Emotional dependency in psychotherapy is a nuanced and delicate aspect of the therapeutic relationship. It involves a client's reliance on their therapist for emotional support, validation, and guidance. Understanding and navigating this dependency is important for nurturing a healthy and transformative therapeutic experience. In this blog, I explore into the complexities of emotional dependency in psychotherapy and look into the sensitive of addressing it with compassion and insight. 

In psychotherapy work, a certain level of emotional dependency is needed as part of the therapeutic process. Clients or patients struggle with profound pain and confusion, especially those with a history of unstable relationships, may find themselves relying on their therapist for an extended period. When life feels unmanageable, especially for individuals from troubled backgrounds lacking essential emotional tools and self-awareness, seeking and depending on external support becomes crucial for personal development. Without this foundation, progress and grow in therapy become nearly difficult to achieve.

It's important to note that most clients or patients entering therapy are not inherently willing or enthusiastic about developing emotional dependency. In fact, resistance to dependency is a common initial concern in therapy. Despite experiencing significant pain and a sense of hopelessness that prompts them to seek professional help, many clients struggle with the idea of depending on their therapist. This aversion often stems from early experiences in childhood, where vulnerability and neediness were associated with potential threat or hurt. 

For individuals from difficult or less privilege  backgrounds, the concept of needs often relates to frustration and disappointment, triggering anxieties related to abandonment and a sense of powerlessness when relying on others for what is needed. These clients may carry deep distrust about the genuine care and willingness of others to provide for their needs, which can be further complicated by the necessity to pay for psychotherapy services, leading them to question the genuineness of the therapist's concern.​ 

These issues often surface early in the therapeutic process, revealing themselves through the transference. While many perceive the transference as a distortion of reality, such as reacting to the therapist as if they were a parent, it actually serves as a nature of a person's emotional struggles, offering a first-hand experience of the psychological challenges they battle with. So, if an individual holds an aversion to neediness and emotional dependency and struggles to establish consistent, meaningful relationships, these same difficulties will manifest in their therapeutic relationship with me in their treatment. They may attempt to maintain emotional distance, unreliable commitment. In such cases, my initial role often involves helping these clients recognise the consistent theme in their various relationships, both inside and outside of therapy -  a profound struggle with tolerating their own needs.

In a recent case with my client work, these very issues took centre stage in our therapeutic relationship. Right from the beginning, my client expressed a fear of forming any form of dependency on me. Their past experiences were marked by both physical and emotional abandonment from their parents, leaving them with a doubt towards the reliability and goodness of others. They often struggle with the intense emotional disturbance with binge eating as a means coping mechanism, opting for food over human connection. Committing to our sessions proved to be a challenge; they struggled with committing our sessions, starting -  then stopping therapy multiple times. This uncertainty sometimes led to abrupt session cancellations, accompanied by anxieties that I might allocate their time to another patient/client.  

Rather than maintaining a therapeutic focus on interpretation, which involves helping them confront and tolerate their fears regarding emotional dependency, I made the mistake of extending open-ended support, regardless of whether they facilitate it. My intention was to reassure them and express my reliability, setting me apart from the unreliable figures in their life. However, they perceive this new setting frame of flexibility as to regulate their feelings of dependency, resulting in frequent cancellations. When I offered to reschedule, they expressed a preference not to make up sessions, as it allowed them to avoid feeling excessively dependent to me. It was at this occasion that I realised I had unconsciously given them a means to avoid the very dependency they needed to experience in order to make progress — specifically, in this client case; giving up their eating disorder and discovering healthier coping methods within the context of a therapeutic relationship. 

When I realised of my mistake and revising my framework to no longer reserve a regular hour for them, but still maintaining an open availability for them to schedule sessions as needed, they became upset and ultimately chose to terminate our sessions. I can understand with their reaction; returning back the offer likely felt similar to another form of abandonment. You’d think that after over than 10 years of practice, I would have been able to avoid such mistakes, but this serves me as a humbling reminder of the complexity inherent in therapeutic dynamics. 

