Following on from our previous post on the work of Sigmund Freud, founder of psychoanalysis, in this post we will turn to his revolutionary thinking regarding the ways in which adult behaviour can be shaped by infant and childhood experiences.

Freud was the first person to articulate a theory of the unconscious mind, and the power and influence it can have over our emotions, behaviour and decisions. Freud believed that the root cause of these unconscious influences often came from our childhood experiences. Though we may forget, and also repress, certain childhood experiences, they nonetheless influence the development of our personalities and inform how we respond to the world as adults.

It is now generally understood, for example, that issues around insecure attachment in relationships can often stem back to childhood experiences, particularly if individuals encounter emotional neglect, inconsistency/abuse (leading to mistrust), or smothering (leading to a lack of separation from the care-giver and a subsequent lack of individuation). This is an example of how challenges or traumas experienced in early life can continue to shape our behaviour in later life, just as Freud articulated.

Often psychoanalytic therapy will therefore explore certain childhood memories and experiences in order to draw connections to the present and identify behavioural patterns. This can function as a means of working to change or evolve certain aspects of our behaviour that might be emotionally challenging or self-destructive. In this way we can see how Freud’s theory of the self is pertinent to how we understand psychological issues such as anxiety, depression or addiction, as we work to address the underlying causes of these symptoms.

In the next post we will discuss Freud’s theory of the defence mechanism in human psychology, another of his theories which has since entered into public acceptance and usage.

Psychoanalysis was founded by Dr. Sigmund Freud (1856-1939). Freud revolutionised our thinking about the human mind, and was the first person to articulate the idea of the unconscious mind and its role in shaping how we behave. His thinking forms the starting point for all subsequent schools of thought within psychoanalysis.

Freud divided consciousness up into three levels: the Id, the Ego and the Superego. The Id was defined as the level of the mind that acts on innate impulse and instinct. Within the three levels of consciousness it is positioned as the lowest level and the most primal, driving our behaviour from below, demanding the gratification of desires, wants and needs.

Above the Id is the Ego, which is defined as the conscious mind. This is the self-aware aspect of our psyche which has to be realistic and to make conscious decisions. Freud said that we naively assume that our Egos – i.e. our conscious selves – are in full control of our own thoughts, when in fact our Egos are unwittingly being driven by the Id, and regulated by the Superego, the final level of consciousness.

The Superego is akin to the conscience, regulating our impulses and desires and dictating what is right and wrong. The Superego therefore stands in direct conflict with and tries to regulate the Id. It is often determined along moral and punitive lines i.e. you should do this, but you shouldn’t do that. The Superego is an often unconscious voice, which commands authority over how we behave.

The conflict that defines the relationship between Freud’s idea of the Id, the Ego and the Superego is indicative of his attitude towards the mind more generally, which he saw as being riven with internal conflict. This, in a way, encapsulates what was so revolutionary about his way of thinking, and why he is still heralded as one of the greatest modern thinkers and as the founding figure in modern psychology.

Freud was the first person to fully articulate and theorise the idea that human beings contain conflicting selves rather than one true self. He was also the first person to articulate, scientifically, the idea that our behaviour in adult life is shaped by our experiences in infancy and childhood: this will be the subject of the next post.

Would you like to attend a practice that specialises in stress-related therapy in London? If so, Portland Practice is the ideal psychotherapy practice for your needs. We have assisted a broad range of clients to confront and deal with stress and the root causes of stress, as well as to help prevent the same patterns of behaviour and psychological response from emerging again in the future.

What do I talk about in therapy ?

During psychotherapy, the more open you are, the more effective the session will be.

Often people new to psychotherapy are worried they won’t know what to talk about. They may consider their problems too trivial to others, or that their issues are too enormous to discuss with a therapist and may lead to highlighting even bigger topics they don’t feel ready to discuss yet.

Whilst understandable, these fears are unnecessary and there’s no “right or wrong” to the discussion. As your therapist we help you to talk openly, in a non-judgemental environment. Typically the difficult topics become much easier to talk about than you may expect.

Learning from our past can help us cope with situations today, tomorrow or in years to come. We’re looking to identify past reasons for behavioural patterns and how you can best cope with situations in the present and future.

Psychotherapy can provide a deep understanding into both how and why individuals feel and react in certain situations. This then gives the opportunity to make positive, substantive changes to your life and wellbeing.

As providers of behaviour therapy for children here at Portland Practice, it interested us to read recently that children themselves are by no means the only direct beneficiaries of such a service. New research has indicated that such therapy for kids with autism can have positive effects well beyond the child, especially for parents who play an active role in treatment.

