Psychoanalysis & Psychotherapy in London

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:

Common issues

Depression, pervasive and deep feelings of unhappiness, overwhelming sadness, or simply being ‘blue’ or ‘down’ affect many people at various moments in life. Sometimes we are not even aware of what it is about our lives or relationships which lead us to feel this way. Such feelings are often associated with hopelessness and a sense of powerlessness to make positive changes. When people describe their experience of depression they often complain of apathy, listlessness, emotional fragility, social difficulties, problems with sleeping, loss of motivation, pessimism, despair, irritability, suicidal thoughts, loss of appetite, diminishment of the sexual desire, a sense of failure and lack of energy.

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.

Anxiety, whether lurking in the background of the mind, more generally pervasive, or localised in sudden panic attacks, can be debilitating in a person’s life. It is often experienced as an underlying feeling, bubbling away and disturbing every waking moment, as well as having the potential to suddenly unleash its full potential in the form of panic, and in associated bodily reactions. Anxiety is different from fear, which is usually a rational reaction to a known danger. With anxiety, it is often unclear what it is that a person is anxious about. The experience of anxiety seems to arise ‘from nowhere’. Many people in the modern world seem to experience anxiety to a lesser or greater degree, yet for some people this affect becomes overwhelming. Anxiety in many ways is worse than fear, because, where the cause is not apparent there is no obvious ‘dangerous object’ to defend oneself against, or to escape from. Describing their experiences of anxiety people often also mention fears and worries, nervousness, claustrophobic feelings, social phobia or over-concern with what people think about them, fear of losing a loved one, about making a mistake, of losing control, and depersonalisation or ‘loss of reality’. Anxiety is also often associated with bodily affects such as increased heart rate and breathing, sweating, difficulties in sleep, and palpitations.

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.

Fears, nervousness, and phobias
Fear and worry may become predominant in a person’s emotional life leading to inhibitions and social and relationship problems. These problems are often described as forms of shyness, being overly ‘introverted’ or nervous. Fears may be more or less rational. Fears around performance, producing, and creating are particularly prevalent in modern life.

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.

Jealousy, envy, and greed
We all feel some degree of jealousy, envy and greed at certain moments in life. Occasionally it can happen that these so called ‘green’ emotions become so pervasive and all consuming that they can have serious detrimental effects upon ones relationships and personal life. These emotions are often found in love and sexual relationships, and if left to develop unchecked may have damaging effects within these relationships leading to breakups and other difficulties.
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.

Relationship and sexual problems
Sexual and associated relationship problems are what often lead a person to seek out some kind of therapeutic help. This area of our lives is often that which is most difficult to openly talk about, and the emotions and desires involved can often be difficult to put into words even when we would like to do so. It is an area of life that many people find it difficult to discuss openly and honestly with their partner. Sexual difficulties can generally be separated into two different areas in which problems might arise. There are problems with sexual function or performance, and problems associated with sexual desire itself. Difficulties in other aspects of a relationship can often have adverse effects in relation to sexual desire and intimacy, and conversely, difficulties which remain unaddressed in the sexual aspect of a relationship can cause serious problems in other aspects of a relationship. Many people can experience difficulties in reconciling sexual desire and love at various points in their life. Sexual problems and relationship difficulties can also link in to questions of identity and belonging, self and body image.

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.

Obsessions and compulsions
People describe a wide range of obsessions and compulsions. Obsessive thoughts are often about being intruded upon, or violated, being responsible for something or guilty about something which one may or may not have even done, whilst compulsive actions often crystallize around rituals of cleaning, washing, repeated checking, strange movements of the body, motions or gestures and touching certain things at certain times in certain ways.

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.

Sexual and emotional trauma
Trauma refers to experiences which may have been more or less shocking at the time of the ‘wounding’, or may involve fear, intimidation, or manipulation over a period of time, but which in either case has led to difficulties in trusting others and oneself, repetitive disturbances of memory or attention, and a range of anxiety states. Trauma almost always refers to certain experiences concerning which a person simply cannot find the meaning, cannot assimilate into their world or understand the significance of. Traumatic experiences, particularly those that have occurred at a young age, are traumatic not simply in terms of the contingent details of the incidents or relationships but that the person undergoing the experiences at the time lacks the emotional and conceptual tools to make sense of and process the experience. Literally such experiences have occurred at a point in time at which the words were lacking, or effect a person to such a degree that they lose faith in words as being able to relate that which is traumatic. This is all the more the case when abusive relationships, whether sexually, physically or emotionally abusive, have featured those who were supposed to care for and protect.

