Tag Archives: therapy

“And I guess that’s why they call it the blues..”

Standard

Wow, it feels like yesterday that I looked at the calender and we were headed into February and my thought then was “wow, cant believe we are entering the 2nd month of the year already!” Its now 7 months down the line, I wipe my eyes and have to look again to realise there are only two and a half months left of this year! Its incredible how fast time flies by.

On the other hand I am also encountering more and more people who feel they have literally dragged themselves through the year, or are finding it increasingly difficult to get motivated and struggle to feel the end of year excitement the way many of us do. Common complaints are feeling demotivated, feeling sluggish, not in the mood to be around people, sleeping poorly and feeling tired all day as well as the occasional feeling of tearfulness. A general dissatisfaction with the way things are and an inability to find the joy in daily activities that used to be enjoyable.

Well my friends – that’s why they call it the blues, and it sounds a whole lot like Major Depression to me. In chatting with many of these people there seems to be a resistance to admitting they may be facing depression, or a resistance to getting the necessary treatment. So I figured I’d spend some time on the issue here and hopefully clear up some misunderstandings.

Let’s first look at the symptoms of depression:

  • Feeling tearful or “down” more often than not
  • Disturbances in sleep – particularly waking up in the early hours and unable to fall asleep again
  • Disturbances in appetite – either over-eating, or a lack of appetite (sometimes weight gain and weight loss)
  • Decrease in energy – feeling sluggish and fatigued
  • Social withdrawal and a preference to be alone
  • Inability to find joy in previously pleasurable activities
  • Feelings of hopelessness and helplessness
  • Thoughts of suicide (more present in severe depression)
  • Indecisiveness
  • Loss of concentration and inability to sustain attention
  • Low libido

Now, if you’ve been feeling most of these symptoms for a month or more, it is more than probable that you are actually struggling with a major depressive episode (that’s the fancy psychiatric name for depression). The really important thing to remember here is that depression is as much a physical illness as pneumonia, or diabetes is and deserves the right treatment too.

What actually happens when you are depressed (“depressed” in the sense of experiencing a major depressive episode – not “depressed” in the general term used when feeling sad)?

anti-depressant Well, to put it briefly and simply – our brains send messages from transmitting neurons to receiving neurons via chemicals known as neurotransmitters. Amongst the 30 odd neurotransmitters found in the brain, serotonin, dopamine and norepinephrine have been associated with emotional regulation, reactions to stress, and the physical drives of sleep, appetite, and sexuality. As a result, anti-depressants function to regulate the amount of a specific neurotransmitters in the brain – some anti-depressants such as SSRI (selective serotonin re-uptake inhibitors) work with serotonin only, while others affect the dopamine levels.

While there does appear to be a very strong relationship between neurotransmitter levels and clinical depression, and that anti-depressants are highly effective for the majority of people, we can still not be 100% certain of the actual relationship between neurotransmitters and depression.

As a result, psychotherapy and a variety of other management techniques are also effective in the treatment of depressive episodes. – Here are a few really important aspects in managing and treating your depression:

  1. EXERCISE EXERCISE EXERCISE: Despite that lethargic, de-motivated, and energy-less feeling you have, the irony of it is that dragging your bum to the gym, or going for a walk actually increases your energy levels, allows for the release of some endorphins and generally gets you feeling better. Besides the health benefits of exercise – its a great way to feel good about yourself when you have actually accomplished something
  2. SLEEP! again, despite the lethargic feeling, try not to stay in bed past your waking up time, try not to have afternoon naps. Get 6-8 hours of sleep per night – no more and no less. Sleep regulation with an exercise programme will do wonders for your mood.
  3. DIET: Its easy to get into the comfort eating mode, wanting “feel good foods” like ice cream, cakes and chocolate. Believe me, engaging in healthy foods is going to help your blood-sugar levels, regulate your energy and generally assist in feeling better about yourself. Make sure you are getting enough vitamin B’s (the full range are excellent in managing depression)
  4. SELF CARE: you deserve to take care of yourself and do nice things for yourself. If you had flu, you would take time out and rest. So, if you feel like you need some time out – take it, but don’t get caught in a loop of self-pity and wallowing – rather take the time to get active in gym, eat healthy and tackle that old hobby you had put aside ages ago.
  5. FIND SUPPORT: talk to your friends and family about how you are feeling and let them take you out occasionally. Don’t shy away from social interaction – isolation and loneliness only feeds the depression
  6. And if all else fails – visit a psychologist! 🙂

treating depression

 

Oh yes, and with summer fast approaching (well here in South Africa) don’t be afraid of getting a little sun – it really does energise and gets your lust for life going!