‘Become more aware of their parenting’

Findings recently published online in the Journal of Autism and Developmental Disorders indicate that mothers and fathers who participate in cognitive behaviour therapy with their autistic children experience improvements in their own levels of depression and emotion regulation. Such services also enabled them to engage in more mindful parenting.

Working on the study was Jonathan Weiss of York University in Toronto, Canada, who observed: “The research showed that parents improved their abilities to handle their own emotions and to see themselves in a more positive light. It helped them to become more aware of their parenting and all of the good they do as parents.”

The value of not isolating parents from their children in treatment

The study involved researchers following the parents of 57 children with autism, aged between 8 and 12, who participated in therapy sessions with their son or daughter where they played the role of co-therapists alongside a professional. With the parents having completed surveys before and after the treatment, their responses were then compared to those of Mums and Dads who had not taken part.

“Most of the time when parents bring in their kids for cognitive behaviour therapy, they are in a separate room learning what their children are doing, and are not being co-therapists,” Weiss observed. “What’s unique about what we studied is what happens when parents are partners in the process from start to finish. Increasingly we know that it’s helpful for kids with autism, specifically, and now we have proven that it’s helpful for their parents too.”

Such findings – although preliminary – serve as a useful reminder to parents of the extent to which they could benefit from behaviour therapy for children like that provided by suitably qualified and experienced professionals from a reputable psychotherapy services provider such as Portland Practice. Enquire now for a consultation in relation to behaviour therapy for your children that gives you, the parent, a central role.

When and where exactly addictions begin can be very hard to pin down. Many of us can be said to follow habits or routines which are of central importance to us, dependencies which to some extent might even structure our lives and without which we feel perturbed or perplexed.

Addictive behaviours can evolve out of different conditions; we can turn to certain habits as a distraction from stress, anxiety, anger, pain or sadness, as a replacement for an emotional absence created by loss or by unmet needs, or in order to relieve boredom and frustration.

Differing definitions

Addiction is sometimes conceived of as a primarily physical or biological problem. Addicts, in this version, are biologically pre-disposed to addiction and are often defined as those whose bodies have become reliant on a substance in order for it to regulate itself.

However, although physical addiction is very real when someone is experiencing the bodily effects of substance withdrawal, the psychological reasons for addiction are much longer lasting than any physical attachment. After the physical withdrawals of severe substance addiction are through people still remain recovering addicts.

It can be common, for example, to substitute one addictive behaviour for another, or to become hooked on habits such as gambling, shopping or cleaning, which are not based on any drug or brain effect. The habit itself only matters up to a certain point; beyond that it is reality, and the need to take action under certain circumstances, which demands our attention. Treating addiction requires an understanding of how it works psychologically.

A way to wrest back control

Recovering addicts will report that the time they most feel like returning to their addictive behaviours is not when they are particularly relaxed or feeling self-indulgent, but rather when they feel ill-at-ease, helpless either to certain life circumstances or to their own unwelcome feelings.

Their behaviour is a way to wrest back control, a way of creating a sense that they and the world are as they should be, and a means of managing painful emotional states and regulating their self-esteem. It can also, therefore, preclude an understanding of the deeper causes of distress and prevent the development of healthier forms of self-regulation.

Addiction, seen in this sense, is a disorder of self-regulation, a coping mechanism which has become a symptom, and it is a very common way in which people deal with feelings of powerlessness. Unsurprisingly, addiction is more likely to be found in individuals who were exposed to adverse childhood experiences such as physical abuse and who subsequently have a diminished capacity to regulate negative emotions.

To assert that addiction is essentially about seeking pleasurable experience is to be misguidedly looking through the wrong end of the telescope. And to declare that addiction has anything to do with a kind of moral laxity is plainly wrong.

Addiction therapy

Therapy offers the opportunity for individuals to engage in self-reflection and identify previously inaccessible inner feelings which offer insight into current behaviour and habits. If we acknowledge that addiction has a strong psychological component and people are willing to use the psychodynamic approach to addiction treatment then it is possible to engage with underlying psychological motivations and to develop alternative forms of self-regulation.

The portland practice offers addiction therapy in the form of individual or group psychodynamic psychotherapy from our rooms in Harley Street in Central London. We offer a service which is tailored to the personal and private needs of every individual, and our team have a great degree of experience in supporting addiction treatment.

Many of those with eating disorders or whose family has been touched by them will have taken great interest in the recently released Netflix drama-comedy film To the Bone, which charts what the distributor has described as a “harrowing, sometimes funny journey of self-discovery” by Ellen, a 20-year-old with anorexia nervosa.