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.

Self-esteem, image and identity issues
When a person begins to talk about their difficulties they will often say they suffer from ‘low self-esteem’. Self esteem can cover a wide range of issues and difficulties involving our understanding of our situation with respect to others as well as to expectations and ideals that others might hold about us.

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.

The contemporary world, it seems is becoming, for many people, increasingly stressful, and many attribute other difficulties or issues in their lives to ‘stress’. Stress is a reaction to emotional or physical overstrain, to increased pressure in a particular area of life or more generally. Stress is recognised as a reaction, often physical, to something with which we have difficulty coping or bearing, to a demand which is made upon us or which we address to ourselves. However, stress is insidious as it is often not experienced as a conscious phenomenon, but can build up, either leading to tension and bodily aches and pains, possibly contributing to physical illness, or in the background of the mind, leading to mental fatigue, exhaustion, or even mental collapse.

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.

An addiction or addictive behaviour is a relation of consumption or use to a source of pleasure or object over which the addicted person feels that they have no control or will power. Many people rely on objects or substances at various points in their lives, or within specific areas of their lives, to aid in relaxation or enjoyment. However such a thing, substance or object becomes addictive when a person orientates their life completely around the object. Everything else in the person’s life then take on second place or a subsidiary existence with respect to the substance or object at the centre of the addiction. This is when the use of substances such as drugs or alcohol, or the use of pornography or the use of computer games or media becomes problematic either for the person considered to be addicted, or more frequently, by their friends, family, or relations. The range of things which people can become addicted to are fairly wide, but these often involve short circuits to pleasure or supposed achievements and can often involve ‘instant gratification’ which quickly fades and then seeks to be repeated. Drugs, alcohol, sex, food or no food, computer screens and media devices, exercise, collections or accumulations of various kinds, adrenaline, are just some of the many things to which a person can develop an addiction. A powerful addiction can take on a parasitic role in a person life and ‘breaking’ an addiction can rarely be achieved without some kind of external help or intervention.

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.

Hopelessness, meaninglessness, confusion
No complaint is more prevalent or pervasive in the modern world, and encountered so often in the psychoanalytic therapy setting, than that of hopelessness, meaninglessness, and confusion. This is often formulated in an initial complaint with respect to who we are, where we might come from, and where we are going in life. Such ‘existential malaise’ hangs over many people like a dark cloud, rendering life difficult and unfulfilling.
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.

No emotion is more destructive than anger, yet anger, if controlled and directed can also be motivating for change. While there may be many legitimate reasons to be angry with this or that aspect of life and the world, the kind of anger that leads people into psychoanalytic therapy is usually that which cannot be related to a rational cause, or that seems to grow our of all proportion to a supposed cause. Anger can lead us to make changes in certain aspects of our lives or attempt to effect change in the world, yet more often than not, anger becomes a consuming force, festering away, sometimes below the surface, and is just waiting to explode when the occasion permits. For many people anger is an underlying emotional colouring of their affective life, without knowing the whys and wherefore of the anger, a sense of irritation and what people sometimes call having a ‘short fuse’. Anger can come over a person and cloud their vision, an experience which is popularly known as ‘seeing red’. Many people are angry yet are unable to say definitively what that anger is about, or where it comes from. In such cases angry outbursts can surface in a person’s life, often misdirected at loved ones, partners, relatives, or work colleagues, but just as often turned back upon oneself. People often describe themselves or others as having ‘anger issues’ and needing ‘anger counselling’ or to attend classes in ‘anger management’. While such endeavours are all well and good, they do not address the underlying causes and deeper motivating issues involved. Unaddressed anger can be rooted in childhood experiences and limitations, such reactions are often inscribed at the level of the body, and communicated through a person’s posture or general tone.

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.