Archive for empathy

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.

Feeling stuck

Couples often come into counselling feeling frustrated and stuck. They feel trapped and confused at certain painful and negative patterns in the relationship. They know it seems counter-intuitive not to just change the reactions which are causing such distress, but it is not that simple.

Therapy can offer a couple the space to reflect on the emotional tangle and gain insight into the dynamics of their particular ‘couple dance’ of hurt and resentment.

Often a set of ‘limiting’ beliefs is uncovered. These are beliefs which influence the way we think about ourselves and our partner, the way we understand the world around us, and affect our reactions to events and situations. A limiting belief is not always obvious. Like the fish who says, ‘Water? What is water?’ we do not realise we are swimming in it – but the evidence is in the stuck interaction. Their ability to accommodate, change and develop has become inhibited and stifled.

Each of us has sets of values and beliefs that we absorbed in our early years, and that are shaped by experience, but sometimes we assume they are human ‘Truths’. We tend to discount information that challenges our ‘Truth’, and focus on information that confirms our belief. We feel reassured by a self-fulfilling prophecy.

So, if confronted by our partner’s contradictory and opposing belief, we feel disturbed and unsettled. We may feel betrayed. We may feel disconnected.

For example, in one family anger flares and is expressed loudly and vociferously, but then swiftly repaired. In another family, anger is suppressed and internalised, raised voices met with strong disapproval. A couple can get drawn into arguments about ‘right’ and ‘wrong’, both feeling absolutely right, and a fractious and brittle relationship develops. The couple assume polarised positions and negotiating the difference seems impossible.

They engage in what Buddhist writer Stephen Batchelor describes as the ‘Walking the Devil’s Circle’. The limiting belief is the ‘Circle’. The couple walks, and keeps walking, convinced they are on the road to somewhere (convincing the other of what is right/wrong). But then, when they look down, they see the same footsteps going round and round in a circle. Because the interactions and counter-reactions have been repeated and repeated, there is no forward-moving path. Now there is a well-worn, and deepening, groove of a cycle which is difficult to escape and which makes the habitual patterns even more difficult to break.

However, the counsellor can support and encourage the couple in the challenge of thinking creatively about their differences. Counselling can help couples explore what it is that they experience as threat. What do they imagine they will lose by compromising? Why do they become so defensive with the person they love the most? When faced with difference of opinion, why does the relationship suddenly feel so vulnerable and insecure? When there is love and connection at other times, what happens in those moments of disagreement?

Empathy allows a flow of well-meaning understanding. The couple can experience ‘togetherness’ again. There is a mutual engagement in managing the difference. It is a relief to learn alternatives to the sticky web of distress, anger and destructive criticism. A softening of attitude establishes generosity and compassion and a process of turning towards instead of turning away. An alternative mind-set can take root and the stranglehold is broken.

Kathy Rees

Competition and Compassion

The discussion of testing even very young school children has been topical recently. We are also nearing the summer GCSE and A’Level exam period – and concepts of success and failure abound. It seems we live in a competitive world. We set up value systems where we rigidly grade, compare and measure our own and others’ worth. What do we understand by ‘successful’? How much money do I have? How thin am I? What promotion have I achieved at work? How many friends do I have on Facebook?

Counsellors in Coupleworks often see clients overwhelmed by the pressure to succeed. The bar is set high and the focus is on achieving fixed goals. People can get caught in a loop of the ‘must-do’ and ‘having-to-do’, to the extent that lives are exhausting and can lack balance. Problems can occur when things do not quite work out to plan and people can become judgementally self-focused and develop a harsh inner voice. They become their own worst critics with their sense of self-worth and self-esteem becoming increasingly fragile. Unhappy couples, too, often come into counselling when they get stuck in a negative, critical loop of relating.

The media sells visions of glossy perfection and we all hold an idea of a ‘good’ relationship. Couples can fear their relationship may be broken when it is not meeting these standards. When expectations are challenged, when a partner has a different style or opinion, it can feel frighteningly disappointing and a hostile, attacking pattern of interaction can emerge. Even the sexual relationship becomes ‘performance’ orientated and be judged ‘not-good-enough’.

Often a couple can become competitive about who feels the most abandoned, not cared for, not listened to, the most taken for granted. They keep count of the slights and the hurts until the loved partner becomes the one most resented. Compassion is driven underground.

In therapy, considering what a ‘good-enough’ relationship might be, can relax things to such an extent that concern and generosity can flourish. Creating a supportive, caring relationship means building empathy. It means the appreciation of each other as flawed, quirky, unique, and lovably different. The couple can then revel in feelings of being accepted, valued and safe.

The psychologist Paul Gilbert, founder of Compassion Focused Therapy, says that ‘Getting unstuck is re-examining your values, recognising that your relationships are the most important things to help you feel happy’, and proposes that the secret of success is the ability to understand that mistakes and failure are not a catastrophe. As Nelson Mandela said, ‘I never lose. I either succeed or I learn.’ In order to manage our feelings of anxiety and vulnerability we need to explore and comprehend the dread. What really is the worst? Can we think laterally, more flexibly, and change and adapt? Gilbert compares it to judo where, in order to do well, we have to learn how to fall and roll with the punches. We, and our relationships, are often more special, valuable and resilient than we thought.

Kathy Rees