Dr Alistair Black practices psychoanalytic therapy in South East London.
Offering a safe, flexible, confidential and non-judgemental approach addressing a broad range of mental and emotional distress, personal and relationship difficulties, and other symptoms of modern life. Experienced in working with a variety of common issues such as:
In modern medicine, and many forms of psychotherapy, depression is often seen as a psychological or mental illness to be alleviated by drugs or by learning ‘positive thinking’ to replace supposedly negative thought patterns or emotional reactions. As such, depression and similar moods are treated as symptoms to be removed or covered over as quickly and efficiently as possible.
The approach of psychoanalytic therapy is different. Depression is understood to be an affective state in which the person has lost the courage to deal effectively with their difficulties, and communicating that a reassessment of one’s life might be needed. So instead of removing or suppressing surface symptoms psychoanalytic therapy explores the specific issues the person brings. This form of therapy approaches depression by exploring in detail the complex narratives or life stories that lie behind the present moods and any life events that may have led to them. Depressive moods or feelings are commonly related to experiences of loss or separation, most often to various forms of loss of love. Sometimes these losses can be easily related to particular events in a person’s life, such as loss of a partner, job or social position, but sometimes the loss is more difficult to pin down, relating to earlier experiences of life and love which the person still carries with them. Psychoanalytic therapy involves an honest self-reflecting on the ideals and motivations that may not at first glance seem to be connected with depression, but may be indirectly contributing to the pervading sense of unhappiness. Depression, as a catch all term, often masks other difficulties, and through the therapy process such connections can be brought out and examined in the light.
Modern medicine sees anxiety as an irrational fear to be tranquilized by pharmaceutical drugs. Psychoanalytic therapy takes a radically different approach. Although the object of anxiety might not be obvious at first sight, this approach understands that there is a cause in the background of a person’s life which, through self-exploration, can be localised and brought to light.
Anxiety in any of its forms is taken as a signal that there is some aspect of a person’s life that needs to be addressed and potentially changed. We can generally agree upon what is involved in the experience of anxiety, however, the particular quality of the affective life of a person is unique. Psychoanalytic therapy explores the specific feelings that a person reports, including the timing of particular episodes of anxiety and the onset or diminishing of anxious moods. Through such exploration the therapy attempts to find relations and links to the wider context of a person’s life and history which might have contributed to the ‘cause’ of anxiety. Investigating the seemingly irrational or coincidental experiences and aiming at specific underlying causes, psychoanalytic therapy works to uncover the hidden thoughts and fantasies that give rise to such anxious feelings. Psychoanalytic therapy while not disregarding the symptoms of anxiety, works through exploration of a person’s life history and events. Often predisposition to anxiety is rooted in early experiences and forgotten traumas and so psychoanalytic therapy seeks to make links between present symptoms and the past. Anxiety states diminish as we discover hidden meanings and begin to make sense of the experience.
Rational fears are the kind of fears which are generally related to some more or less present danger which may threaten one. These are the kind of dangers or threats for which most of us would agree such fears are expedient. However fears can often be irrational and crystallize into what are clinically known as phobias. All kind of fears either stop us from doing something or make us set up some kind of defence to counter the danger. Shyness can be limiting in a person’s life, and understanding why it is so, or how it functions, can be liberating. In advanced phobias strategies of avoidance and inhibition can have a marked adverse effect in a person’s life.
Depending on the quality and context of the fears, worries, or phobia, psychoanalytic therapy works by placing any such experiences into context. Rational fears can be addressed though developing the courage to face up to these life experiences, through putting such fears in perspective. Irrational fears and phobias can be addressed through exploring the function and meaning that these take on in a person’s life. Psychoanalytic therapy works by investigating the hidden sources of these fears and inhibitions, the sense that people make of their experiences, and attempting to find alternative strategies if a phobia is too pervasive and disruptive in a person’s life.
