Archive for Mental Health

We’ve got to go through it….

There’s a wonderful children’s picture book by Michael Rosen, ‘We’re Going On A Bear Hunt’, that I think has a message for us all.

We wake every morning preparing to face the stresses of the day. We take a real or metaphorical deep breath, look for the positives, remember our skills and abilities, and search for resilience. We can even understand life as an adventure.

‘We’re going on a bear hunt. We’re going to catch a big one. What a beautiful day! We’re not scared.’
We can all feel the thrill and excitement of risk. There can be an adrenaline rush that comes with sport or travel. Stepping outside our comfort zone can be exhilarating.

But then, of course, the unexpected can happen. Life throws a curve ball and we feel shaken by the challenge of unexpected adversity.

The children in the book, buoyantly setting off on a country walk, are suddenly faced with a number of ‘Uh-uh!’ obstacles that stop them in their tracks. A river, deep mud, long grass, a big dark forest means they have to make a decision as to what to do next.

If they are not to abandon the walk they realise that, ‘We can’t go over it. We can’t go under it. Oh, no. We’ve got to go through it.’

And that is true for us all too. We have to endure and find a way of surviving unexpected and overwhelming events. The ending of a relationship that breaks our heart. Redundancy and sudden financial insecurity that hits like a sledgehammer. Facing gruelling treatment after a frightening medical diagnosis. The loss of a loved one that feels unbearable.

The wonderful illustrations by Helen Oxenbury show the children looking more daunted and worn down by each obstacle. Their energy levels lower as they stumble in the thick forest and struggle through the snow storm. They draw closer and cling on as they try to help each other get through.

Then the children discover that, unlike the fantasy, the reality of an actual bear is terrifying. They race back to the sanctuary of home and leap together into the bed and under the duvet.

When we are facing a devastating situation, or the sheer number of difficult incidents has worn us down and we are peering into the abyss, we all need a sense of a safe haven. At the very time we feel we are free floating, with nothing to ground us, we need to reach out and clutch on. No one can take away the pain, but we need support until we find the resources to manage and cope.

In Jerusalem’s trauma centre, when there has been a catastrophic occurrence, they have found it is essential for the victim’s recovery that close family and friends are immediately brought to the bedside.

We will all have different ways of coping and managing the turmoil. In her book ‘H is for Hawk’ Helen Macdonald describes training a hawk when overcome with grief at the death of her father.

http://www.telegraph.co.uk/culture/books/10989164/H-is-for-Hawk-Helen-Macdonalds-intense-relationship-with-her-goshawk-Mabel.html

Sometimes it can be the counselling room which offers the safe place to begin to let out the pent up agony and find a way to breathe again.

Kathy Rees

Depression and the Couple Relationship

Like many I was impressed with the way in which Prince Harry talked so honestly about the struggles he has had since his mother died and how he came close to a complete breakdown on a number of occasions. Last week’s Mental Health Awareness Week has also made more people aware that in England one in six people will be affected in any given week by a common mental health problem such as anxiety and depression.

Therapists, whether working with individuals or couples, are very familiar with the way in which depression in particular can be the trigger that brings people into our consulting rooms. Historically if you were feeling low and that life wasn’t worth living, you went to your GP who would prescribe anti-depressant medication or counselling or indeed both. The patient might then seek individual counselling or therapy for their malaise. However in working with couples part of the challenge is to explore how the depression as a presenting problem is worked out in the couple relationship – in other words whose depression is it anyway?

Of course the origins of depression are complex and varied. As therapists we are aware of the differing contributions that biology, genes, hormones, seasonal factors, personality, stress and social triggers can make to the onset and maintenance of depression and the fact that these may vary from patient to patient.

Over the last five years, after NICE identified the potential role of couple relationships in triggering, maintaining and resolving depression, an integrative behaviourally based 20 session model has been developed, which is now being made more generally available in IAPT services in the NHS.
What studies have demonstrated is that, in cases of mild to moderate depression, where couples are treated together in therapy, there are significant levels of relief from the depression in the depressed partner. It may be hard for the non-depressed partner to recognise that anything they are doing is making matters worse, but what this model does is to highlight the interaction between the couple as being potentially a contributing factor rather than identifying one of the partners or the depression itself as the problem. By doing this it breaks the vicious cycle that couples find themselves stuck in and often find it impossible to break.