This experience has been a humbling reminder that attempting to compensate for a lifetime of abandonment and indifference through changes in cancellation policy is a form of arrogance. In the future, when faced with similar challenges, I will endeavour to do what I should have done from the start: provide the client with what they truly need – a consistent and reliable presence, capable of setting reasonable limits and maintaining them. 

Shame and guilt are complex and often deeply ingrained emotions that can significantly impact our mental health and wellbeing. As a counsellor or psychotherapist at Misma Counselling Service, I believe it’s crucial to understand these emotions and explore how they can affect our lives.  I think - for me, that the dynamics of shame and guilt is perhaps one of my reasons that lead me to want to study the mind, as I wished to understand the ability to undermine our pursuit of a good enough life. 

Shame is a powerful and painful emotion characterised by a profound sense of inadequacy, unworthiness, and self-loathing. It often arises from a belief that we are fundamentally damaged or morally wrong in some ways. Unlike guilt, which tends to focus on specific actions or behaviours, shame goes much deeper, attacking our very sense of self. 

Shame can manifest in various ways, from social withdrawal and self-isolation to self-destructive behaviours like substances abuse, addictions or eating disorders. It can be especially challenging to cope with shame because it tends to be hidden in the shadows of our subconscious, influencing our thoughts, feelings, and behaviours without us even realising it. As a therapist, I see how hard it is when patients realise such destructiveness expressed in shame which can take different shapes and forms. This painful realisation is often accompanied by confusion, hopelessness, and sometimes even more destructive resentment.   

Guilt, on the other hand, is related to a specific action or behaviour that we perceive as wrong or hurtful. While guilt can serve as a healthy moral compass, prompting us to take responsibility for our action and make amends, it can also become overwhelming and harmful to our wellbeing.
 
Excessive guilt can lead to rumination, where we replay past mistake in our minds, creating a never-ending cycle of self-blame. This can be particularly complicated and difficult, affecting our self-esteem and causing anxiety and depression.  

​But why do we have these feelings? Why is that from time to time we feel overwhelmed and down, then we choose what’s bad for us, things will mess up aspect of our lives that we so much want to grow and develop? Why do we find ourselves tangled with unhealthy and destructive cycles, be them in behaviours or feelings? It’s just doesn’t make sense to pursue something that lead to suffering. Why so? 

Shame and guilt are interconnected emotions that can reinforce each other. For instance, experiencing guilt for a perceived wrongdoing or fault can trigger feelings of shame if we internalise that wrongdoing as a reflection of our worthiness. On the other hand, unresolved shame from the past can make us more susceptible to feeling guilty, even for minor transgressions. 

One important thing to recognise is the inner conflict, a struggle between the desire for feel valued and the fear of making mistakes. This conflict is met with counterproductive self-criticism. It’s akin to an internal version of Newton’s law, where every action is met with an opposing force, each driven by its own instinctual energy. While occasional self-doubt and mistakes are normal, if these feelings persist, they can impede our personal grow and wellbeing. 

Freud can help us understand this conflict, a bit more. Freud suggested that real guilt comes from our hidden intentions. Doing something wrong isn’t what makes us feel guilty; it’s the awareness of our wrongful intentions. Legal guilt is about breaking the rules, while moral guilt is about our personal sense of right and wrong. 

In his early theories, Freud talked about the “id”, which is the like part of us that interacts with the world around us. The “ego” then changes the environment so we can make the most of what it offers to satisfy our desires or needs. Later on, Freud (in 1923) introduced the word “superego” to describe the part of our mind that the ego adopts to help control the id. Freud studied the mind and how people behave, but there’s an underlying belief that human behaviour can be understood like the laws of physics, which predictable patterns. ​

In simple term, feeling guilty is like feeling anxious, especially when we’re torn between love and hate. It’s easy to see how guilt is connected to the inner struggle of loving and hating someone at the same time. Freud went even deeper to explain that these feelings are linked to our basic instincts. ​

