The psychological effects of Brexit on EU nationals in the UK

Some thoughts on the psychological effects of Brexit on EU nationals living in the UK

In: In depth

On 23 June 2016, a majority of the British electorate chose to leave the European Union. The economy and political landscape in Great Britain are changed dramatically, and beyond this, individuals can find themselves deeply affected. 

One of my patients, an english man who has been seeing me for several years and has been thinking about bringing his therapy to a conclusion, told me after the results of the referendum: “I can’t make a decision either way at the moment, because with all the buzz about remaining and leaving, it’s hard to listen to my own mind”.

As therapists, we tend to look at our patients’ past to help them see how it shows up in the present. With the current events unfolding, we need to be very mindful of the effect that social movement and discourse can have on individuals.

“With all the buzz about remaining and leaving, it’s hard to listen to my own mind”. 

This summary describes three effects of this crisis on the individual psyche.

1 – The disappearance of a safe and secure environment creates a void, which is filled with past memories

A Russian patient told me a few years ago about what he experienced when the Soviet Union was dissolved on Boxing Day 1991: “I woke up one morning, and my country had disappeared”. The European Union may still exist, but I have heard many other people voice a similar sentiment in respect of how they are perceiving its impending partial breakup. 

The safe and secure environment that EU citizens have enjoyed up to now has changed dramatically. Another patient, a young french man, tells me: “I’ve studied in an international class from age 10, studied on an Erasmus programme, I’ve lived and worked here for five years and never asked myself any questions. It’s not just that the conditions of my stay here have changed: I feel like the foundations of my education and culture are challenged. What is going to become of my generation of young Europeans?”

“I chose to emigrate to the UK at 20, so I could take control of my own destiny, and here I am in the same situation again. I’m ten years old, my future has been robbed and I don’t know what to do”. 

A vacuum has appeared in society because some of things that existed to ensure the safety of some of its constituents have disappeared. Memories of past experiences can then fill this vacuum. For example, people who, as children, have had to live through their parents’ separation, however amicable, will inevitably re-experience in the present some of the anxiety that comes with a challenge to the integrity of their family, or of their broader environment.

A polish woman, who fled communist Poland as a child in the early eighties, explains: “my parents kept their plan a secret, so that I wouldn’t give them away at school. I thought we were going on holidays in the Eastern bloc but, when we found ourselves in Stuttgart, they calmly told me we’d stay here to live, and that everything would be OK, which it wasn’t. I chose to emigrate to the UK at 20, so I could take control of my own destiny, and here I am in the same situation again. I’m ten years old, my future has been robbed and I don’t know what to do”.

2- A new vulnerability resonates with a vulnerability from the past

For a number of months, EU citizens have been called “Migrants”, and have found themselves conflated with the stream of refugees risking their lives in the mediterranean. The perspective of an effective withdrawal from the EU will also mean that this newly labelled population will be submitted to additional controls. Disempowered groups of citizens also find themselves likely to be used as collateral in withdrawal negotiations. 

A country hitherto perceived as stable and nurturing for EU nationals is now acting like a volatile parent, making up rules as they go along. This is likely to resonate with past experiences of parental inconstance, and bring up ways of thinking and feeling that are closer to the experience of an infant rather than an adult. This is compounded by the increased feeling of powerlessness and dependence upon an external authority, which are also childhood experiences.

Any sweeping, black and white statements about “brexiters”, “remainers”, foreigners, governments etc. needs to be seen as a resurgence of an infantile way of experiencing relationships. 

Infants slowly learn to handle ambivalence and complexity in their relationships. For them, it is not just puzzling that someone good could do a bad thing. It is literally un-thinkable. So, to manage the emotions linked to their mother, for example, they split her in their minds into an entirely good and entirely bad mother, which bear no relation to one another. It is the task of the mother to help her child merge the two mothers into one figure, that can be good and bad at the same time. 

Any sweeping, black and white statements about “brexiters”, “remainers”, foreigners, governments etc. needs to be seen as a resurgence of an infantile way of experiencing relationships. 

3- Beyond “Them and us”: grieving and re-engaging with the other 

This infantile, binary organisation of the psyche and binary discourse, damages relationships. Boundaries, which were fluid and constantly negotiated within relationships of mutual curiosity, have crystallised into an uncomfortable “them and us”. Young and old, rich and poor, town and city, find themselves pitted against one another on either side of a suddenly concrete and frozen boundary.

EU citizens were part of an “us”, and now find that they are “them”. It is tempting to buy into this, especially since powers of adult judgement are being challenged by the regressive experience of vulnerability and dependency. So, it’s for us to do our best to remain intellectually and emotionally honest adults in the face of this experience, and to remind ourselves that they black and white world that has taken shape is a conceit that seeks to hide complexity and to attack our capacity to be in relationship with one another. 

“we need to go beyond our regressive experience and actively grieve for our recent past if we are to develop peaceful relationships in good faith”. 

Importantly, we also need to actively engage with our new situation. It is a case of grieving an old order of things and welcoming what is emergent. Psychiatrist Elizabeth Kubler-Ross (1969) understood that a grieving person will go through 5 stages: denial, anger, bargaining, depression and acceptance. It is easy to apply this model to post-referendum Britain:

  • in denial, both EU and UK citizens feel nothing will change. The result is a narrow victory and does not mean anything. Sadiq Khan tells EU Londoners that they are welcome as before. People think there may be a second referendum, or that article 50 may never get triggered.
  • In anger, hostility arises and the ‘”them and us” takes shape.
  • At the stage of bargaining, we may feel that if we do certain things, everything will be as before. We will feel secure again, empowered and welcome. This is where people apply for passports, apply pressure on their MPs
  • During the phase of depression, powerlessness and vulnerability consciously sink in. 
  • Acceptance is the time for an active engagement with the new situation.