These emotions are often rooted in fear of abandonment by another. Whilst jealousy and envy in small amounts might be seen as protective of a relationship or possession, and serving a certain function within that relationship, these forms of emotion can easily bring with them suspicion, dishonesty and paranoid ideas and feelings. Some jealousies, for example, can be clearly seen to derive from a particular behaviour or stance of a partner, yet often feelings of jealousy grow out of all proportion. Jealousy and envy can be experienced as powerfully pervasive yet without really being able to say why one is so jealous or envious, seeing oneself that the response is overwrought, yet not being able to release or assuage the feeling. The threat of losing something or someone, becomes so great, and affects ones interactions to such a degree, that the jealousy itself becomes the factor which precipitates the loss.
When confronted with loss and threat of losing something we love, psychoanalytic therapy works to analyse what is at stake in this experience of fear of abandonment or the loss of love. Through in depth exploration of the issues and problems the therapeutic work seeks to find answers to the question of why a person can become irrationally jealous or envious of others and seem to seek to destroy the very thing she or he holds dearest. Psychoanalytic therapy can also help identify patterns and repetitions in relationships, placing these in relation to earlier experiences of lack, loss and love. Focusing on patterns of thinking and behaviour and reflecting on the ‘emotional logic’ which may be involved, psychoanalytic work explores questions of self-image, identification and desire, which may contribute to jealousy and envy. This exploration involves a re-examination of a person’s life history and its wider context, including a person’s family background. Reflective distance within the therapeutic work often provides important clues, derived from earlier examples, of the kinds of emotional and relational difficulties being experienced in the present.
Psychoanalytic therapy offers a non judgemental, honest and safe arena in which to possibly put such difficulties into words. Often it is the first time that a person has had the opportunity to try to speak openly and honestly about their desire or its lack, their satisfaction of lack thereof. Psychoanalytic therapy does not seek to normalise, or fit people into set categories or mould desire so that it would be more ‘socially acceptable’. Difficulties in sexual relationships and love relationships are often experienced as rooted in hidden earlier difficulties in a person’s life. Psychoanalytic therapy seeks to uncover these earlier patterns and behaviours in order to attempt to throw some light on the present. To be able to speak about things in confidence which concern intimacy with another, and yet to someone not directly involved in the person’s relationships, can allow a reflective distance and contextualisation of the difficulties within a person’s life, desires and loves.
Obsessive thinking and compulsive actions are understood in modern medicine, and in some forms of psychotherapy, as indicative of a specific ‘psychological disorder’ or form of ‘mental illness’ which has been labelled obsessive-compulsive disorder (usually abbreviated to OCD). These repetitive thoughts and actions which force themselves upon a person as having to be carried out in a particular manner at a particular time, are taken to be illogical, irrational and mistaken ways of behaving, and which need to be corrected through a person coming to see the error of their ways, learning to think more rational and positive thoughts, and challenging themselves to stop their repetitive rituals or routines through behavioural conditioning. Whilst some people find such approaches useful in the short term, more often than not, through attempting to remove the surface symptoms, or force a different way of thinking or recognise a ‘wrong emotion’, such approaches just displace the problem elsewhere in a person’s life. Many people experience obsessive thought patterns or worries and also develop routines and rituals. For some people however obsessions can become so pronounced and the compulsion to perform repetitive acts so irresistible, that these can have seriously detrimental effects on a person life. Obsessions, obsessive thinking or worrying tends to indicate a manner of being stuck or of going around in circles, and are often associated with feelings of anxiety and guilt, the source of which is either obscure or completely unknown by the person experiencing such obsessive thought. These thoughts are often seen as intrusive and critical and can in some cases verge on feelings of paranoia. Compulsive actions are often precise routines to be followed exactly and without variation, or personal rituals which demand to be performed. Although experienced by a person as irrational, compulsive actions are experienced as necessary in warding off the danger, and can be a defence, but can also be related to feelings of punishment and expiation. Emotionally exhausting rituals and anxious thinking processes can damage work prospects, personal relationships and self-esteem.