Neurotic: Some individuals, for some reasons, view a parent o a loved one as someone who has not succeeded in life, perhaps as someone weak or powerless. Unconsciously, they may form a kind of unhealthy attachment to this struggling parent. This can lead to feelings of shame and a determination never to surpass them. The idea of growing, improving and becoming better is then seen as something shameful, with a looming sense of guilt and punishment as a consequence. Achieving wellness is met with an internal judgement, enforced by a harsh and unkind part of the mind. Furthermore, some people believe that if they were to let go of this struggling figure they identify with, and try to create a separate, improved life, they would be contributing to their demise. For instance, they may worry the loved one might harm themselves, perhaps through excessive drinking. So, a life dominated by feelings shame and guilt unfolds, in all an attempt to avoid the greater destruction they fear would happen if they were to break this unhealthy attachment. 

Punishment: Punishment through shame and guilt can be a way of penalising oneself. But what’s the crime? It’s for having desires, feelings, thoughts, or fantasies that are considered forbidden, and often harmful – thus to be pushed away from the unconsciousness. This helps the person avoid confronting certain destructive aspects of themselves, which may be directed towards loved ones. Inside us all, there exists a part that acts as our own internal judge, making us feel guilty if we go against our own set of rules. Freud termed this the “superego”, an internalised version of our parents that monitors and can punish us if we step out of line. Consequently, guilt arises from a demanding superego, penalising the person for what it believes is an internal transgression, which may not always align with external moral or legal standards. ​

Based on what I’ve seen in my therapy sessions and learned from my studies, it’s clear that shame and guilt can be harmful and also serve as a way to protect oneself. However, unless a person recognises the consequences of their self-undermining patterns and actively seeks to change them, it’s likely that shame and guilt will persist in their life. 

​In our modern society, discussion around men’s health often focus on physical wellbeing, leaving mental health in the shadows. However, it’s crucial to recognise that mental health is just as important as physical health for leading a fulfilling and balanced life. In this blog post, we’ll look into the significance of men’s mental health, common challenges they face, and practical strategies to promote mental wellbeing. 

Unfortunately, there still exists a pervasive stigma surrounding men’s mental health. Society often perpetuates the notion that men should be strong, stoic, unemotional, and resilient in the face of adversity. This expectation can lead to reluctance to seek help or discuss their feelings openly. It’s essential to break down these barriers and create a safe space for men to acknowledge and address their mental health. 

Prioritising men’s mental health is an important step towards achieving holistic wellbeing. By breaking down the stigma surrounding mental health, understanding the common challenges men face, and promoting healthy coping strategies, we can create a supportive environment where men feel empowered to take charge of their mental wellbeing. Remember, it’s not a sign of weakness to seek help; it’s a sign of strength and self-awareness. Together, we can foster a culture of mental health awareness and support. 

#men's mental health awareness #mentalhealthawareness #mensmentalhealth 

"I was able 'to sit' with my feelings and emotions. I no longer have the need to binge or purge this emotions" shared my client who worked through their eating disorders.  ​

Understanding eating disorders can be challenging if you haven't experienced them yourself. While many are familiar with anorexia and bulimia, there are lesser-known disorders like AFRID (Avoidant/Restrictive Food Intake Disorder). Diagnosing these disorders is complex due to the overlapping symptoms, and they may manifest differently at various stages of one's life.​

Emotion avoidance involves actions aimed at stifling any emotional reaction, be it anger, sadness, fear, anxiety, or loneliness. Those struggling with eating disorders often turn to constant eating or abstaining from food as an automatic way to deal with their feelings and seek relief. Using eating disorders to numb emotions is typically a response to negative emotions and unresolved trauma, especially situations that haven't been addressed or processed in a healthy manner.