As Jean-Paul Sartre illustrates in his 1944 play “No Exit”, bad faith is the reason why two consciousnesses cannot communicate. He adds later that this “incommunicability” is the source of all violence. It is this very bad faith that can prevent us from seeing that we are free to choose our positions, at a time when they seem dictated by the collective will, and which makes the Other disappear as a person to know intimately. It is also this same bad faith that fuels the first four stages of grief in Kubler-Ross’ model.

Therefore, we need to go beyond our regressive experience and actively grieve for our recent past if we are to develop peaceful relationships in good faith.

By: Cedric

Addressing Career-related issues with psychotherapy and Counselling

In: Featured Home, Individual psychotherapy

What kind of career-related issues do we encounter?

Work can be a place and process of true personal realisation. Our work is an expression of our vitality and values and helps us contribute to the welfare of our families and to society.

It is precisely because work is so important in our lives that the problems that relate to it can be so debilitating. And in the same way that rewarding work helps create the conditions for a better private life, problems at work always “spill over” into the time we reserve for our leisure, our friends and families.

The most common example of such an overspill is the degradation of work-life balance because of overwork.

The most frequent problems that can appear at work are:

  • stress
  • anxiety
  • loss of motivation
  • loss of self-confidence
  • significant lowering of performance
  • blocked progression or career
  • deficient leadership
  • work relationship problems such as bullying or harassment

How can counselling and therapy help with work-related issues?

These problems reveal themselves because one notices (or is told of) a change in one’s behaviour, or in other people’s. Sometimes it is clear that they are the consequence of events in the workplace, which are beyond one’s control, such as disciplinary procedures, redundancy, company-wide restructuring or performance problems. Sometimes the link is less obvious: a problem appears at work but it is harder to see what is causing it.

Wherever the causes of the problem, its resolution requires skills, knowledge and support that are not available at work.

My business background and qualifications, as well as my experience of one-to-one coaching for professionals including senior business leaders have given me in-depth knowledge of the problems affecting professionals on the workplace and the approaches that are most successful to support those who are affected by them.

I suggest an initial contact for you to:

  • describe your current circumstances and concerns
  • receive immediate, emotional and practical support
  • find out about how I can provide further help

After this initial contact, you may want to opt for further counselling consultations. These consultations are a safe, containing and supportive environment in which to develop deeper insight into patterns of behaviour, and get support to try out concrete changes.

In my experience, focused work such as this can be very powerful. I have also found that, sometimes, my clients choose to engage in longer-term work when they feel that they need more time and support to get to the bottom of the issues that they are facing.

How we could feel like a fish in water at work...
By: Cedric Tags: , , , ,
Couples therapy and counselling helps untangle those knots!

Relationship and couples counselling & psychotherapy

In: Couples psychotherapy, Featured Home

What makes for a well-functioning, ultimately successful relationship? It’s up to every pair to find out what works for them. This “finding out together” is a vital part of being in a relationship. One could even say that it is the relationship.

However, sometimes communication and intimacy get lost, and situations become stuck. Any deadlock can affect both partners and perhaps children or dependents, and often threatens the existence of the relationship.

Conflicts are a natural and healthy occurrence in every relationship and offer great opportunities to learn about each other and to make it stronger. When the relationship does not seem to allow for this learning, then it is worth investing in a space, where this inquiry can start and live.

For this, it is appropriate to consider:

  • relationship counselling and psychotherapy for each partner
  • counselling and therapy for couples
  • a combination of both individual and couples or relationship therapy. This solution is particularly effective.

Individual counselling and psychotherapy for relationship problems

In relationship counselling, the primary aim is to understand the patterns of behaviour that affect the functioning of the couple, how they have come about, how this affects the client, and how to correct them.

In my experience, clients who come to see me for relationship counselling or relationship therapy also experience anxiety, depression or stress, and may require help with anger management. It is very common for the two types of work to progress alongside each other.

Couples counselling and therapy for couples

Couples counselling or therapy is a space for the relationship to become clear and conscious. It helps the partners to:

  • begin or improve communication
  • see things from the other’s perspective
  • make informed choices about how to engage with each other.

Couples counselling is particularly effective when the problems that the partners are experiencing are due to a recent and sometimes unexpected change of circumstances in their relationship. For example, this may be due to:

  • problems conceiving
  • issues with sexuality
  • infidelity of one or both partners
  • the birth or adoption of a child
  • a change in professional circumstances such as a promotion, an expatriation or a redundancy

Couples therapy is effective when partners notice that, over time, the quality of their relationship seems to have diminished, and that the meaning of their being together is no longer evident.

I have experience in both couples counselling and couples therapy, and have helped many individual clients who came to my London practice seeking help for problems related to their couple.

By: Cedric
Depression can indeed feel like a bottomless pit

Counselling & Psychotherapy for Depression

In: Depression, Featured Home, Individual psychotherapy

Depression is the most prevalent of mental health problems. Studies have shown that it occurs in 1 in 10 adults or 10 per cent of the population in Britain at any one time, (Healy, 1998, Hale, 1997). It is quite common to experience a depressive episode as a reaction to an event. It also happens that depression sets in “out of the blue”, and does not seem to go away by itself.