 

“Happiness and sadness run parallel to each other.  When one takes a rest, the other one tends to take up the slack.”  ~Hazelmarie Elliott (“Mattie”)

 

Advertisements

Take Off Your Boxing Gloves – Advice for couples part II

Standard

We have all had it in our relationships – you start discussing point A, your partner hears you say B and before you know it you are arguing about Z (having worked your way right through the alphabet!). A small issue about wet towels becomes a huge argument about in-laws and everything in between so that you no longer remember what the point of all this was and you’re left feeling much angrier than when you started! This miscommunication when discussing issues in relationships is universal. Everyone has experienced it and no one knows why it happens! But ladies, lets admit it – half the time we also expect our men to just know what we mean, to intuit the fact that right now we need them to hug us, or for them to have psychically understood that the dishes were supposed to have been done already and that is why we are irritated. 😉

Why is it, in our closest relationships, we just don’t come out and ask for what we need? I mean, lets face it, most arguments are born from an unmet need. Usually a need to be loved, or a need for closeness. All relationships have these issues, and the longer you’re in that relationship, the more you come to realise that there are some issues that, no matter how many times they are revisited, they just never really get solved. Some couples begin to feel frustrated – begin to believe that their relationship is faulty, that their partner just doesn’t want to change, or hear them.

Well, the news here folks is that all relationships have problems and, whats more, all relationships have perpetual problems. After all, some wise person did say that “marriage is choosing a set of problems that you are willing to work through for the rest of your life”. The “faultiness” comes in when those problems become stuck and you are no longer able to discuss them.

So today we are going to look at some techniques that keep arguments on course (instead of wafting through a number of issues that are not relevant to the point). Techniques that keep arguments fair and respectful, and lastly, some techniques that will help both partners feel like the issue has been resolved (if only for a short while).

The first thing to keep in mind is your approach. If you are the one carrying around an issue that needs discussing, keep your approach gentle. Bulldozing in there with arms flailing, raised voice and a whole sack load of accusations is only going to make your partner cower in fear, or throw up the armour – either way you would have lost him/her. Your approach needs to be gentle.

  • Instead of an accusation, rather make the statement about you – Crouching issues in criticisms is simply not O.K. So instead of “you’re a horrible husband – you always ignore me” try saying “I feel really alone when you seem to ignore me”.
  • Keep it concise – no one is going to want to listen to a whole barrage of issues and evidence for their faults being slung at them. Its really hard to hear a complaint that goes on and on…Deal with one issue at a time and try not to hoard all your partner’s ‘wrong doings’ as proof of what a ‘terrible person’ they are.
  • If you can, try start with something positive. so instead of starting with “you always watch TV and never talk to me anymore” try “It was so nice when you sat chatting with me last week, I wish we could do more of that”. This isn’t always an easy point to remember – especially when you’re feeling angry. But try it folks – it works wonders! Sometimes it even sidesteps an argument altogether!
  • Talk clearly about what you need. Instead of “this kitchen is a mess!” (and then stomping around a little), try saying “I’d like some help cleaning the kitchen”. Your partner is not psychic and cannot always intuit your deepest needs – using subtle hints is bound to leave you disappointed.
  • Be polite – you don’t need to be nasty when complaining or requesting something. Using words like “please” and “I’d appreciate it..” makes your requests/complaints much easier to swallow.

Once you’ve made your approach, give your partner time to respond. The response should always include a little empathy. Try to find at least one thing that you can agree with. Accepting some of what your partner is saying allows you to remain connected during the issue. Remember you dont have to agree with his/her point in total, just a small part of what is being said. How about an example?:

Rob says (with a gentle approach because he read this blog beforehand :)) “Sue, I loved it when you came to watch my rugby match last week. It is a little disappointing that you refuse to come along ever again” Now Sue says “Mmm, it was nice being with you (see how she accepts this), but its really boring for me to just sit there on my own – you never come to my functions”. Now its Rob’s turn: “Maybe it is boring (see how he accepts this) but its only for an hour and then we are all together afterwards having fun, your functions go on for hours!”

