Differences in values and beliefs
  • Changing over time
  • Manipulation
  • Money
  • Conflict
  • Prioritizing the relationship

  • Criticism
  • Addiction
  • Over-use of the internet and social media
  • Taking responsibility and division of labour
  • Jealousy
  • Lack of support
  • The birth of a baby
  • The death of a child
  • Approaches to child-rearing and ‘blended’ families
  • Mental health issues
  • Emotional abuse and domestic violence
  • Unrealistic expectations

The causes of relationship problems and how I work with them

Beyond the areas given above, the causes of relationship difficulties are so diverse that it would be very hard to try and list them all. The same goes for the ways in which I work with them. It depends on the particular problem.

However, some general points can be made. I work with individuals, either one-to-one or in groups. I don’t currently offer couples therapy or relationship counselling but I do often take people into therapy who come with relationship issues as the presenting problem. Frequently it turns out that other things are going on under the surface and we also explore those. Analytic psychotherapy is about working with the problems underlying the relationship issues rather than giving relationship advice

For example, if someone has an emotionally abusive partner, we will look at dynamics that may be at work beyond conscious awareness. Why has the person chosen someone who hurts them? What might be repeating from the person’s own history including childhood and adolescent experiences? Might the person themselves paradoxically be contributing to an abusive relationship or even unwittingly getting something out of it? Might each partner be unconsciously putting disowned parts of themselves into the other person? What, in short, needs to happen to develop a healthy relationship?

Also, at a general level, I work with a wide range of psychological conditions, most of which will impact on relationships in one way or another. For instance, obsessive-compulsiveness, tendencies to withdraw from life, an impulse to be overly dependent, depression, anxiety, self-defeating behaviour and so on can’t help but affect relationships – sometimes hugely.

Relationships are at the heart of analytic psychotherapy

These psychological difficulties and many, many more don’t get created in a vacuum. Along with much of our personalities, they’re created in relationships – often family relationships. So relationship issues are the ever-present subject matter of psychoanalytic psychotherapy. Although psychotherapy isn’t a quick fix it offers the possibility, through a therapeutic relationship with an analyst or with the members of a therapy group, of inner change and improved relationships in the outside world. In an analytic group, for example, current patterns of relating to people get played out and can be ‘paused’, thought about and modified. A group is a ‘laboratory of life’ for relationships!

Other pages which may be of interest

For more information about Addiction
For information on Anger
See our blog post: Ever Been Bullied by a Putin?


Addiction

An addiction is when someone takes a substance or engages in a behaviour which is initially enjoyable or serves a purpose but whose continued use becomes compulsive and interferes with the responsibilities of everyday life.  It’s been said about alcoholism, for example, that there’s a problem when drinking costs more than the price on the bottle.  Among other things, we can be addicted to alcohol, drugs, nicotine and tobacco, inhalants and medication.  A list of the so-called behavioural addictions would include gambling, the internet, sex, spending, working and video gaming.

Addiction needs addressing on two levels.  An essential first step is to stop the acting out of the addiction and to keep it stopped.  The fastest and most effective way to do that is with CBT (Cognitive Behavioural Therapy), sometimes combined with medication.  CBT teaches a person simple skills to interrupt the cycle of addiction with new ways of thinking, feeling and acting.  PLEASE NOTE THAT I DO NOT OFFER CBT.

The second level is where Guildford Therapy might be able to help.  Once the symptoms of the addiction are under control, there may be a wish to work on its underlying causes.  Analytic psychotherapy may be useful at this point.  It’s important to be aware that, unlike CBT which may work relatively quickly, psychotherapy often takes quite a lot longer because it’s tackling the roots of the addiction.

If you have been struggling with an addiction which has now been brought under control and would like to discuss the possibility of psychotherapy exploring the reasons behind the addiction, please contact me today.  Please note that I would need to be sure that the habit has not been acted out for a year or so.

What are the signs of addiction?

Although addictions take many forms, certain symptoms are frequently present.