This experience can be deeply painful; poet John Keats wrote to a close friend: “I am in a temper that if I were under water, I would scarcely kick to come to the top”.

This experience can be deeply painful; poet John Keats wrote to a close friend: “I am in a temper that if I were under water, I would scarcely kick to come to the top”.

It is part of life’s requirements that we should be able to tolerate periods of low mood, and it is to be expected that sometimes we find ourselves challenging the value of things and of life itself. Psychotherapist D.W. Winnicott (1958) wrote of John Keats that:

“[he] was someone who took the risk of feeling things deeply and of taking responsibility. […] If we look at depression this way, we can see that it is the really valuable people in the world who get depressed.”

If however we have an entrenched feeling of futility and find ourselves disempowered and persistently disengaged from life, this is probably something worth attending to.

How can therapy and counselling help with depression?

In my experience it is possible to understand and successfully to address depression through the process of psychotherapy and counseling. The aim of this process is to allow insight to emerge and to use the therapeutic space as a “springboard” to reconnect with oneself, with others and with the world.

What happens when we get better
By: Cedric

Counselling & Psychotherapy for Anxiety

In: Anxiety, Featured Home, Individual psychotherapy

Anxiety is one way to respond to an external event that we see as a threat. In a state of anxiety, some of our physical and mental functions are heightened so that we are able effectively to confront what is threatening us, or to escape it. This is referred to as the “fight-or-flight response”. As such, it has been essential to our survival as a species, and continues to serve us in situations of severe danger.

However we find that we often experience it in situations that don’t really call for it.

What is anxiety for?

In itself, anxiety does not teach us anything about its causes. It does not tell us anything about the best way to resolve a problem. It does not tell us how to be less anxious. It just prepares us for a very simple response – fight or flight. We may even find that, in a state of anxiety, we are less able to act, as a situation really requires – in these cases, anxiety clearly “gets in the way”!

So, paradoxically, anxiety can end up decreasing our quality of life, sometimes to the extent that it becomes intolerable. It is estimated that about one in six adults experience levels of anxiety that they feel are excessive and debilitating, with 1.5 to 3.6% of these being diagnosed with General Anxiety Disorder (Carter RM, Wittchen HU, Pfister H, et al, 2001).

How does counselling and therapy for anxiety help?

People who have come to see me for psychotherapy and counselling at my London practices have wanted help with finding out why they were excessively anxious, and what they could do to change this. It is therefore my aim to help my clients:

  • better contain and express their anxiety
  • understand the cause(s) of their anxiety
  • develop ways of responding more appropriately to their environment
  • make decisions concerning the causes of their anxiety

It is through our understanding of the root causes of our anxiety that we can see clearly how we could change certain aspects of our lives. It is my aim to support my clients in developing this clarity and making essential life changes.

By: Cedric Tags: ,

Addressing social anxiety through psychotherapy

In: Anxiety, Featured Home, Individual psychotherapy

What is social anxiety?

Most online and offline publications will define social anxiety as the excessive fear of social situations. People who have come to see me for help with this problem have also often described that they may feel discomfort in any social interaction, even if this is with “just the one person”. Because of this, I prefer to define social anxiety as the discomfort that relates to the experience of any relationship.

«In every contact, we communicate a bit of ourselves to the other, and the other is there to receive it, for better or for worse. In that respect, every social situation is significant, because it says something about us.»

Why does it happen?

We form our person and our character in the context relationships – to the family we were born in, to the community around us, to school, to our chosen communities of friends, spouses and children, to our communities at work. These relationships are not just a backdrop to our lives: by interacting within them, we evolve through them, and them through us.

It is perfectly healthy to feel a measure of trepidation in all forms of contact with other people, whether it is a brief exchange with a waiter, a discussion with a headmaster, or a presentation in front of the board of a company. After all, every personal contact, no matter how brief or apparently shallow, is an  experience that engages our person, consciously and unconsciously. In every contact, we communicate a bit of ourselves to the other, and the other is there to receive our communication, for better or for worse. In that regard, every social situation is significant because it says something about us.

«Psychotherapy, to be effective, must include two aspects at least: reflection on oneself and action on one’s environment.»

When does it become a problem?

However, for many, this creates a level of discomfort that can feel difficult to bear, which may lead some to assuming that all social contact will be painful, and therefore to avoiding certain social situations, and sometimes, most, if not all, social situations. This can be extremely distressing and debilitating.

Addressing the issue

It is my experience that psychotherapy, to be effective, must include two aspects at least: reflection on oneself and action on one’s environment. This is especially true when the concern that needs addressing is social anxiety. Action alone, which can be, for example, challenging one’s assumptions about other people’s thoughts about us and changing the way we interact with them, is not enough to create a deep-seated sense of safety in a social setting. Similarly, reflection alone will not help the person to “land” the insights acquired and create new and more helpful behaviours.