Couple therapy explores how each individuals early attachment patterns and how they learnt, or did not learn, to be close, together with looking at some of the ways in which emotions and feelings were dealt with in their families of origin. Communication skills are then modeled and facilitated. As each partner learns to understand and be curious about the other’s emotional world, the couple develop empathy and acceptance for each other and move towards each other rather than being polarised. They can begin to see the ways in which they miscommunicate and misunderstand each other and how this leads to increased stress in their relationship and to each of them feeling unsupported.

Working with both partners to help them to find some positive caring behaviours each can do for the other generates an increase in positive feeling in their relationship and can help to address the focus on negativity.

Both clients and doctors, and indeed society in general are quite wedded to the idea that there is very much an identified patient in couples where one of the partners is depressed. From my experience of both working with couples and as a supervisor of practitioners working with this model, I have found by adopting this approach and alleviating some of the distress in the couples system, it often goes a long way towards lifting the more depressed partner and increases the well being of their couple relationship.

Sarah Fletcher

This blog has been adapted from an article originally published by BACP in the Private Practice Magazine in March 2017.

Trauma and the Couple

‘The effects of unresolved trauma can be devastating. It can affect our habits and outlook on life, leading to addictions and poor decision-making. It can take a toll on our family life and interpersonal relationships. It can trigger real physical pain, symptoms, and disease. And it can lead to a range of self-destructive behaviours. But trauma doesn’t have to be a life sentence.’ (Peter A.Levine: ‘Healing Trauma’)

Counsellors in Coupleworks frequently work with couples who are struggling to deal with the repercussions of traumatic life events. Depending on our backgrounds, past experiences, and psychological states of mind, we respond in our own unique way to the impact of sudden, shocking or distressing events and couples can be upset, confused and shaken when the other’s response seems alien and the opposite of their own. For example, the death of someone much-loved can cause one person to shut down, close off and withdraw, and appear unavailable at the very time their partner is looking for connection and support.

We can all become overwhelmed by powerful reactions to difficult childhood experiences, violent intrusion, attack, abuse, loss and bereavement. The critical factor seems to be that at the time we had a perception of helplessness, a sense of disconnection from our usual effective competent self, and a feeling that we had lost the ability to deal with the incident. The pain, the shock, the level of threat experienced, and the sense of incapacity, causes the brain to release a flood of adrenaline and cortisol and react with a ‘Flight’, ‘Fight’ or ‘Freeze’ response. We are not in control of this reaction and symptoms can be observed in disconcerting bodily reactions: either overwrought physical hyperarousal – or denial, numbness, dissociation, immobility and freezing.

Peter Levine explains that, not dealt with, these aftereffects can be evident and ever-present. Or they can be unstable – ‘they can come and go and can be triggered by stress. Or they can remain hidden for decades and suddenly surface… They can grow increasingly complex over time and can even feel unconnected with the original trauma.’ There can be a detrimental effect on mental health and the development of psychosomatic illness.

It can be particularly confusing for a couple when re-enactments are played out in their relationship but they are not aware of the trigger. They have not made the link to the trauma that is the source. It can result in each partner feeling bewildered, hurt and disconnected. A seemingly unbridgeable gulf of misunderstanding opens up and they feel lost and emotionally unavailable to each other.
For example, it can feel lonely and hard to reach a partner suffering from a distressing bleak depression. A frightening rift can be created when a partner turns to alcohol or drugs in order to obliterate the pain. Angry or violent outbursts are terrifying and disturbing. Complaint and critical attack fosters resentment and negativity erodes good will.

Careful and sensitive relationship counselling can aid recovery. Appropriate and gentle guidance towards approaches for dealing with the distress can create understanding. Peter Levine again: ‘It is not necessary to consciously remember an event to heal from it.’ But it is important that it is addressed and managed in a supportive environment. With the recognition of their resilience, and of the love, care and concern that they hold for each other, the couple can emerge from their difficulties to establish a deeper more fulfilling relationship.

Kathy Rees

Couple Therapy can help with Mental Health Issues

Mental Health Awareness week takes place from 8-14 May and this year’s theme is ‘Surviving or Thriving’. Since 2005 mental health problems are on the rise – we are making progress on our physical health but not doing the same with our mental health. Thanks to journalists and TV programmes speaking out against the stigma of mental health, our awareness is being heightened as to the effects of mental health issues on daily lives. Thanks to Prince Harry leading the charge of his own experience of depression and anxiety and his work with the Heads Together Campaign with The Duke and Duchess of Cambridge they have highlighted the importance and power of conversation and how being able to talk openly about mental health challenges can be life changing. It now seems a good time to think about how mental health issues impact on our couple relationships.