Treatment for eating disorders encompasses a range of techniques and approaches aimed at aiding patients in their recovery journey and enhancing their overall wellbeing. An essential component is teaching them how to recognise and navigate their emotions, rather than avoiding uncomfortable emotional states.​

For younger children, desensitisation therapy, particularly the 'playtime' approach, is often employed to help them become more comfortable with the sensory aspects of food. Another technique, exposure therapy, aims to reduce the anxiety associated with certain foods through relaxation exercises and discussions about the avoided items. It also focuses on acquiring positive coping mechanisms for food-related fears and anxieties. Cognitive Behaviour Therapy widely used for various mental health conditions, addresses the negative thought patterns and behaviour that may underlie eating disorders.​

Psychotherapy or talking therapy frequently utilised in eating disorder treatment, helping individuals exploring their difficult emotions and feelings. 

It's important to communicate to patients that their eating disorder behaviors often serve as coping mechanisms to regulate their emotions. While these behaviours may have provided temporary relief from difficulties and traumas, they aren't long-term solutions.

The current pandemic is leaving many of us anxious and worried. Uncertainty and the unknown shake our basic life routines, we loose our life structures, leaving us feeling confused and lost. Confusion and loss can create a negative imagination and this is fear. The fear of contagion and the virus can impact on our psychological responses.

Right now, we know Covid-19 has separated us, divides families, jobs, and cities; stripping our existence as social human being. Our lives has been disrupted in body, mind and spirit. 

Coronavirus has occupied our thinking, in news, radio, tv and social media, with frighting death statistics and daily updates. This constant exposure of news can result in heightened anxiety with an immediate effect on our mental health.  The constant feeling of threat can deeply effect our psychology response. The fear of contagion may lead us to become over-anxious and less accepting of the 'normal' such as being tactile, hugging or visiting others. Our moral judgement becomes harsher and our social attitudes more conservative during these times. Outcries on social media and news outlets show that people are more ready to judge and condemn behaviour that until yesterday was 'normal' - it is amazing how quickly the jump to the new moralising behaviour becomes. 

Sadly, researchers have found that stigma has worsened the suffering from every major infectious disease epidemic in our human history, and no doubt, it will certainly play a role in current Covid-19 pandemic. Remember when AIDS and HIV occurred among us, who were the group of people we judged and discriminated against?

Stigma is an evolutionary response that our mindset has ingrained to our physical response: we will distance ourselves  from others who could infect us. This whole suite of response is called 'parasite avoidance'  , defensive strategies to prevent ourselves from contracting infection disease (reducing infection risk). The reactions are what make us feel threatened by signals of sickness, such as coughing, vomiting or sneezing; whether or not these signals indicate an actual threat to our own health. 

Since humans are social beings that have evolved to live in big groups, 'parasite avoidance' modifies our interaction with people when infections occur to minimise the spread of the disease, resulting spontaneous social distancing.

​The response could be quite harsh!. 

Statistics consistently reveal a stark gender disparity when it comes to suicide rates. According to the World Health Organization (WHO), the global suicide rate is approximately 9.0 per 100,000 individuals. However, when we break it down by gender, a startling trend emerges. In nearly every country, men are significantly more likely to die by suicide than women. In the United States, for example, men account for approximately 3.5 times more suicide deaths than women.

These staggering statistics from the Office for National Statistics UK underscore the urgent need for a deeper understanding of the multifaceted factors contributing to suicide, emphasising that it can affect men from all walks of life, dispelling the misconception that it only strikes those who are deemed "unwell" or "weak". ​

Some researchers suggested that unraveling the intricate "why" behind suicide involves a complex interplay of various risk factors and adverse life events that can ultimately tip vulnerable individuals towards a breaking point.

This distinction also emphasis the critical importance of understanding the gender-specific nuances in suicide, where women may be more inclined to attempt, but men are more likely to choose more lethal methods, highlighting the need for tailored prevention strategies.​ 

Promoting Mental Health Awareness: Increasing public awareness about mental health, especially among men, is crucial. Encouraging open conversations about emotions and mental wellbeing can help reduce stigma and create a more supportive environment. 

Breaking Down Gender Stereotypes: Challenging traditional notions of masculinity can create a more inclusive and understanding society. Encouraging vulnerability and emotional expression in men can help them seek help when needed. 