Therefore, I encourage my patients to:

  • take a historical perspective on their experience of social interactions
  • examine the feelings, thoughts and sensations that they associate with them
  • get a deeper sense of who they are as a person, and what sort of social existence they are really meant to live
  • observe in detail what they go through as they apply their insights and progressively approach life with others in different ways

The quote by St Francis of Assisi sums quite well my approach to helping people address their social anxiety, as it reflects its progressive nature and the surprises that can arise out of the process:

«Start by doing what’s necessary. Then do what’s possible; and suddenly you are doing the impossible»

By: Cedric Tags: ,
The psychological effects of Brexit on EU nationals in the UK

Quelques considérations sur les impacts psychologiques de la crise du Brexit

In: In depth

Le 23 juin, une majorité de l’électorat britannique s’est prononcée en faveur d’un retrait du Royaume-Uni de l’Union Européenne. Au delà des conséquences politiques et économiques immédiates et à long terme, les individus eux-mêmes sont touchés profondément par cet événement sans précédent. Ce court article, à l’usage des pscyhothérapeutes et des personnes intéressées par le sujet, recense quelques données psychologiques avec lesquelles ils doivent dorénavant composer, et se concentre sur les défis qui s’adressent aux citoyens de L’union Européenne vivant en Angleterre.

“En nous” et “autour de nous” : l’effet du contexte sur la personne

Un patient anglais, qui me voit depuis plusieurs années, et qui pense depuis quelques semaines à conclure sa thérapie, me dit : “de toute manière, impossible de prendre pour l’instant une décision dans un sens ou dans l’autre. Avec tout ce bruit dans le pays à propos de partir ou rester, c’est difficile de s’entendre penser”.

Si, dans leur démarche, les thérapeutes se penchent avant tout sur le passé de la personne, tel qu’il se manifeste en eux, il est donc plus que jamais nécessaire d’écouter attentivement ce qui se passe autour de la personne (celle du thérapeute et celle du patient) dans le présent. Cela permettra de prendre en compte l’effet considérable que les mouvements de la société et son discours peuvent avoir sur le psychisme de la personne.

«Je me suis réveillé un matin,

et mon pays avait disparu»

Il est possible de dégager d’ores et déjà, de distinguer deux grandes catégories d’effets, que j’appellerai “appel d’air”, et “écho”. L’appel d’air est lié à la disparition d’une chose prise pour acquise, dont l’absence soudaine crée un vide dans lequel un vécu révolu peut s’engouffrer. L’effet d’écho est lié à l’apparition d’une nouvelle donnée, qui est susceptible de faire écho à des expériences passées.

La disparition d’un environnement sûr crée un appel d’air avec le passé

Un patient Russe, membre du conseil d’administration d’une entreprise privée, me confiait la détresse qu’il avait ressentie immédiatement après la dissolution de L’URSS – “je me suis réveillé un matin, et mon pays avait disparu”. De nombreux témoignages récents sur la manière dont les citoyens de l’UE vivent le Brexit rejoignent celui-ci. Bien que, aujourd’hui, l’Union Européenne existe toujours, elle connait aussi, dans son état de désintégration latente, cette remise en question tant sur le plan de son territoire que sur celui de sa population. Une désintégration qui menace le territoire Britannique lui-même, et qui, quelle que soit leur nationalité, menace ses habitants dans leur personne même.

Cette désintégration s’exprime d’abord dans la sphère du rapport de l’individu au groupe. Un de mes patients m’expliquait avec passion : “j’ai passé ma scolarité dans une classe internationale, j’ai fait un programme d’échange Européen, je travaille ici depuis des années, et je ne m’étais jamais posé de question. On met aujourd’hui en doute, non seulement les conditions de mon séjour ici, mais aussi les fondations de mon éducation. Que va devenir ma génération de jeunes européens ?”

«J’ai à nouveau 10 ans, on m’a volé

mon futur et je ne sais plus quoi faire»

Ce jeune homme a l’impression d’être à la dérive, et son groupe d’appartenance ne lui offre plus de garantie pour le futur. Une situation que beaucoup auront vécue dans le contexte de la cellule familiale à la veille d’une séparation, qu’elle soit amicale ou non. L’appel d’air, ici, se fait avec les mémoires inconscientes liées à cette séparation, et a pour conséquence de remettre au jour un éprouvé qu’on ne sait pas toujours identifier.

Voici une autre illustration de ce phénomène : une jeune femme polonaise, dont les parents ont fui la Pologne communiste des années 80 avant la chute du mur de Berlin, m’explique : “ils ne m’avaient rien dit, pour ne pas que je vende la mèche. J’avais 10 ans et j’aurais sûrement parlé de leurs plans de quitter le pays si j’avais été au courant. Je croyais que nous partions de Pologne pour des vacances dans le bloc de l’Est, et me suis retrouvée à Stuttgart avec des parents qui m’expliquaient calmement que nous ne retournerions plus dans mon pays, et que tout irait mieux ici – ce qui n’a pas été le cas. J’ai émigré en Angleterre à 20 ans, et me revoilà dans la même situation. J’ai à nouveau 10 ans, on m’a volé mon futur et je ne sais plus quoi faire”.

La vulnérabilité actuelle fait écho à une vulnérabilité passée

Les citoyens de l’UE sont maintenant des “migrants”, amalgamés, en nom, avec les réfugiés risquant leur vie en Méditerranée. En faisant son apparition dans le discours social, cette nouvelle donnée amène une refonte, parfois spectaculaire, des relations interpersonnelles. On se regarde parfois de travers, et les amitiés, voire les liens familiaux, en souffrent.