I’m sure you get the point, The discussion may very well turn into an argument about a perpetual issue – namely that Sue is always supporting Rob, but isn’t feeling very supported herself. Maintaining some acceptance of your partner’s viewpoint will assist in both partner’s feeling heard and understood. Should things get a little heated, however, the next point is super important.

Watch out for becoming emotionally overwhelmed. Basically if you start to feel tense, holding your breath, clenching fists, raising your voice, stopping eye contact, or feeling really angry – you are getting overwhelmed. Research shows that when your pulse reaches 100bpm you are actually no longer capable of being rational (Gottman,1999). This is as good a time as any to call “time out” and cool off. Take a 30 minute breather, go for a walk and calm down. Make sure, though, that you are thinking about what your partner is trying to say, rather than self righteously reiterating your point to yourself. When you get back – start from the top with a gentle approach and see if you cant work things out this time.

Lastly – compromise. Make sure you have accepted some of what your partner is telling you and that you communicate what you intend to do differently next time. They should do the same. Make sure that neither of you are compromising too much – a compromise that amounts to a sacrifice will often end in resentment. So for example, if Rob were to give up his rugby for Sue – that would be a sacrifice. However, if he were to play rugby twice a month instead of every week so he could attend some of her functions – that would be a compromise.

The goal of any discussion / argument is to reach a compromise where both feel heard, understood and are willing to try meet the other one’s needs.

So there we have it friends – 4 steps to conflict resolution:

  1. Gentle approach
  2. Acceptance / empathy
  3. Avoid becoming emotionally overwhelmed and take time out
  4. Compromise

Till the next time:

“The biggest mistake is believing there is one right way to listen, to talk, to have a conversation — or a relationship.” – Deborah Tannen

The “D” Word – Dealing With Divorce

Standard

Recently, I have found that the topic of divorce has been popping up in various conversations. It’s strange how you can go for months without hearing anyone talk about it, and then suddenly, it’s all you hear about – the “D” word. So I thought it would be relevant (and useful) to discuss some issues relating to the process of divorce and how to help children deal with it – because, lets face it, the kids are the victims here.

No one gets married with the option of divorcing – we all have stars in our eyes and huge hopes for the future when the knot is tied. Down the line, we even have kids and continue to hope and dream about their futures. However, in some cases (more these days than in the past – but that’s another topic for another day) these dreams and hopes begin to dim as the discord in the marriage increases. Today’s post is not going to deal with why and how this happens – but suffice to say that more and more marriages these days are on the rocks and headed for divorce, leaving a wake of collateral damage called children. So how can we make things easier for them?

In 8 easy points I will sum it up for you:

  1. First things first – be honest and communicate clearly! Depending on the age of the child, it is essential that you explain to them from the start what is happening and ensure they understand that it is NOT THEIR FAULT! This is something that you are more than likely going to have to repeat, because for some reason, kids always think they are to blame – so keep reassuring them that this is your mess, not theirs.
  1. Clearly explain the changes that will be taking place – everything from where they will be living, to whether or not they will still get to watch Ben10 on T.V. They need to be fully aware of the transition to make it less scary for them.
  1. Allow them to discuss their feelings with you. Create a space where it is OK for them to feel sad, scared, and even angry at you or your ex. Validate their feelings and reassure them that none of this changes how much you love them. Allow them to express wishes for you to reunite again – validate this wish, but make sure you also explain the finality of the decision.
  1. Remain civil and polite with your ex, especially in front of your children. This is a really important one, so listen up. Do not bad mouth your ex to your kids, do not blame, be angry at or lay guilt trips on your ex in front of the kids. Do not ask your kids to “report back” on your ex after visiting them and, ultimately, do not ask them to choose sides, or who they want to live with! Again, the dissolution of your marriage is your own doing and has nothing to do with the kids – they love each parent equally and should not be put in a position of having to break loyalty with either.
  1. Another really important issue – do not use your kids as emotional support. Having lost your partner and now, possibly, being on your own, makes it easy to lean on your kids for support. This often results in lasting damage and goes against the grain of parenting. Your kids need you to be the emotional support. They should not see you cry, they should not have you confide in them – let them keep the illusion that you are superhuman and can heal all hurts! They will need this especially during this time.
  1. Keep consistency in routine, rules and discipline. Make sure that homework times, meal times and bed times are adhered to. Ensure that rules that once were in the family unit still remain, as should methods of discipline. If you grounded your children before for coming home after a curfew, then continue this! Leniency and being spoilt does not make things easier for kids. Ensure that both you and your ex instil these consistent boundaries. While children often kick up against the rules, consistent boundaries and routines enable them to feel safe and secure, so you will, in fact, be doing them a service!
  1. Never ever say things like “you are so naughty – no wonder your mother left!” or “if you do that again I will send you to live with your father, he can have you”. If you are saying things like this, you might need to examine your own management of the situation and ask whether you are taking it out on your child.
  1. Lastly, seek support for yourself. This is a stressful time and a transition that is fraught with pain and guilt. If you do not seek help, or support, you are likely to let the emotional stress from the divorce spill out and over into your relationship with your kids. You might find yourself irritable, snappy and even saying hurtful things. This is a vulnerable time for you as well as your children and it is essential that you deal with it gently and sensitively.