Among them are:

  • An inability to stop the activity – with or without regret afterwards
  • Intense craving
  • Escalating use due to tolerance
  • Repeated relapses
  • Risk-taking
  • Increased secrecy including lying
  • Neglecting other activities, interests or obligations with resultant declining performance in other areas of life such as work
  • Impaired relationships
  • Changes in sleeping patterns resulting in chronic fatigue
  • Sudden changes in mood, irritability, aggression, depression, apathy, suicidal thoughts
  • Financial costs
  • An increasingly obsessive focus on indulging the activity
  • Continuing the behaviour despite the negative consequences

With some addictions there may also be:

  • Slurred words or rambling speech
  • Frequent illness
  • Bloodshot or glazed eyes, flushed skin, broken facial capillaries, trembling hands, bloody or black stools, chronic diarrhoea, vomiting blood
  • Temporary blackouts or memory problems
  • Changes in weight
  • Withdrawal symptoms such as sweating, shaking or being sick
  • A deterioration in personal appearance and hygiene.

How do I know if I have an addiction?

There’s a lot of information about the symptoms of addiction in the public domain, not least online. However, it’s always advisable in the first instance to talk to a professional. Your doctor should be able to assess your difficulties and, along with medical professionals generally, provide you with a non-judgemental context in which to talk things over. There are also specialist addiction helplines run by the NHS, charities or private organisations which are used to giving sensitive, confidential help to those making initial enquiries.

What are the causes of addiction?

One of the most common addictions for which people seek help is alcoholism. What follows applies to alcoholism but also to most addictions.

Growing up with parents who have an addiction makes it more likely that one may develop an addiction oneself. So does the early use of addictive substances and activities or living and working in an environment where such substances or activities are used by other people.

Addictions tend to be more common in those with mental health problems such as depression or anxiety. Stress can also be a factor as can emotional damage, abuse, deprivation, confusion or trauma in childhood. Other influences like abandonment, family discord, anti-social or aggressive behaviour in a parent, mental illness in a parent and over-controlling parents may also play a part. A very good book exploring the mechanisms of addiction – and on which I’m drawing here – is The Psychodynamics of Addiction, edited by Martin Weegman and Robert Cohen.

Trying to contain pain

We all know that addictions can be physical but there’s often a psychological addiction too. A relationship with a ‘drug’ takes the place of a relationship with a person. When I say ‘drug’ I mean any kind of addictive substance or behaviour. Sometimes something has gone wrong with a relationship with a parent or other caregiver in childhood with that person not providing containment for the child’s otherwise uncontainable emotions. In the present, the ‘drug’ is used to contain and process painful feelings originating in the past. This may be beyond conscious awareness. The trouble is that more and more of the ‘drug’ is needed to contain the pain because a tolerance is built up and simultaneously the ‘drug’ increasingly diminishes one’s own ability to contain the pain from inside or from painful external situations. A vicious spiral downwards is established.

Trying to find security

A child’s normal instinct is to be close to their mother for security and reassurance if they perceive danger to themselves or a threatening separation from her. In an addiction, a person may use a substance or a behaviour in a similar way. Stressful situations generating negative emotions (which so often precede an addictive episode) drive them into the ‘secure’, ‘satisfying’ and ‘comforting’ embrace of the object of their addiction. They may feel this preferable to relatively precarious attempts to relate to human beings and may have the illusion that they don’t need people.

Trying to counter low self-esteem

If all goes well, a child’s parents will reinforce his or her sense of strength, solidity and self-esteem while the child in turn admires and feels part of the parents’ calm and apparent infallibility. Over time, the child takes into themselves the capacity to perform the self-accepting, self-comforting and self-motivating functions implied by this. The child learns to regulate their own wellbeing. When this process goes awry, a person may use a ‘drug’ to make up for something missing in the building blocks of the self.

The problem is that, although the ‘drug’ may make someone feel better (for instance, more accepted, powerful or stimulated) in the short term, no real strengthening or permanent learning from life are happening. In fact, confidence is being undermined because each time the ‘drug’ is used, the person receives fresh confirmation that they’re not able to solve their central predicament, leaving them in a worse state than before. Self-esteem is lower and so they start all over again.

What can be done about addiction?

As I have explained above, addiction needs to be addressed on two levels.  The first is to bring the acting out under control.  Cognitive Behavioural Therapy is an effective way of doing this.  PLEASE NOTE THAT I DO NOT OFFER THIS.

When that has been done, some people may wish to proceed to the second level – working on the underlying causes of the addiction.  This is where analytic psychotherapy of the kind I offer may come in.  This is a longer-term therapy.  If you think how long it takes for problems to become ingrained in a person, it’ll be clear that a magic wand can’t be waved to unearth and work through those areas and that the work is unlikely to be completed quickly.  As with any therapy there can be no guarantee of success but the aim of analytic psychotherapy is long-lasting change.