«Le climat social actuel favorise donc, en écho avec les vulnérabilité passées, un fonctionnement infantile chez tous ceux qui sont témoins de la crise, et plus encore chez les populations en situation de plus grande vulnérabilité, réelle ou imaginée»

En outre, à l’horizon hypothétique de l’application du fameux article 50, ce groupe nouvellement désigné et singularisé sera également soumis à un contrôle particulier, réservé jusque là aux populations d’autres pays. Entre temps, il devient, comme l’expriment certains journalistes, l’otage de négociations de sortie du Royaume-Uni. Cette nouvelle soumission à un contrôle, cette nouvelle vulnérabilité face à une entité jusqu’ici accueillante et nourrissante, et qui maintenant se comporte comme un parent volatile, feront écho avec des expériences vécues dans l’enfance.

Elles remettront donc au goût du jour une partie des névroses qui y sont liées, en même temps qu’elle redonneront du poids au psychisme archaïque qui règle la vie du tout jeune enfant. En effet, comme celui-ci n’a pas encore acquis suffisamment de resource interne pour gérer l’ambivalence de ses sentiments par rapport à son parent, il doit scinder, dans son esprit, le parent en plusieurs parties nettement distinctes et sans relation apparente entre elles, les bonnes et les mauvaises. Il “dé-intégre” son parent pour ne pas éprouver de confusion, ni sentir qu’il se désintègre lui-même.

«Les citoyens de l’UE touchés par le Brexit

subissent un “double-whammy”.»

Chez l’adulte, tout jugement à l’emporte-pièce (par exemple, “les Brexiters sont tous racistes”, “les Remainers sont tous progressistes”, “les Européens seront déportés”), participera de ce résidu de fonctionnement infantile, où il prendra sa pertinence et son énergie.

Le climat social actuel favorise donc, en écho avec les vulnérabilité passées, un fonctionnement infantile chez tous ceux qui sont témoins de la crise, et plus encore chez les populations en situation de plus grande vulnérabilité, réelle ou imaginée.

En résumé, et pour reprendre une expression anglaise, les citoyens de l’UE touchés par le Brexit subissent un “double-whammy”. La disparition de certitudes met en lien inconfortable des vécus présents et passés, et la mise en exergue d’une vulnérabilité, par sa cristallisation dans le discours social, peut faire régresser l’individu en termes de son fonctionnement psychique.

Plus grave encore est le fait que la notion même d’individu est mise à mal par la polarisation discours et du corps sociaux en un “eux et nous” rigide.

Le “Eux et nous” fait disparaître la personne et menace la relation à l’Autre

Jusqu’à il y a deux semaines, les démarcations entre jeunes et vieux, locaux et “migrants”, riches et pauvres, étaient perçues en principe comme une chose à négocier à l’infini dans le cadre d’un réseau de relation de curiosité mutuelle à l’autre. Ces démarcations acquièrent maintenant un caractère collectif, concret et figé. On semble collectivement baisser les bras et se résoudre officiellement à ce que la différence soit insurmontable. La dynamique de rapprochement incarnée par l’UE se transforme en une dérive aliénante. La frontière du “eux et nous” s’est déplacée : en tant que citoyens de l’UE, nous passons d’un “nous” à un “eux” inconfortable.

Dans ce contexte, il est difficile de s’affranchir du mode de pensée binaire décrit plus haut, et il est aussi devenu plus difficile de voir la personne en tant que telle, plutôt qu’en tant que représentante d’un groupe particulier, dont elle hériterait les caractéristiques par défaut.

Comment vivre la nouvelle donne ?

Nous pouvons aborder cette question sous deux angles. En rapport à l’effet d’écho, qui remet au goût du jour un fonctionnement psychique infantile, il s’agit de se demander comment fonctionner comme adulte en dépit de notre vulnérabilité et de notre dépendance. Pour ce qui est de l’effet d’appel d’air, ou d’anciens souvenirs sont réactivés avec les emotions qui y sont associées, il s’agit de voir comment vivre un deuil.

«L’honnêteté intellectuelle et émotionnelle sont donc deux atouts à cultiver ou à apprendre, pour tous ceux qui ont du mal à penser et sentir au delà des discours qui nous sont offerts par le corps politique et la presse, et relayés par certaines sections du public, britannique ou de l’Union Européenne.»

Rester adulte

Comme décrit plus haut, les jugements à l’emporte-pièce sont une manifestation d’un fonctionnement, où la nuance n’a pas encore la place, et où il convient de classer les choses de manière simple, sans qu’elles ne soient en relation mutuelle. Les bons doivent être totalement bons, et les méchants totalement méchants. Chaque tentative de cloisonner les choses en soi, que ce soit en parlant d'”eux et nous”, ou en niant la complexité des individus de part et d’autre de ces démarcations maintenant cristallisées, doit alors être comprise comme un archaïsme à dépasser. La façon la plus sûre de neutraliser cet archaïsme est de rester curieux par rapport à l’autre, quel qu’il soit, et d’accepter la complexité de ses positions.

L’honnêteté intellectuelle et émotionnelle sont donc deux atouts à cultiver ou à apprendre, pour tous ceux qui se retrouvent à ne plus pouvoir penser ni sentir au delà des discours qui nous sont offerts par le corps politique et la presse, et relayés par certaines sections du public, britannique ou de l’Union Européenne.

«Avec la disparition annoncée du lieu concret, où on se rencontre, c’est une relation dynamique et nuancée à l’autre qui menace de disparaitre, au profit d’une relation concrète par l’intermédiaire du collectif.»