And as a survivor of divorce has also noted:

If, despite your best efforts, you fail at some of the above, some of the time – don’t be too hard on yourself, you are only human after-all! Pick yourself up – get the support you require and try, try again…

So, if you are getting a divorce, have had a divorce, or simply know someone that is going through a divorce – keep the above in mind. They are simple guidelines that can make the world of difference and spare kids unnecessary heartache.

Till next time, remember…

“It is easier to be wise for others than for ourselves.”
Francois De La Rochefoucauld

P.S. as usual, please feel free to post comments, or questions – or even ideas for future topics!

Really – they study for 6 years? What for?

Standard

I thought a nice follow on to the last post (What actually happens in therapy?) would be to look at the different models / theories that are used to guide the therapy. Yes, folks, this is where the “work” lies and the bits that keep psychologists studying for 6 years!!! As mentioned, we’re not all about the “chatting” in therapy – there is some very real work that happens, some deep talking that occurs, but just what you talk about is very much informed and guided by the therapist’s choice of theory.

So here is the breakdown.

There are many methods / models of therapy. To name a few, Cognitive Behavioural Therapy, Psychodynamic Psychotherapy, Interpersonal Therapy, Emotion Focused Therapy, Strategic Therapy, Narrative Therapy and many more. For the purposes here, I am really only going to discuss the ones that I use most often, but you would be well within your rights to find out what your psychologist uses and how it all works!

(Disclaimer: what follows is a very simplified version of what actually goes down in the session)

CBT = Cognitive Behavioural Therapy:

This is a very common form of therapy and extremely useful in treating conditions such as Anxiety, Social Phobia, Specific Phobias, Depression, Obsessive Compulsive Disorder, Stress Management and many many more. It is a far more directive form of therapy that includes homework assignments and ‘experiments’. In fact, CBT is a time limited form of therapy that has a very specific goal and definite steps in attaining this goal.  The focus here is on your thoughts (the “cognitive” part of the name) and how these affect your feelings and in turn your behaviour (the “behavioural” part of the name).  It all looks something like this:The Cognitive TriangleSo, if our conditions such as Anxiety, Depression, Phobias, Panic attacks etc all manifest behaviourally, then it would make sense for us to target our thoughts first, right? Need an example?

OK, let give an example of Depression… some thoughts you may have had could be: “Im not coping in my job” “I’m a useless mother”, “Im a useless father / wife / husband etc”, “No one likes me”, “I cant do this” etc etc etc. Feelings that would automatically follow thoughts like these would include loneliness, sadness, feeling useless and unloved etc. As a result, your behaviour would not be one of prouncing joy – no, you would probably stay in bed, cry, not want to go out and see people, not try very hard at work, become demotivated etc. Now, here is the important part – this behaviour CONFIRMS your thoughts – i.e.: not trying hard at work would probably lead to you not getting everything done and, therefore, feeling like you cant cope. Not getting out of bed, crying a lot and not wanting to see people would lead to you isolating yourself, not looking your best and essentially feed back into thoughts such as “no one likes me”, “I am a useless mother / father / wife / husband”… AND THUS THE CYCLE BEGINS! CBT therefore focuses on breaking this cycle by examining your thoughts and exploring how these are affecting your feelings and behaviour! Your psychologist will give you homework assignments designed to train you in “catching” your thoughts and challenging your beliefs, as well as relaxation training excercises, thought/worry stopping techniques and stress management methods.

