Archive for interaction

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.

Technology and Humans.

For many years I have been struck by the similarities between technical frustrations and difficulties which can arise in a couple.

If we look at the comparison of a computer’s hard drive and a human’s unconscious, we can see an example:  If you put the wrong software into an incompatible computer it will act out by throwing up windows full of incomprehensible jargon and probably shut itself down.

This is similar to pressing the wrong button in your partner and igniting an inexplicable reaction, far outweighing the nature of the trigger.  The human may well shut down and become an alien to the offender, just as a computer does.

With a couple, various scenarios may occur.  Anger, hurt, detachment, withdrawal from intimacy and a rift, hopefully temporary between the bemused offender and the withdrawn or furious reactor.

What follows with a computer shut down is further frustration, anquish and stress when ringing a call centre operative for help. This person, who within a brief of 10 questions and answers, tries to help. Temperatures rise, solutions don’t help and in the end a supervisor is found who helps to calm things down and get the computer working again.

With human breakdown in communication there is a similarity.  A number of accusations and denials, familiar to the couple, are hurled to and fro till in the end one or the other suggests that a couple counsellor needs to be found.  The result often being that things are calmed down and a different way of managing these communication breakdowns is found.

Technology and human interaction are, of course, not the same thing at all but technological hard and software both need human insertion in order to work,  thus it is not surprising that reactions in both cases are similar.  Coupleworks can help with human misunderstandings when couples have tried everyway known to them without success.  In the same way a supervisor has to be sent for as a solution to the computer break down.

Rapidly developing technology requires change  A sketchy knowledge of a multitude of different professions is now a necessary feature of couple and family life.  Travel agent, flight booker, medical knowledge and decisions about personal health, banking, user names and passwords crowding a human brain along with daily life.

Coupleworks listens to couples and treats their dilemmas with respect. Together they try to unravel the difficulties encountered in their individual stories.

Clare Ireland