Cette vulnérabilité doit aussi être abordée concrètement, pour la mitiger et la mettre en perspective. Il est possible pour de nombreux résidents de se “régulariser”, de se soutenir mutuellement (des groupes de soutien dédiés apparaissent et grandissent sur Facebook), de faire pression sur leurs élus au niveau municipal, ou encore de prendre des dispositions pour un départ, qui se feraient dans leurs termes.

Faire un deuil

L’effort de rapprochement entre les peuples d’Europe, symbolisé par une des clauses controversées régissant l’Union Européenne depuis 1957, est maintenant en suspens, et peut-être en train de se transformer en un éloignement progressif. Un éloignement vécu comme une aliénation de l’individu par rapport au pays qui l’accueille, mais aussi par rapport à l’Autre. Avec la disparition annoncée du lieu concret, où on se rencontre, c’est une relation dynamique et nuancée à l’autre qui menace de disparaitre, au profit d’une relation concrète par l’intermédiaire du collectif.

La psychiatre Elisabeth Kugler-Ross identifie en 1969 qu’une personne, face à l’annonce d’une maladie terminale, va éprouver une succession d’émotions qu’elle appelle les cinq phases du deuil : Déni, colère, marchandage, dépression, acceptation. Il sera utile d’examiner notre situation sous l’angle de ce modèle.

Dans le déni, la personne, choquée de la nouvelle, va nier la nouvelle réalité et son caractère irréversible. Elle se dit alors : “Il y aura un second référendum, les anglais se sont trompés, rien ne va changer”. Et les citoyens du Royaume Uni, affectés eux aussi et, pour une grande partie, dans ce même déni, feront écho à cette croyance, comme Sadiq Khan cherchant à rassurer les citoyens de l’UE résidant à Londres que rien ne change et qu’ils sont toujours les bienvenus comme hier.

Dans la colère, il y aura des manifestations, des invectives, de la hargne contre le gouvernement, un sentiment d’injustice et d’impuissance bien familier. La relation à l’autre souffre alors que les positions se durcissent.

Dans la phase de marchandage, les positions respectives s’assouplissent à nouveau. On se dit alors que si on satisfait à certaines conditions, la relation pourra survivre. On cherche à acquérir un nouveau passeport, en se disant que cela rétablira les choses, et que cela fera revenir notre relation à nos hôtes à son état d’origine.

Suit alors ce que Kübler-Ross définit comme la phase de dépression. C’est un moment pour se débattre, dans la tristesse, avec un inéluctable qui semble nous dépasser complètement. Il ne sert plus à rien de nier que la relation va disparaître, de se mettre en colère contre son bourreau, ni de chercher à marchander avec lui.

C’est l’arrivée à une phase d’acceptation qui indique alors que la personne est en passe d’avoir fait son deuil de la relation. La dépression fait la place au sentiment d’être prêt à un engagement total et actif avec cette disparition annoncée. Il y a alors un nouveau travail de rapprochement à débuter avec les nouvelles données, internes et externes.

A la recherche d’un nouveau rapprochement

Comme Jean-Paul Sartre l’illustre dans Huis Clos, la mauvaise foi est source de l’incommunicabilité de deux consciences. Il ajoutera plus tard qu’elle est source de toute violence. C’est cette mauvaise foi qui peut nous empêcher de reconnaitre notre liberté de choisir nos positions alors qu’elles paraissent dictées par le collectif, qui fait disparaitre l’autre en tant que personne à connaître. C’est cette même mauvaise foi qui anime les premières étapes du deuil. Une relation de bonne foi à l’autre, sans violence, passe donc par un effort conscient pour dépasser nos fonctionnements infantiles passés, et par un deuil actif d’un passé immédiat.

Professional psychological help and support in the heart of London

In: Featured Home

We live in a time, where constant change is fast becoming the norm: change in society; change in work conditions and circumstances; change in the key relationships that shape our private sphere. This can have a considerable bearing on how we feel in ourselves. It is no surprise that sometimes, the constant demand to adjust to seems to be more than what we can manage with what we know. In my experience, it is beneficial to recognise this and to seek help to find in ourselves the resource we need to live fully. Psychotherapy and counselling helps to engage with the problem with the professional support of a qualified and experienced practitioner.

In Brief: what happens during the initial consultation?

In: Latest News, Series: "What happens in a session of psychotherapy?"

People who come to see me for the first time often tell me: “I’ve never done this, what happens now?”. The workings of psychotherapy appear indeed to be shrouded in mystery, which is why I’d like to list a few useful bearings for people who are considering psychotherapy or counselling and haven’t carried out extensive research. I have taken those from a longer article from this blog, which you can find by following this link.

The goal of the initial consultation is to find out if therapist and patient can work together, and if so, how. To do this, I pay attention to what a person tells me, and how they say it to me. At the end of the consultation, I am able to tell the person if psychotherapy could be of benefit to them, and will discuss frequency, term and boundaries.

The “what?”

There are a few direct, specific questions that I like to ask to find out more about the person’s history and current circumstances.

For example, I may ask someone suffering from symptoms of anxiety to describe how they experience them, and what impact they have on their life and their daily functioning. I’ll also be curious about the history of these symptoms: are they a new experience, are they reoccurring? Also, do they seem to be triggered by external factors (such as, for example, an deadline approaching for a performance, being in the same room as a specific person, or being in crowded places) or do they seem to be occurring spontaneously?