The society expectation for men to be self-reliant and the primary providers can lead to immense pressure. The loss of employment and financial struggles often experienced by middle-aged men not only brings about stress but also a profound sense of identity crisis, exacerbating feelings of inadequacy and a perceived loss of masculinity.​​

It's important to note that there is no evidence to suggest that depression affects men more severely than women. ​

Indeed, it's important to recognise that there are many other reasons for cheating, some of which may have little to do with the dynamics, attitudes, appearances, or behaviours of either partner in the relationship. Let's explore a constructive approach to repairing your relationship and rebuilding the trust that was shattered by infidelity. In this blog, I'll explore the various factors that influence the potential for recovery. 

In psychodynamic approach, infidelity or cheating in a relationship can be understood through various concepts and dynamics to consider. According to Sigmund Freud's psychoanalytic theory, human behaviour is influenced by unconscious desires and conflicts. Cheating may be manifestation of unresolved conflicts or unmet needs within an individual's psyche. 

Id, Ego, and Superego: Freud proposed that the human psyche is comprised of three parts: the id (driven by instinctual desires and impulses), the ego (mediates between the id and external reality), and the superego (internalised moral and society values). Infidelity may arise from conflicts between these components. For instance, the id's pursuit of pleasure and novelty might clash with the superego's moral constraints. 

Defence Mechanisms: Psychoanalytic theory suggests that individuals employ defence mechanisms to protect themselves from experiencing uncomfortable or distressing emotions. Cheating might be a defence mechanism against feelings of inadequacy, insecurity, or fear of intimacy.

Repetition Compulsion: Freud proposed that individuals are driven to repeat unresolved psychological conflicts and traumas in an attempt to overcome or resolve them. If an individual has experienced past relationship difficulties or trauma, they may unconsciously recreate similar situations, potentially leading to infidelity.

Attachment Theory: While not strictly psychoanalytic, attachment theory aligns with some psychoanalytic ideas. Infidelity might be viewed as an attachment-related behaviour, reflecting underlying attachment insecurities or unmet emotional needs.​

Unconscious Fantasies: Psychoanalysis suggests that individuals have unconscious fantasies and desires that can influence their behaviour. Infidelity might be driven by these hidden fantasies, which may not be fully acknowledged or understood by the individual.

It's important to note that psychoanalytic interpretations of infidelity do not excuse or justify the behaviour. Instead, they aim to provide a framework for understanding the underlying psychological process that may contribute to such actions. Additionally, modern psychology couples with a wide range of perspectives, and not all therapist strictly adhere to traditional psychoanalytic theories.  ​

The aftermath of infidelity often leads to the dissolution of many relationships or marriages, as the breach of trust and the difficulty of forgiveness prove impossible for some. In many cases, infidelity arises from a sense of dissatisfaction, whether consciously acknowledge or not, either within the relationship or within oneself.   

Open Communication: Honest and transparent communication is crucial for healing. Face your feelings and your fears, share these with your partner/spouse who have been offended. Sometimes, the emotional closeness in your relationship has been cut off resulting in one or both of your becoming vulnerable to outside attentions. In the sense, both of you must be willing to have difficult conversations, express your  feelings, and listen empathetically. 

Genuine Remorse and Accountability: The partner who cheated must take full responsibility for their actions, express genuine remorse, and commit to making amends. Choose time to have this conversation and let the offended partner processes the information in their own time. Please note: It's up to you to disclose the details of the incident. 

Rebuilding Trust: Trust is not easily regained, but it is possible with time, consistency, and a demonstrated commitment to change. 

Therapeutic Support: Seeking professional help, such as couples counselling or individual therapy, can provide a structured environment to address underlying issues and learn healthier communication. 

Forgiveness: Forgiveness is a process, not an event. It requires both partners to be patient and compassionate, and for the cheating partner to understand the depth of pain they've caused. 

​Learn and Grow Together: Use this experience as an opportunity for growth, both individually and as a couple. Explore new ways to connect and understand each other on a deeper level.