It’s important to keep in mind that I would need to be sure that anyone interested in therapy had not been acting out their habit for a year or so.

If you’re looking to explore the underlying causes of your addiction, please contact me today.


Depression counselling and therapy

Depression

Depression Counselling and Therapy

Depression Counselling in Surrey, Guildford, Farnham, Woking and surrounding areas.

This page looks at how depression counselling and therapy can help in the treatment of depression.

An interesting thing about psychology is that every age has its own emotional disorders. When Freud was developing psychoanalysis at the end of the nineteenth century and start of the twentieth, hysteria was the illness of the day. Today depression is one of our main conditions; in fact it’s the world’s leading disability. Affecting more women than men, it can range from a mild dose of the blues to a serious disorder that may embrace self-harm and may generate suicidal thoughts and actions.

There are two main types of depression. Reactive depression stems from external factors like bullying, career problems, domestic violence, redundancy, illnesses such as cancer and a host of other causes. If and when the problem improves, the symptoms also tend to improve. Endogenous depression, on the other hand, is lodged deep in our psyche and is not so dependent on day-to-day events to trigger it. It’s that form of depression that I’m thinking of primarily here, although there is overlap.

What are the symptoms of depression?

Sometimes people come for therapy not specifically mentioning depression at all. It may feel more like a general dissatisfaction with life or a lack of fulfilment. Often depression is associated with other symptoms too, such as:

  • Having a flat, depressed and sad mood for much of the day
  • Feelings of hopelessness and helplessness
  • Difficulty in concentrating, making decisions and remembering details
  • Not finding enjoyment in anything.
  • Not feeling like talking or socializing
  • Lacking motivation

  • Insomnia (including early waking) or sleeping too much
  • Tiredness and loss of energy
  • A sense of worthlessness and guilt
  • Over-eating or loss of appetite
  • Irritability
  • Possible thoughts of suicide.

How do I know if I suffer from depression?

There are various online ‘tests’ for depression that you can do although self-diagnosis can be fraught with problems. It’s advisable to talk to a specialist. Your GP is often a good starting point. Symptoms may also be due to more than one cause or to a different cause.

People suffering from depression don’t all have the same symptoms. But if some of those in the list of symptoms persist for weeks or months, it might be an indication that you are depressed. They can be also combined with anxiety, struggling at work, indecisiveness, unexplained aches and pains, restlessness and losing interest in sex. Sometimes there may be a sense deep down that one is ‘bad’ and an accompanying tendency to be harsh on oneself.

What are the causes of depression?

There’s some evidence of a genetic component to depression. But factors linked to one’s formative years are frequently at work too. In her excellent book Psychoanalytic Diagnosis, Nancy McWilliams talks about these and what follows draws on some of her material.

Early loss

The experience of overwhelming and/or repeated loss in childhood is a common preliminary to depression. It may be obvious loss like the death of a parent or something less concrete like the loss of childhood itself when someone is made to give up natural emotional dependence on a parent before he or she is ready.

Turning against the self in childhood

A child losing a parent through an event like death or divorce may be too young to understand what has happened. They may believe that they themselves caused the parent to go away. That guilt may be heightened in families where a need to be upset about the loss is denied or criticized. Actual or emotional abandonment plus parental criticism can lay the foundations of depression.

The reason why children turn against themselves in this way is that, faced with a choice between accepting fear, desertion or uncertainty – which would mean powerlessness – and believing that the cause of their unhappiness is within themselves – which will preserve some control over circumstances – they will choose the latter. People often prefer any suffering to impotence.

Turning against the self also explains why depressed people are often very self-critical. They may have had a parent or other relative whose criticism of them they took in deeply or, as I say, a caregiver who, as children, they believed they drove away. Understandable feelings of anger about the loss are turned inward.
A final cause of depression can be having a depressed parent. A genetic factor might be implicated, but so might a child’s guilt for the normal demands they make on their incapacitated parent. Again, turning against themselves.

What can be done about depression?

There are various treatments for depression and analytic psychotherapy is one of them. It’s not a quick fix and there can be no guarantees but psychotherapy aims for long-lasting change through exploring and working with the (often unconscious) roots of the condition. Sometimes people can be helped by combining GP-prescribed medication with psychotherapy.

If you are in the Surrey area contact us for help with depression therapy.

Other pages which may be of interest

For more information about Anxiety
For information on Anger
See our blog post about stress: All stressed up and nowhere to go