Couple Therapy- Addressing Depression....

Depression is very common in today’s world. It affects not only the individual who has it, but also the partner and other members of their family.

The impact of depression varies depending on the severity of depression. Some couples suffer badly because of one partner’s major depression. They are either living parallel lives or are living separately. If they have children the latter are the worst affected. Such couples get caught in a vicious circle in such a way that untreated depression deteriorates their relationship and deteriorating relationship aggravates depression and hopelessness. At some stage it becomes difficult to pinpoint the actual cause and effect.

Major depression continues to reoccur and it becomes a life-time challenge, taxing the couple emotionally, financially and socially.

It has been observed that individual or partner-involved therapy may not be effective in major depression. Couple therapy, especially Behaviour Couple Therapy  may, however, prove effective since it takes into account the reciprocity of relationship distress and depression. It aims to change the relationship to alleviate depression. BCT is based on the reasoning that thinking, feeling and behaviour are inter-related and a change in one brings a change in the other two. Since behaviour is observable and measurable, BCT stresses to change the behaviour. It focuses on changing the communication, problem-solving skills, cognitive functioning and intimacy.

BCT assumes that depression develops when people do not get an appropriate positive reinforcement after showing the desired behaviour. Various experiments have demonstrated that performance level decreases when the organism fails to get a certain reward that it used to get earlier. Depression also develops when people are not able to avoid aversive stimuli. Experiments have proved that an animal develops helplessness when his instrumental behaviour fails to terminate an aversive stimulus.

BCT focuses on changing the relationship patterns of couples which may have caused helplessness and hopelessness and so indirectly it treats the depression. BCT also collaborates with pharmacological treatment if symptoms are severe and there are safety issues.

The assessment process of BCT is very intensive. The therapist assesses both; the relationship functioning and individual functioning. The assessment is rather an intervention in itself as the therapist tries to create positive feelings and hope in the couple. BCT applies various techniques to have a clear cut assessment of the severity of the problem. Therapist interacts with the couple, asks questions, takes history, and enquires about their future plans. He/she also talks to each partner separately. In addition therapist uses various self-report questionnaires.

Since BCT acknowledges that  all these techniques have their own limitations to give accurate data as depressed people have pessimistic view about themselves and others, so it asserts to rely on the clinical observation of the therapist for the final conclusion. Therapist actually utilizes negative appraisals in determining the cognitive patterns and the areas of dissatisfaction of each partner.

In the last part of assessment,  the therapist shares the observation and assessment with the couple, conveys to them the importance of their role in the treatment process, gives rationale of BCT and set certain rules for the treatment sessions. Of the two main rules; first is that till the treatment is over they will postpone any plans for separation and the second is that they will not keep any secrets from each other.

All techniques of BCT are well structured. Sometimes giving some psycho-education is also helpful. Positive reinforcement is given after thorough investigations.

BCT also stresses on communication. This is very important because depressed people are passive and they avoid interaction. Partners are also trained to resolve small problems together and are encouraged to resolve complex issues.

BCT is an optimistic approach. When it is used in collaboration with medical therapy it can give significant positive results. 

Couple Therapy- Addressing Illness.

A ‘Bio-Psycho-Social’ model is found very effective in helping couples coping with medical problems.

This model suggests that all the three factors, biological, psychological and social, play significant roles both in health and disease.

In many cultures a connection of mind and body has been well recognized since long. That is why several techniques to strengthen mind and will-power are in vogue.

Similarly, the contribution of community or social support is also well recognized in the healing process.

The role of a family therapist is of great importance here. All over the world people take the help of a therapist in dealing with issues related with disease and illness.

In the above model, the couple is considered as a ‘unit of care’. So the focus is on the couple and not just on the individual who is coping with the disease. In case of a chronic illness, a successful management depends on how well the couple is able to adapt to the prevailing conditions. Some illnesses demand major shift in roles and lifestyles and that may create a lot of stress on the couple.

The main task of the therapist is to assess the level of functioning of the couple. For this, a lot of information is collected by the therapist. He directly communicates with the patient and the partner and talks about their perception about the disease, their current challenges and losses. He encourages them to tell the story of their illness. For them, hearing each other’s experiences is very therapeutic in itself. The therapist also collects couple’s history of the disease, their earlier ways to deal with disease and illness, their current fears and expectations etc. The therapist may also take the help of other professionals to collect data and genograms. All this information not only helps the therapist but also the couple to better understand them in the light of current situation.

This model of therapy generally presents two goals; the first one is helping the couple accept that the illness is there and that they both have to deal with it as a team that requires active involvement and commitment. The therapist helps them to know what is in their control and what is not. This type of understanding reduces their sense of helplessness. The second goal is to create a social support system for the couple, both within the family and the community in general.

