Archive for depression

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

Autumn

Autumn has early memories for all of us who live in countries with seasons and brings many feelings as it arrives. It can bring a sense of wellbeing and comfort and also melancholy and depression.

This disparity highlights how hard a couple needs to work together with kindness and understanding to incorporate difference and find a creative third space to share their feelings and benefit by the other’s experience.

The quotes which follow show different thoughts on this particular time of year. A gateway to winter and a closing of sun and warmth. Reading them can throw a light on all angles and collectively expand what would otherwise be only one way of thinking.

October gives a party
The leaves by hundreds came,
The Ashes, Oaks and Maples,
And leaves of every name.
The sunshine spread a carpet,
And everything was grand;
The sight was like a rainbow
New fallen from the sky…George Cooper.

The sun tires of summer and sighs itself into autumn. Terri Guillemets.
Autumn repays the earth the leaves which summer lent it. Georg Christoph Lichenberg.
Winter is dead; spring is crazy; summer is cheerful and autumn is wise. Mehmet Murat Ildan.
Of all the seasons autumn offers the most to man and requires the least of him. Hal Borland.
No spring nor summer beauty hath such grace as I have seen in one autumnal face. John Dunne.
Autumn – the year’s last, loveliest smile. William Cullen Bryant.
Why is summer mist romantic and autumn mist just sad? Dodie Smith.
falling leaves
hide the path             a haiku from John Bailey.
so quietly
Autumn wins you best by this, its mute appeal to sympathy for its decay. Robert Browning.
Love the leaves until their leaves fall off, then encourage them to try again next year. Chad Sugg.
Autumn is a second spring when every leaf is a flower. Albert Camus.
There is something incredibly nostalgic and significant about the annual cascade of autumn leaves. Remy de Gourmont.

Autumn is the perfect time to take account of what we’ve done, what we didn’t do and what we’d like to do next year. Author unknown.

Clare Ireland.

Coping with Grief and Loss

‘I hold it true, whate’er befall;
I feel it when I sorry most;
‘Tis better to have loved and lost
Than never to have loved at all.’

Alfred Lord Tennyson wrote these words in response to the sudden death of his friend Arthur Hallam. But it does not need a death to trigger grief – the break up of a relationship; unrequited love; missed opportunities; the abuse of trust – each in their own way results in grief and loss. At Coupleworks helping our clients to begin to process these feelings is part of our work.

Almost 50 years ago Elizabeth Kubler Ross frustrated by the lack of studies on grief, and inspired by her work with terminally ill patients, described the 5 stages of grief: denial, anger, bargaining, depression and acceptance. She was also concerned to underline that not everyone who is grieving will go through all the stages and the stages may not be in that order. Everyone’s grief is his or her own and there is no right way of experiencing it, nor can you predict how intense it will be. However they remain a useful tool to help people see that what they are experiencing is normal and natural and accepting this can be very helpful.

The 5 stages of grief:

Denial: in this stage the individual is trying to deny their loss, they can’t believe it is happening to them, they feel as if it is a mistake. If the loss is sudden and unexpected then sometimes there may be numbness like waiting to wake up from a bad dream – all will be better tomorrow but it isn’t.

Anger: The intense reality of the pain can feel too much as the denial stage wears off, but a way of avoiding that pain is for the individual to look for someone to blame. It can be themselves for not doing something or being there or directing it to others.

Bargaining: Here the characteristic phrase is ‘If only….’ I had done this or been there then it might not have happened. This is a normal reaction to feelings of helplessness and vulnerability, to feel as though despite what has happened we still have some control.

Depression: what is the point of going on? I can’t be bothered any more…. The feeling of sadness and pain just seems so overwhelming, and ordinary things that we enjoyed previously feel mundane.

Acceptance: this is the final stage and not everyone reaches it. It is the point of beginning to come through the grief – a gradual reinvesting of energy into life. There is an adjustment and acceptance that life can go on even without our loved one or those lost hopes.

Sometimes it can feel like the pain is never ending but time can heal and things may eventually become more bearable. We can find ways of living with the loss.

A few tips to help you cope and keep going….

1. Allow yourself to feel sad and express and release your feelings. Don’t be afraid to cry – it is better than bottling up your feelings.
2. Look after yourself – don’t forget to take exercise even if that is going for a walk.
3. Sleep if you can and have a regular bedtime.
4. Avoid drink and drugs that temporarily dull the pain – you will only feel worse afterwards.
5. Plan ahead for grief triggers such as anniversaries or special reminders.
6. Find support and don’t be afraid to talk to family and friends
7. Counselling can be helpful to talk your feelings through and have a space to share the pain.