A film almost guaranteed to divide opinion

The Marti Noxon-directed film certainly has no shortage of star appeal, featuring the British-American model and actress Lily Jane Collins – the daughter of musician Phil Collins – as Ellen, along with Keanu Reeves as Dr William Beckham and The Good Wife actress Carrie Preston as Ellen’s stepmother, Susan.

However, while To the Bone has received critical acclaim from many quarters, receiving a 73% rating on Rotten Tomatoes and being described by that site’s ‘Critics Consensus’ as “an insightful, empathetic look at a widespread issue”, other observers have been less charitable in their assessments, even likening it to a ‘how-to’ manual for anorexia.

That latter view comes from Northwestern University psychology professor Renee Engeln, who was quoted by the American TV news programme Chicago Tonight as stating: “There’s a very real sense in which the film could be used as a how-to manual for someone struggling with eating disordered behaviour. From my perspective, a good film about anorexia doesn’t provide a how-to manual; it doesn’t show close-ups of ribs and spines like this film does.”

Similar sentiments were voiced by critical reviewers such as Ellie Williams, who wrote for Cambridge University student newspaper Varsity that the film “does not represent the complexity of eating disorders, or the diversity of those who experience them.” She described the character of Ellen as being similar to the image of “an emaciated yet ethereally beautiful, white teenage girl… that has been romanticised and tokenised by online communities for years.”

A sensitive portrayal of anorexia, or an oversimplification?

There is much more that could be said about To the Bone’s approach to the frequently extremely complicated and fraught subjects of anorexia and eating disorders in general – and much more certainly will be said.

Amid all of the claims and counterclaims about the film’s content, it should be noted that Noxon herself struggled with anorexia and bulimia in her teens and 20s and has spoken of the “tricky balance” to be struck in directing such a film. As she told Vanity Fair: “We didn’t want to show a whole lot of behaviour [and] make it aspirational. But we also wanted to tell the story in a way that felt authentic.”

We are sure that the debate will rumble on as to whether To the Bone makes a positive or negative, helpful or unhelpful contribution to the discussions surrounding eating disorders and anorexia and how these conditions are depicted and addressed in wider culture.

In the meantime, if you are affected by any of the issues addressed in the film, please feel free to contact Portland Practice to learn more about the highest standard of suitably and sensitively tailored psychotherapy in London.

When the recent T2 Trainspotting movie was released, the big shock for the die-hard fans of the gritty, drug-infested, bleak landscape of Glasgow was the switch to the Euro-focused, clean and shiny Edinburgh of the second movie.

We watch a man who had been skeletal, bed-ridden and cruel turn into the broad shouldered Ewan McGregor we’re familiar with.

It might not have been the film its fans were expecting, but it showed another facet of the world of drugs. It was no longer heroin in shacks, but cocaine and pretty dresses, ecstasy in brightly lit clubs, fountains of alcohol. It was addiction with another face, recreational drugs with the young and bright and wild.

Addiction – even in glamorous surroundings – is still addiction

This is the world of addiction, but infinitely harder to pin down as addiction. It doesn’t feel like addiction if the MDMA is only on Fridays, if the cocaine is only on a bad day, if the drinks are never alone. “I don’t need it, I want it”, is the most common refrain.

But what happens when you want it all the time? Where is the line between choice or desire, and addiction? The reality is that for most of us, we won’t ever know. For a country like the UK, statistics like nine million people drinking more than the recommended daily limits, or 8,697 alcohol related deaths in 2014, don’t surprise us. Nor do they stop us.

Alcohol is the most pervasive source of addiction, probably because it is so socially acceptable. The NHS estimates that 9% of adult men and 4% of adult women show signs of alcohol dependency, but even this statistic is hard to swallow, given how many people I know who have never honestly reported the amount of alcohol they drink to their doctors.

The difficulty of long-term addiction management

The hardest part is accepting the difference between that choice, dependence and addiction. It is easier to admit that we choose our vices than that we are dependent on them, or that we are dependent on substances rather than addicted to them. The road is famously slippery and the lines notoriously blurred.

During that Trainspotting sequel, Renton turns to Spud on the peaks of Scotland and explains how he overcame his addiction. It was a long road, a road that doubtless required self-analysis, hard choices, determination and desperation. It is a road that he clearly never finishes walking; a life transformation that is never complete and only continues through difficult choices made every day. By rechannelling his energy, the drive to obsess, into other pursuits he could overcome his deep-seated needs.