Psychoanalytic therapy takes a different approach than direct symptom removal and challenging of supposedly inappropriate thoughts or feelings. The obsessive thoughts or compulsive actions are seen in terms of the meaning that they have for the person and the function that these have served in their lives, whatever function these ideas and actions served in the past they are now experienced as troublesome and causing their own difficulties. Psychoanalytic therapy seeks the hidden causes and motivations for such thoughts and actions. Through the psychoanalytic work we investigate the background and wider life context in which the thoughts and actions have their purpose, and explore possible alternative strategies. The approach involves seeking out the roots of the anxiety, which is often related to internalised ideals and injunctions, often to be found in early childhood experiences and fantasies.
Memory and sleep are often disturbed, and yet the person may have only a vague understanding of what might have led to the difficulties. Trauma may be related to early sexual experiences and may have involved abuse or manipulation by adults or older children. However trauma might also be experienced related to more recent disturbing events in a person life, for example related to sexual experiences or being the victim of violence or crime. Shame and guilt are also often associated with such experiences and anxieties, and a person often takes upon themselves the blame or responsibility for what happened. Trauma seems to lead a person into an experience of ‘impossibility’ in which they feel stuck and unable to escape from the fears and anxieties generated by the original traumatic experience.
Psychoanalytic therapy addresses the complexity of traumatic experiences and does not start from the perspective that trauma can be understood as a distinct disorder such as the well known ‘Post Traumatic Stress Disorder’ (or PTSD). Instead, psychoanalytic therapy recognises the difficulties in bringing the trauma to speech and the disruption of memory which may be involved, and it explores the depth of the life situation of a person, exploring the ideas and ideals and sense of betrayal or confusion involved. Through assisting in bringing the ‘unspoken’ into language, and exploring different aspects of the traumatic past situation, the therapy helps a person in situating this within their life and relationships. Through understanding and building the significance around a traumatic experience, psychoanalytic therapy works to alleviate the ‘meaningless’ repetition of anxiety states and other disturbances which adversely affect a person’s life in the present.
Often we have internalised the views of others concerning what or who we should be, or what makes us successful. Feelings of being worthless or lacking in some way in comparison to others almost always relates to issues of image, whether self image, body image or ‘ego’, and to questions of identity and belonging. Although it is a ‘catch all’ term low self esteem does relate more often than not to other life problems. Such difficulties can involve an overly critical or negative view of oneself, feelings of insecurity in social settings and in relationships, or suffering from a chronic lack of confidence. Low self-esteem can manifest in social or personal withdrawal, leading to feelings of anxiety and depression, or an excessive need to be liked. A negative self-image is only ever presented in comparison with a perceived ideal, either by comparing oneself with an idealised version of oneself, or by citing an ideal that others achieve but which the person him or herself considers themselves incapable of achieving. Problems with self esteem can lead to harmful actions or activities with respect to oneself and one’s body image. Questions of identity and belonging can be confusing and lead to feelings of social isolation and exclusion if left unaddressed. Issues related to gender identity, sexuality, and sexual desire, can be closely bound up with these questions of self value and worth.
Psychoanalytic therapy explores the person’s ideals and attempts to connect these to feelings of low self-esteem. It leads to question concerning the relation to the viewpoint of others which might be involved and internalised. Through exploring processes of identification which have led to certain view of the self and others, through questioning ideas and ideals related to self image and ability, psychoanalytic therapy seeks to find a way beyond these alienating blockages. Through investigating the source of our ideals and self image, many of which may have been internalised in childhood or adolescence, confidence in finding a unique and personal solution to questions of image and identity may begin to grow.
We often either ignore or minimise the signs of stress as contemporary culture and media tells us that we should be able to cope, that others can bear it so why not us, and that being ‘stressed’ is normal. We are constantly bombarded with messages in the modern world to succeed, to achieve, to compete with others, and threatened that if we do not do so we will end up a failure, perhaps losing jobs or damaging relationships. Advertising and glossy magazines constantly inform us of what we are lacking and what we should aspire to. We are scrutinised and tested in every corner of our lives, rated and berated by commercial interests and media propaganda. For many people simply making ends meet on a daily and weekly basis is in itself stressful. However the signs of stress should not be ignored, as these are often indications that something needs to change in a person life, that something is out of balance, and if not addressed could lead to more serious breakdown in the future.