And perhaps hold on to those words of Tennyson, however difficult it may be to believe them – still less to feel them. ‘Tis better to have loved and lost, than never to have loved at all’

Sarah Fletcher

What happens to The Couple when children leave home?

Watching the mesmerising and compelling performance of Gina Mckee in Florian Zeller’s production of The Mother at the Tricycle Theatre in Kilburn last week left me questioning long after the final curtain.

Gina Mckee plays the role of a mother floundering between reality and hostility as her family starts to fall apart and move away from her. She captures the longing and desperation of a mother desperate to hold onto the memories of her life and children as it used to be and portrays a mother on the brink of madness as she sees her ‘little boy’ grow up and flow the nest and find a girlfriend.

As a couples counsellor we often find ourselves working with couples who present with relationships that have grown distant and disconnected and its often blamed on poor communication when really underneath the presenting problem are couples who are struggling to come to terms with children leaving home and the difficulties with having to be just the two of you.

For some couples when children have been the glue in their relationship when they leave there is a sense of dislocation as a huge void is now present which is often scary and unmanageable.

We know in theory that as parents we bring our children up to let them go as adults to make their own way in the world and seek out their adult relationships. But in practice this can play out in a very different way as parental addiction to children manifests. Strong feelings of grief, loss and rage can be projected onto our partners as we struggle to come to terms with this incomprehensible life transition. Especially as this time can also coincide with menopause, ageing parents and impending retirement.

At Coupleworks we often see couples who struggle to identify that children leaving home can cause such difficulties between them. What often manifests is their communication breaks down and they stop spending time with each other and seek out alternative experiences.

Feelings of sadness and loss of role for a mother who may have given up work to care for her children and has spent most of her life doing everything for children may make them more vulnerable to depression and marital conflicts. It can be very difficult for a partner who may still be busy at work to acknowledge the acute sadness and loss that the mother is going through when all he may be experiencing is her hostility and turning away from him.

Couples don’t have to fall apart when the nest becomes empty. For some it is important time to reconnect and spend more time focusing on being a couple than you have done previously. It is an opportunity to work on your own relationship and restore what has been neglected between you.

At Coupleworks we see many clients at this important transition in their lives, it is normal and important for children to feel that they are leaving behind a secure and solid home base to return to.

For others this transition according to psychologists, from being an actively involved parent to being two independent individuals can take up to 18 months to 2 years. It is important to talk to your partner about your feelings. You may be surprised that they have similar feelings and will relish the chance to talk it through.

 
Dawn Kaffel

The Use of Antidepressants and Therapy

My views on antidepressants have changed over the years. Where I was once not in favour of their use, I now see their benefits with clients. The problem is that most antidepressants are too freely given out without thought or proper assessment and there is rarely follow up with clients to reassess their progress.

It is important to say that feeling low at times is part of the human experience and allows us the opportunity to know ourselves better and helps us to manage these feelings as they come and go.

Anti-depressants need to be prescribed by a Psychiatrist who is knowledgeable with psychopharmacology drugs. Because there are so many anti-depressants available, without a comprehensive assessment it’s difficult to pinpoint which drug will be best for which individual. An assessment will also help to differentiate whether the person is going through normal loss and grief or going through depression. This is a crucial distinction.

Antidepressants allow people to work through their issues with a therapist because it lifts the depression enough for the person to feel more hopeful and therefore allow them to begin to have another perspective on an issue.  I often use the analogy of a person standing in water up to their eyes; they can’t breath or do anything except try and survive.  If the water level is lowered (with antidepressants) it allows the person to see things differently.

Our brain’s neuropathways can change the way we think and experience things. If we have long periods of depression and our thought process is negative it impacts the way we see others and ourselves.  With antidepressants, we are able to bypass the depression and different parts of our self begin to emerge. With consistent and regular positive thoughts, our brain chemistry alters and our perspective can change.

My experience tells me that clients who are very depressed do not utilise the process therapy offers at that time.  The ideal combination is therapy with antidepressants. This can offer an opportunity for clients to understand the origin of their depression and work through and learn to manage their depression.

A new protocol is needed to look after clients from beginning to end to ensure they are on the correct dosage of medication and progressing. Psychiatrists/GP’s would do better to work together with psychotherapists/ counsellors in order to best serve their clients.

Shirlee Kay