I also consider all facts about a person’s earlier life to be a very important source of insight for both patient and therapist, for two reasons: first, it tells me what external factors may have influenced their development during childhood; second, it tells me how the person understands themselves. When I know more about what a person’s life has been like, and how they have this in mind, I have useful, factual information that allow me to decide whether or not it is appropriate to offer to help them through psychotherapy.

The “how?”

Not all of us will have paused and thought about ourselves as a person with a past, present and future. To many people that I have worked with, this even initially looked like “a luxury”. Life indeed seems to afford few opportunities to stop and truly reflect on oneself. And we are often given the message by our parents, friends, colleagues, partners and bosses to “get on with it” and not indulge in “navel-gazing”…

This is why it is not rare that people aren’t really able to tell me much about themselves, even when I ask them specific and precise questions. This is why I pay as much attention to what people tell me to he way they tell me it. And if I find that, in an initial consultation, a person find it difficult to tell me about themselves using words, I will help them to concentrate on this very difficulty, so that they may begin to see themselves more clearly and progress towards a better comprehension and verbalisation of their experience.

I have written an account of such a consultation in a longer version of this article, which you can read here.

What happens at the end of the session?

Before the fifty minutes of the consultation are up, I will tell the person if I can offer to see them for psychotherapy. If they tell me that they would like to start therapy, we then discuss the frequency of the sessions, and whether they want to set a term to their treatment from the outset. Some people also want to set specific goals, which we can discuss, and some will prefer to have free rein to get into whichever area of their life they feel is important in every individual session.

In my experience, my patients benefit most from therapy when they are able to come at least once a week, and the large majority of people choose not to set a term for their engagement in therapy right at the beginning. Some choose to do this later on.

Once I have communicated my policy that I require seven days’ notice for any change of session, the patient and I decide whether or not we will see each other again, and if yes, we make an appointment for the following time. Many people choose to start treatment right away and will set their appointment time and frequency there and then.

By: Cedric

Series: “what does a psychotherapy session look like?”

In: Individual psychotherapy, Series: "What happens in a session of psychotherapy?"

1- The initial consultation

Abstract: People considering psychotherapy and researching the topic and looking online for practitioners are not readily presented with material that will give them a concrete idea of what goes in a session. This is partly a result of the fact that each course of therapy is unique to the individual, and it may even help the therapeutic process. It is however possible and beneficial to publish facts about psychotherapy, that inform while leave enough to the imagination.
The first article in this series is about the initial consultation. I make the point that even though this key session looks more structured and concrete than the sessions that may follow, it is still unique to each individual. Some data is necessary for the therapist to assess a patient's presenting problems and suitability for psychotherapy, but this data can be transmitted and acquired in various - and sometimes surprisingly roundabout ways.

People who come to see me for their first consultation of psychotherapy often say right at the beginning: “I’ve never done this before, what happens now?”. This is not very surprising. We hear more about people’s experiences with their doctors, lawyers or even their plumbers than we hear about their experiences with their therapists. I have even become quite convinced that psychotherapists willingly cultivate an air of mystery around their practice.

«Working with a person’s expectations of a relationship is a key aspect of psychotherapy, and it starts “working” before the protagonists (patient and therapist) have even met.»

If you have indeed been looking for a therapist online and have visited their websites and blogs, you may have noticed that little appears to be said about what exactly goes on in therapy. Therapists write, as do I, about their principles, ethics and theoretical frameworks. They write about how, in general, psychotherapy can help people with certain common ailments such as anxiety and depression, but more rarely about what it is that really forms the interaction of patient and therapist in the fifty minutes of a session.

While researching this, you may have come across Irvin Yalom’s lively and thoughtful accounts of existential psychotherapy practice, or perhaps watched three of the old masters, Fritz Perls, Carl Rogers and Albert Ellis, respectively demonstrating in the film “Gloria”, gestalt psychotherapy, person-centred psychotherapy and rational emotive behaviour psychotherapy. A lot has been – and is being – written, and professional journals will abound with what is dryly called “clinical material”, but, unless this material makes its way to paperback or interactive media, there is little chance that someone willing to undertake psychotherapy will be readily presented with it by professionals.

***

Undeniably, there are three upsides to this. First, when therapists stay vague about what happens in a consultation, they give a greater opportunity to the person considering psychotherapy to imagine what it could be like, and then to confront what they have imagined, with what is happening in reality. Working with a person’s expectations of a relationship is a key aspect of psychotherapy, and it starts “working” before the protagonists (patient and therapist) have even met.

«Is it possible to write something that informs, and perhaps inspires, while respecting the frame of mind of the person looking for help, and acknowledging the unique character of each session?»

Second, it is genuinely difficult, and some would argue, unhelpful, to be precise about the course of a session. Sessions are conversations between two people, where one has the function of attending to the other’s needs. And whatever patterns may emerge in a conversation between two people rarely applies neatly as a template for another conversation.

Third, allowing some degree of mystery about psychotherapy is consistent with, and respectful of, the fact that the forces that the individual feel are at play in their psyche may feel like a personal mystery. Psychotherapy aims to help a person develop an interest in this mystery, so that its workings becomes known, so that they can grow beyond the experience of helplessness that often characterises their life before therapy.