Mental Health Professionals tend to focus on symptoms and treatments with the individual and overlook the huge impact this has on our couple relationships. Any couple relationship can have its proverbial ups and downs but what about when there is the extra challenge of being the partner of someone who has a mental illness. Losing harmony and connection in a relationship is difficult enough but especially so if some of the relationship changes are brought about by one or both partners developing mental health issues. Things can be very challenging for a partner without mental illness who has to assume a care giving role

Most people fall in love because they are enjoying each other’s company, have fun together and live harmoniously. Life doesn’t always work out as planned. When a partner becomes depressed, they often tune out, withdraw and have little energy to do much except sleep. This can often give the impression to a partner that they are no longer cared about, and there is no interest in them, or going out or having sex. This often leaves the other partner having to pick up the slack especially if there are children. As frustration and exhaustion develop over time, this often turns to anger and resentment at a partner who cant seem to “get over ‘ the depression. If this pattern continues it can often lead to affairs and a complete breakdown of the relationship.

Issues with mental health can be debilitating and its important that partners recognise some of the signs that suggest a partner is suffering:
signs to look out for:
withdrawal
agitation
hopelessness
acute tiredness
poor self care
change in personality

In my work with couples I see how a healthy relationship can serve as a buffer to help ward off mental health conditions. Equally it is well documented that relationship stress can negatively affect the person who is struggling with mental illness and make the condition worse.

We all come to our adult relationships with conscious and unconscious patterns from our own experiences and feelings around mental health. For example growing up with a parent or family member who may have been depressed, anxious or suicidal can greatly influence how we manage mental health issues in our current partnerships.

Couples coping with some mental health issues are not that different from other couples in therapy. Often individuals experienced a difficult childhood, a history of low self esteem and lack of confidence, trauma and loss. Although many of these things happened in the past, they often find a way of infiltrating the couple relationship resulting in on-going conflict. They too develop patterns of poor communication, increased conflict and loss of intimacy. They too have got stuck in negative cycles leaving them feeling distant, helpless and sad.

Give therapy a try

Coming to Couples Therapy with your partner is a positive step forward. Every Mental Health issue presents its own unique challenge and can be complicated and testing on our relationships. It requires special attention in couples therapy from a skilled couples therapist to help give clarity to the situation.

Finding a qualified couples therapist is a valuable option to help explore the roots of the mental health issues and to try and understand how it affects each partner. At Coupleworks we pride ourselves in taking care to consult with the patients GP, primary care worker or psychiatrist so that we can all work together for the patient to bring about change. We don’t have to just Survive we can learn to Thrive.

Dawn Kaffel

Couple Therapy for Depression

Depressed? Feeling low? Life seems pointless? Historically if you were feeling like life wasn’t worth living and you went to your GP, the doctor would prescribe anti-depressant medication or recommend that you saw a counsellor or indeed suggest both. However in the last few years one of the treatments of choice in the NHS for mild to moderate depression, if you are in a relationship, is to refer you to Couple Therapy for Depression. This model has been developed over the last 5 years after NICE identified the potential role of couple relationships in triggering, maintaining and resolving depression. This treatment is not available everywhere but it is increasingly available in many parts of the country.

What studies have demonstrated is that where couples are treated together in a 20 session integrative behaviourally based model, then there are significant levels of relief from the depression in the depressed partner. It may be hard for the non-depressed partner to recognise that anything they are doing is making matters worse, but what this model does is to highlight the interaction between the couple as being potentially a contributing factor rather than identifying one of the partners or the depression itself as the problem. By doing this it breaks the vicious circle that apportions blame and just makes matters worse for the individuals and the relationship.

Once the couple has been helped to identify their interaction, known as the formulation, they can then work together towards accepting and tolerating each other’s differences. Behavioural tasks are used to help the couple to learn to communicate more effectively, manage their feelings, and find alternative methods of solving their problems and caring for each other. This reduces the distress and increases the overall level of support in the couple’s relationship. In addition it is now clear that the work they do around their relationship reduces very significantly the level of depression in the partner presenting with depression.

Whilst it is not true that the one suffering from depression experiences a complete ’cure’, it does mean, for many, that they can function better both individually and as a couple. From the NHS’s point of view money is saved both in the short and long term through reducing the necessary levels of medication but more importantly the ‘depressed’ partner in the couple becomes healthier and is able to re-engage in society and get back to work where this has not been possible.