The therapist also facilitates communication among the partners, between the couples and the health care system and between the couple and social support system. A lack of communication must not come in the way because it aggravates the problem and the recovery. The therapist, therefore, 

arranges sessions with friends, extended family members and other families facing similar problems. 

With this kind of therapy, the couple is able to take charge of their lives and develops a way to live a ‘new’ normal life by ‘putting illness in its place.’

The therapist also discusses the principles of ‘keep the doors open’ of brief psychotherapy with couples to give them a sense of security that whenever they need they can contact and take help of their therapist.

Couple Therapy- Addressing Separation & Divorce.

Separation and divorce are very sensitive issues. For a couple seeking separation or divorce and even for therapist, it’s a delicate matter.

For a therapist divorce is a process and not an event. This is more true if the couple has children.

Therapist considers separation and divorce as a transition and so his/her first task is to ascertain whether this transition is avoidable or not.

Whatever the couple decides, to stay together or separate, the therapist’s first focus is on improving communication and increasing understanding between the partners. This process provides the opportunity of reconciliation between the partners for deciding to stay together but this also creates an environment for emotional and psychological healing should the partners separate.

Generally, the desire to separate is not mutual and so it has to be recognized that there is a ‘Leaver’ and a ‘Left’ partner and the therapist has to deal with an imbalance of emotions of the partners.  

In case the couple decides to separate, the goal of therapy becomes making partners realize the importance of developing a mutual relationship based on acceptance and forgiveness.

In a way, it is to make the couple understand that divorce does not mean an end of relationship, rather it means re-relating to each other but in a different way, especially so when children are involved.

Separation of parents is very stressful for children. But when partners separate in the above mentioned way, children adjust much faster and may agree that their parents have done the right thing.

In situations where partners lose all respect and love for each other, when there is verbal, physical and mental abuse and there is no hope to regain love and respect, divorce is justifiable. Such separations are rather beneficial for children.

It is a fact that therapeutic mediation helps couples to have a successful transition so that there are minimal psychological after-effects of separation.

Examination- 'Only way to golden door to bright future............is it really ? Part II

Every year during and after the examination many students contemplate or take the extreme step of taking their own life. Mostly it comes as a shock to parents and teachers.

Examination stress is real. Don’t assume that once the examination is over stress will go away on its own. Do not assume that “my child cannot harm himself/herself.”

It may not go away if the student develops psychological pain due to loss of self-esteem and failure to live up to parental expectations.

Suicidologist, Shneidmen, explained that “In almost every case, suicide is caused by… psychological pain, or “psycheache”…. Suicidal death, in other words, is an escape from pain….” Psychache is the hurt, anguish, or ache that takes hold in the mind…. The pain of excessively felt shame, guilt fear anxiety, loneliness, angst and dread…….. It’s introspective reality is undeniable. Suicide happens when the psychache is deemed unbearable and death is actively sought to stop the unceasing flow of painful consciousness.”

It’s is very important for parents, teachers and other significant people in student’s life to notice any warning signs and take help.

A marked change is student’s mood and behaviour may be a significant warning of possible suicide. For example student-  

·         Becomes depressed and withdrawn.

·         Undergoes marked decline in self-esteem.

·         Shows Deterioration in personal hygiene.

·         Shows unusually impulsive and or reckless behaviour, including self mutilating.

·         Gives away prized possessions, or unusual gift-giving.

·         Writes  stories and poems about death, dying, or suicide

·         Profound loss of interest in studies.

·         Stops attending classes and stays at home most of the day or runs away from home.

·         Communicates the distress to at least one other person, often in the form of a veiled suicide warning.

·         Saying things like, “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out.”

·         Speaking positively about death or romanticizing dying (“If I died, people might love me more”)

The impact of examination stress increases many fold if there are other stressful events happening in the student’s life like loss of a close interpersonal relationship, often the breakup of a romantic relationship, accident, illness or death in the  family etc.

So it’s high time to come out of denial that your child or student will never think about taking the extreme step.

Our awareness can save many precious lives.

Reference: Abnormal Psychology- James N. Butcher ; 13^th ed.

     

Examination- ‘Only way to golden door to bright future’……………Is it really?

The word Examination itself creates a lot of stress and anxiety in the minds of young adults, their parents and teachers.

The most affected are the young adults. They start dealing with this, right from the time they begin their schooling. By the time they reach high school, examination-related stress, anxiety and tension increase multiple folds.

• Examinations are stressful because students have to understand, learn, remember and recall a lot of information in a limited time.

• Examinations are stressful because students and not just their knowledge will be judged based on their performance in those just three hours in the examination hall.

• Examinations are stressful because of the expectations of the parents, relatives and society and the pressures built up by them.

• Examinations are stressful because of the personal aspirations, expectations of students and the prevailing extreme competition.  

• Examinations are stressful as these are assumed to be the only way to open the golden doors to a bright and successful future.

Parents and teachers in their effort to motivate and maintain the pressure on students constantly tell them that -

If you score well your life will be set.