Psychoanalytic therapy works by fostering a space in a person’s life where all these issues can be openly and honestly addressed. The causes or a person’s stressful life or reactions can be acknowledge and recognised, and the deeper issues of value and life aims can be evaluated. Through a discussion of the complexity of a person’s life and desire, psychoanalytic therapy explores the ideals and ideas which constrain or maintain a person’s horizons, and helps the person to discover their own unique solutions to their problems. Many people experience fairly quickly a notable decrease in the reaction of stress through engaging in psychoanalytic work and beginning to articulate their difficulties to someone who is prepared to give them the time to listen.
Psychoanalytic therapy does not rest with the overly simplistic and widely accepted talk of a supposed ‘addictive personality’. The issues involved are far more complex and deeply rooted. Psychoanalytic therapy explores the complexity of the issue involved, such as, why this particular addiction, in this manner, and at this point in a person life? Through exploring the issues of desire and enjoyment, pleasures and fantasies, involved in the addictive behaviour or relation, psychoanalysis allows for a reassessment of the place a particular substance, object or thing occupies in a person’s life, the function it may serve, and explores possible solutions through reflecting upon the origin of the addiction within the context o a person wider life. Understanding the deeper psychological problems involved can lead to radical changes in addictive behaviours and positive moves beyond reliance upon the addictive object or substance. Psychoanalytic therapy can also be useful in support of programmes of ‘abstinence’ where the addiction involves a substance which forms patterns of physiological dependence.
With the diminishing power of traditional systems of belief and the standard answers to such existential questions as ‘why am I here…?’ or ‘what is all this for…?’, people are often set adrift amid the many alternative and competing voices which might provide the beginning of an answer. With the evaporation of traditional certainties and growing complaisance about asking really meaningful question about life, we are inevitably thrust into anxiety over who we are and what we have done with our lives, what we might hope for and what we ought to do in the future. While many people manage to fit together their own way of answering such questions, and get by with makeshift constructions, others are left floundering with a pervasive sense of lack of meaning and direction in life. Engaging in a process in which these issues are taken seriously and thought about, can have transformative effects in a person’s life. It is often discovered through this process that such malaise is rooted in deeper problems and dilemmas going all the way back to childhood. But questions of hope and meaning are also relevant for everyone as we face the process of ageing and related changes in life and expectations.
Psychoanalytic therapy can be beneficial with such problems offering a non-judgemental and free space in which to explore these questions, sift through decisions and responses, and engage with the personal issues of hopelessness and meaninglessness so prevalent today. Psychoanalytic therapy does not claim to have the answers to the meaning of life, the universe, and everything, yet through engaging in a self-reflective and explorative dialogue, the process can lead to a rediscovery of hope and meaning in a person’s life, and a clearing up of confusion. Psychoanalytic work can involve asking the ‘big’ questions concerning one’s life, loves and hopes. It is even one of the few ‘spaces’ left within contemporary society in which such questioning is fundamentally encouraged.
Psychoanalytic therapy addresses the deeper structure of the anger, rather than attempting to remove or cover over the surface symptoms. If the deeper causes of a generally angry feeling or stance within the world are left unaddressed, any removal of surface manifestation will only later re-emerge in other ways and forms. Anger itself is often difficult to speak about and to put into words leading to the predominance of ‘actions’, destructive behaviours and sudden outbreaks which can lead a person into difficulties in their relationships and social engagement. Through an open and broad ranging discussion of the roots and causes of the specific manifestations of anger in a person’s life, exploring in-depth the issues and history of experiences of anger, psychoanalytic therapy, works to find a way to either direct anger in a more positive way, or to transform the energy involved in the anger into less destructive and more productive emotional responses.