So the next big one is Psychodynamic Therapy – yes, the father here is Freud, but he lost favour years ago and the theory is now informed by more recent theorists that do not place all that much emphasis on the Oedipus Complex 🙂 Where CBT  is a more goal directed form of therapy, Psychodynamic therapy is less time-limited and guided more by the client and his/her associations (this is a fancy word for “talking about whatever comes to mind”). The aim of this model is to uncover how early childhood and formative experiences have shaped how we react and feel about current situations. So the therapy here would require you to talk as freely and openly about your current circumstances, while your psychologist tries to link these experiences with earlier ones and places an emphasis on how you have been shaped by those experiences. Essentially, by uncovering the source of our frustrations, we are often able to think differently about them and, ultimately change the way we feel and react to current ‘curve balls’.psychodynamic cartoon

This is a great form of therapy if you are wanting insight into why you feel or behave in certain ways, insight into your relationship dynamics with your partner, insight into why you keep having the same sort of experiences (you know the case of getting involved with the wrong kind of partner over and over and over again?), or just want some personal growth experiences. Psychodynamic therapy is very explorative and while it has moved on from the “lying on the couch” experience, it still aims to probe the deeper recesses of the mind and uncover the anxieties and defenses we have hidden there.

I think this gives you a pretty good idea of what lies behind the practice of therapy and I certainly don’t want to bombard you with any more information… as usual, however, please feel free to post questions if you are interested in other forms of therapy, or have any comments you would like to make…

Great chatting to ya, until next time remember:

There is only one meaning of life: the act of living itself.” (Erich Fromme)

So, what actually happens in therapy??

Standard

This is a good question, really. It seems the whole concept of “therapy” is shrouded in mystery – not very much information out there regarding what actually happens when you see a psychologist, and those that are in therapy are not likely to discuss it in much detail. I have often been told by others that they would love to have my job as a psychologist – “you get to sit around and chat all day!”

Well, for the most part, there isn’t much “chatting” going on in a therapy session. And it certainly isn’t about making friends! – not for the client and not for the psychologist. In fact the relationship between the client and the therapist is a tricky one, quite different from all other relationships. Firstly, it is a pretty intimate relationship, one where the psychologist gets to be part of a very personal journey of self discovery that is often not shared with others in the client’s life. Very personal thoughts and feelings are explored with the therapist in an entirely confidential and non-judgmental space. As a result, the therapist often gets to know the client in a far more intimate way than others have done in the past. Secondly, it is not a reciprocated relationship. The therapist does not share their own personal stories with the client – in fact in most cases, the client actually knows precious little about the therapist and his/her life. As a result, the relationship can feel quite  one-sided.

So, what actually happens in the therapy session if we are not “chatting” and making friends?

Well, as you can see, the relationship is a very important one, so a large part of the first few sessions is about establishing this relationship. Forming a “working alliance” we call it. Basically the psychologist gets to know the client, while making every effort to leave the client feeling well understood and accepted. This is possibly one of the most important factors in establishing whether therapy will be effective or not. Many great theorists have surmised that the success of therapy is based entirely on the therapeutic relationship and whether or not the client and therapist have made a connection. So, folk, this is important to remember – its no use continuing with a psychologist if you dont feel you can establish a “working alliance” with them.

OK, so now we have the relationship – what else happens?

We TALK! Psychotherapy is known as the “talking cure” and as such, talking forms the basis of what you “do” in therapy. Its what you talk about that makes the difference and this depends largely on the type of therapy being used. (I will deal with different therapy models in more detail in future posts). For now it is suffice to say that the therapy model often depicts the focus of the therapy and what is spoken about. Having said that, however, there is no right and wrong regarding what may and may not be spoken about during therapy. This is YOUR time, an hour that is dedicated solely to you and, consequently, you get to be the leader here. Your therapist might guide you in certain directions, but you have the power to talk about as much or as little as you like. And NO! Your psychologist cannot mind read, or magically pull out your deepest darkest secrets. No, therapy is based on honesty and trust – a space where you come be as honest as you can about things, and in the process learn to trust again… and isn’t that what we all want?

I guess its in the talking, the being honest and the forming of a really important relationship that the details are sorted out. This is where the problems find solutions, the significant relationships with others are restored, the wounds of the past are healed and new coping skills are learnt.

Hopefully this has de-mystified the therapy process a bit for you and given you some encouragment in taking the next step and getting involved…

Till my next post, remember

“A journey of a thousand miles must begin with a single step”