The scarcity of material relating to what happens during a session seems to be both unavoidable and beneficial to the unfolding of a person’s psychotherapy. So, is it possible to write something that informs, and perhaps inspires, while respecting the frame of mind of the person looking for help, and acknowledging the unique character of each session?

This series of short articles will attempt to do this. I first aim to address the need presented by many patients in their first session, by giving some bearings about what happens during the initial consultation.

***

This initial consultation is the easiest to describe, as it often appears to follow more of a formula, as there are things that I will be interested with every new person. It is a first contact between patient and psychotherapist, and the aim is for both the therapist to find out if they can help the patient, and for the patient to form an opinion, or at least get a sense if the therapist can help them. At the end of this session, I am in a position to make a recommendation to the person in respect of psychotherapy, and to establish  together what the frequency of the sessions should be, and perhaps the term of the treatment, if this is important for the person at the time.

In this consultation, it is important for me to get an understanding of what is troubling the person who has come to me for help, and to know more about their current circumstances and the history of these troubles and how they fit (or not) in the person’s life story.

«I don’t need to know everything about a person in the first fifty minutes – In fact, it has happened quite a few times that a patient tells me something quite important about themselves much later in their therapy – sometimes, several years after the initial consultation.»

I will be interested in hearing the person’s perception of their life so far, and to see if anything stands out for them in some of the key relationships that contribute to forming one’s personhood, such as parents, siblings, significant relationships at school, college, the workplace, and any other significant setting.

In my experience, this can take many different shapes. Some people choose to tell me stories about themselves and do it with ease, (and sometimes gusto), some like talking about themselves in a less structured way, some have very accurate memories and others quite vague ones. Some people don’t like talking about themselves at all and find it difficult to put into words what it is that they struggle with and what makes them seek help. This is all fine.

Indeed, while it is important that I know some basic facts about a person’s personal history and current circumstances, so that I can establish if psychotherapy is a suitable form of treatment or if the person should be referred to another professional, I don’t need to know everything about a person in the first fifty minutes. In fact, it has happened quite a few times that a patient tells me something quite important about themselves much later in their therapy – sometimes, several years after the initial consultation.

***

I recall a first contact with a young man who seemed to be struggling to answer my questions. Generally, I ask open questions, so that the person has the space and time to give whatever shape they wish to their discourse. It also informs me greatly about their state of being to see how they use the space that I provide for them. I have found that asking too many precise questions right away tends to give impression that psychotherapy is a data collection exercise, where there are right and wrong answers.

This young man would answer my questions in a very vague, perfunctory manner. His childhood was fine, his parents supportive, his partner was nice, he sort of liked his job… it was just that he needed to turn his life around by making a bold decision about where to live and work, and he found himself unable to make this decision, without knowing why. This was all said quite briskly in the first few minutes of the session, and once I was done asking him questions, he looked at me expectantly.

I told him that, on account of how fast he’d run through the story of his life, I had the impression that he didn’t seem to find it worth saying too much about it. He didn’t reply directly, and told me that he just wanted to stop feeling rudderless and indecisive all of the time. I asked him more questions about his experience of indecision. Again, his answers were quite perfunctory. I smiled and made the observation that it seemed that I was more interested in him than he was. He seemed quite puzzled by this, and reiterated that, really, he’d come to see me to sort this particular problem out, and didn’t feel that talking about himself would be helpful at all. As for his childhood, he didn’t remember much before the age of 10 anyway. But he did have some facts about it, which he shared with me.

«This young man’s apparent inability to talk to me about himself during the initial consultation was a live, “here-and-now” illustration of how he had been shaped by his earlier life.»

He explained that he was the youngest of three siblings, who had been born quite close together. His parents argued a lot throughout his childhood, and began separating when he was eleven. They divorced when he was eighteen after a protracted custody battle that involved both children needing to “take sides”. He also told me that, after offering his mother constant emotional support throughout his late childhood and early teens, he had chosen to stop doing so for his own sake.

It became apparent to him that his inability to make big decisions in the present was consistent with his earlier experience of his parents involving him in their own. On the one hand, he was to act like an adult by supporting his mother and then choosing which parent he would live with. On the other hand, he felt he was being treated as a child because those decisions were being imposed upon him. If his parents had taken an interest in him, they would have understood that all that he wanted was for them to make up ask him how he was.

So, this young man’s apparent inability to talk to me about himself during the initial consultation was a live, “here-and-now” illustration of how he had been shaped by his earlier life. It showed clearly that it was new for him that anyone should take an interest in his person. His reluctance to take the lead in the session also illustrated that, for him, there wasn’t a positive experience of taking the lead in his life, and he wondered whether he would one day be able to do so.

On the day of his last session, five months later, as I was waiting for him to ring the doorbell, I received a call from him. He was at the airport, about to board a plane for New Zealand. He had wanted to have his last session over the phone, saying with humour that it was “so that we are both certain that I’m going to get on that plane!” He was able to muster the resolve that had eluded him for so long, and moved  there to live and work.

***

As a conclusion to this short article about the initial consultation, I would like to stress that there is no set, perfect way to go about it, neither for the patient, nor for the therapist. My aim is to offer my patient a space, where they can tell me about themselves and start to see themselves with a greater degree of clarity. This initial consultation shouldn’t be something for patient or therapist to “pass with flying colours”. It is about being curious about the other, in a way that leaves them the space to say what matters to them, or if words are not available to them at the time, to show me with their actions what is holding them back in their life.