“You’re an addict, so be addicted. Just be addicted to something else”.

Learn more about how a psychotherapist in Harley Street from Portland Practice could help to ease your concerns about addiction by contacting our small, intimate team today.

Our world is full of advertisements – on our buses, on our televisions, in our train stations – which claim to offer the opportunity for a more pleasurable life. We only need go to a supermarket, and whether we desire something sweet, sour, bitter or salty, all our frustrated hungers can be met with ever-faster and ever-more-satisfying effect. Choice is the order of the day, and happiness is the goal.

How has all this choice shaped the way we conceive of satisfaction? The psychoanalyst Adam Phillips, in a conversation about pleasure and frustration, commented that, “One of the obstacles is the demand that we be happy, that we enjoy our lives. I think it’s a huge distraction, and it’s very, very undermining. So, living in a quasi-hedonistic culture, I think it’s a big problem. It’s wrong because, if we are to make this crude, in the old days, whenever that was, there was an internal injunction to be good. Now the injunction is to be happy, or to be enjoying yourself. And the reason this is a distraction is because life is also painful”.

Phillips’ point here is not puritanical. He is not encouraging abstinence or austerity or self-punishment by saying that you should, on moral grounds or otherwise, be rightfully denied your chocolate bar or your glass of wine or your beach holiday. After all, we all know that life’s pleasures can be, to put it simply, enormously pleasurable. And although there are discussions to be had about the consequences of different commodified pleasures, Phillips is directing our gaze elsewhere.

Instead, he wants us to think about what pleasure has come to mean to us, philosophically and psychologically, in a quasi-hedonistic culture. Problems arise, he reasons, when pleasure becomes a means of “evacuating” pain, as if there is a quantifiable equation where more pleasure equals less pain which results in more happiness. “What we are continuously being sold are possibilities for pleasure, as though all we want to do is get rid of the pain and increase the pleasure.”

The mistake lies in trying to eradicate pain with pleasure as if pain is a privation, or an appetite, that requires feeding. Instead of trying to eradicate pain, which is ultimately an impossible task, we would do better to think about what we can do with it, how we can modify it. Pain is ineluctable, so if our cultural ideal of a “good life” is centred around the pursuit of the state of happiness then our cultural goals are always going to be unrealisable, and they will always, to some extent, punish us.

The cultural consensus about a good life might, in a different environment, involve an acceptance and a more developed understanding of the vicissitudes and unpredictability of life. We need, as Phillips says, “better pictures of satisfaction with a more adult sense of the way the world is.” If we are able to reconceptualise the notion of satisfaction and recognise that pleasure is far from the principal determinant of a good life, then we are also better able to make something of the pain and enjoy the pleasure.

In the wake of the last election the issue of mental health has risen to the forefront of political issues and the way we handle it in the NHS has become a top government priority. It is estimated that major depression is the second leading cause of disability worldwide and a major contributor to the burden of suicide. One in six people in the past week experienced a common mental health problem.

The continuing fight for change

The enormity of the issue of mental health and how we tackle it comes as no surprise to thousands in the UK. They have campaigned for decades for greater awareness of mental health issues and funding for mental health programs. The campaigns address not only the root issues of mental health, but also the stigma and discrimination that surround it.

Campaigns have fought against this discrimination and despite a blooming attitude of acceptance, the toll on those with mental health issues is overwhelming. The movement of social change is a slow beast, with campaigns from media outlets, advertising and educational efforts combining to change the attitudes of the next generation.

Shorter-term and more directly, health foundations are encouraging people to get the right help at the right time. Shocking statistics suggest that over one in five people have been waiting over a year without receiving therapy, having registered through the NHS.

But it isn’t merely the waiting times; every person has different needs. Not all therapy and not all therapists are right for each individual. The element of choice is vital, as it always is out of respect for our individuality, humanity and independence, but especially to those seeking help.

Less than two-thirds of people with severe mental health problems are offered evidence-based psychological therapies. The choice of therapist, time of therapy and routine are all key, but also the type; would you be better suited to individual therapy, group therapy, counselling, or psychotherapy? Are antidepressants the right choice for you?

A very real – but important – cost

No one should have to wait, is a key message. Why should someone have to wait until they are suicidal, or almost beyond help, before they receive it? Prevention, as always, is better than cure.

The effective cost of mental health care in the UK can be totalled to hundreds of billions, but far more important is the immense human cost of not providing such care at all.

For both short and long-term therapy on which you can rely, don’t hesitate to contact our experienced and well-qualified professionals at Portland Practice.