If you don’t work hard, others will outshine you.

If you don’t perform well in exams you will struggle all through your life.

What people will say if you don’t do well in exams?

           

You have to perform well in exams and bring honour to the family.

You have to score well and fulfil our dreams.

You are our only hope, don’t disappoint us.

Our neighbour’s/relative’s children have done well so you have to do well too.

If you are not able to get an admission in a professional college what will you do to earn a respectable income?

These and other such anxiety and guilt ridden statements may usually be bombarded on the young and impressionable minds, as early as in the first grade.

Some students who are either sensitive, or think they do not have enough capability to meet their parents’ expectations, or do not have an inclination to become a doctor or an engineer may start feeling guilty.

Constant persuasive reminders to perform well in exams may lead them to feel worthless, helpless and hopeless.

As a result these students may start contemplating to end their pain by ending their lives.

As parents, teachers and relatives, if you are able to remove the pain of those students, you may be able to save many precious and promising lives.

The foremost step you can take is to challenge your own deep-rooted insecurities and unrealistic expectations. World has drastically changed. There are so many options and opportunities. Team up with your children and explore the possibilities in the area of their interest.

The other step you can take is to find out positive ways to motivate your young ones. Instilling fear of failure may demoralize and discourage the youth. It may also affect their creativity, spontaneity and risk taking ability.

Examination stress is real. Don’t assume that once the examination is over your child will be fine or assume that ‘my child cannot harm himself/herself.’

Every year hundreds of students commit suicide. In most of the cases it comes as a shock to parents and teachers. Know about the warning signs and be alert. A timely intervention may save the life of your child.

Continued……….

MORAL DEVELOPMENT......................

In today’s competitive and complex world parents and teachers constantly think as to how they can inculcate right values and morals in children.

Moral development is a gradual process. Like intelligence it evolves in stages. Kohlberg, a renowned development psychologist identified six stages of moral development.

Stages evolve when children directly or indirectly encounter moral dilemmas and they seriously think about those ethical issues to find answers.

There is no direct way to teach children to think ethically so that they can move to the next stage of moral development. Children’s ability to understand, analyze and resolve the ethical issues will move them from one stage to the next stage.

Parents, teachers, peers and significant others can stimulate children’s mental processes to think about moral and ethical issues.

Authority, pressure /power to conform and fear of punishment hinder moral development. Children may conform to others but they will not be able to develop their own reasoning of what is right or wrong.

Integrity and character develop in a democratic environment. Such environment gives the opportunities to children to discuss their view- points. Children also learn that others may have their own point of views which may be different from theirs.

 Social interactions give them the opportunity to see things from a different perspective. They learn to accept and respect diversity. They become more accommodating and cooperative.

In the process of their moral development they challenge, modify and develop their own thinking. They can achieve the highest level of moral development when they start to discuss and stand for universal justice, human rights and equality.

Like children, societies and nations also go through similar stages of moral development.

We can assess the stage of development by analyzing the justification given for the resolution of ethical or moral dilemma.

Those who are at stage one will obey the authority, assuming that authority is always right. Not conforming to authority is wrong and that may lead to punishment.

Those at stage two understand that any issue can have multiple perspectives. So it is important to protect one’s own interests. They may negotiate and exchange favours.

Those who are at stage three also think about the interests of people who are close to them. They think about themselves as members of a particular community which has its own values, norms and culture.

The ones at stage four think about society as a whole. They believe in following laws for the smooth functioning of the society.

Those at stage five think and discuss about values and principles. They believe in changing the rules of the society if they are obsolete and doing no good to society.

The ones at stage six think and discuss about values and principles which are beyond the boundaries of their own community, society and even nation. They believe in universal principles of equality, rights, respect and dignity.

Unlike intelligence, moral development is an ongoing process. One may remain stuck at lower stages or one may move to higher stages at any time in their lives. One can do that by expanding one’s social circle, meeting new people, visiting new places, reading literature, listening to other’s experiences, discussing ideas and challenging one’s own thinking.

This is true for people, communities, societies and nations.

Relationships Misconceptions

Loving relationships are important part of our lives and we try to nurture these in our own ways.

But sometimes our unrealistic expectations and misconceptions defeat our relationships.

R.M. Gilbert, in his book "Extraordinary Relationships" mentioned some common expectations and misconceptions-

• The other person will make me happy.

• I can change the other.

• Emotionally mature person must be cold and unfeeling.

• It is my right to respond from my emotions to my partner’s anxiety.

• This relationship will never get any better.

• I have changed myself all I can and things aren’t any better.

• Whenever one “needs” to talk it out or get feelings out, the
other must agree to listen.

• Excessive worry about the past- your own or the other
person’s- is often defeating to relationships.

• If you don’t love me like my mother did, you don’t love me.

• I can cut off from my extended family and still have good
relationships.