Tag Archives: depression

The Ups and Downs of Therapy; a client’s story

The thing I liked about my therapist when we first met was that she seemed different from me – the last thing I wanted was to talk to someone similar. The relationship would be different from anything I had experienced: it was the first time I had discussed my life intimately with another person.

 

The idea of ‘difference’ became the key to approaching therapy. Sessions were an opportunity to experiment with different ways of thinking, without relying on reason or analysis. Instead, I would talk about whatever popped into my head at the time – no matter how irrelevant it seemed – and see where it led.

 

My first fear was that I would sabotage therapy, probably by convincing myself that it had been going on too long. To counter this, rule number one was that there would be no time-limit: if it took years, it took years and I wouldn’t leave until it felt good to do so.

 

The second fear was that I would develop an attachment to my therapist that would become painful, so the boundaries of the relationship were very important. I determined not to cross these boundaries under any circumstances: no contact between sessions, no trying to discover personal information. The therapy room would become a bubble, although, as I later discovered, there was a downside to this.

 

As therapy progressed, the word ‘instinct’ kept cropping up, and I began to realise how powerful the unconscious mind is, and that it is often right. Understanding my past behaviour in this context – that a lot of it was actually self-preservation – was a huge relief. I began to trust my instinct more as a guide through the process.

 

Self-expression was surprisingly hard. I found the spoken word incredibly limiting and the habit of editing myself as I went along didn’t help. A lot of the time it felt as if I was talking around a feeling, but couldn’t be completely accurate – I just didn’t have the language. Images were very helpful in this respect. If I couldn’t describe a feeling I would imagine it as a scene or a story and describe that instead. In fact, the further away we got from the literal, and the closer we got to symbols, stories and art, the more satisfying and truthful the conversations felt.

 

Going to therapy for a long period, it was inevitable that some subjects would be discussed many times. This wasn’t a problem, but I was aware that each time we repeated a subject, I would describe a set of feelings that were different to what I had said before. Thankfully my therapist didn’t point this out, although I have no doubt that she noticed the contradiction. The question is, why did this happen when I was trying to be honest? The best answer I can come up with is that I was just saying what needed to be said on that particular day. This pattern of repetition/contradiction did lead to some answers that you could call ‘truth’,  but the answers seemed less important than the process of finding them.

 

One of the more unnerving sensations was the feeling that life was on hold. In the midst of the therapy bubble, most of my time was spent looking forward to the next session or thinking about the previous one. The outside world felt less important. If it had ended at this point I suspect it would have been pretty devastating and knowing that I was dependent made me nervous. It was a leap of faith to trust that one day I would feel differently. Until then, the frequency of the sessions gave me enough security to keep going.

 

But the relationship between therapy and my life in the outside world was something I struggled with. Whenever we discussed making a change, I had all the reasons not to do it. This inability to connect therapy and life felt frustrating at the time. Looking back, I probably didn’t realise how much was shifting around in my unconscious. Every so often change would rise to the surface and I would suddenly decide to do something completely out of character. Eventually I learnt that I didn’t have to force the change to happen, I just had to be open to it.

 

I think one of the great misconceptions about therapy is that it’s all about the moment of catharsis. That the right question will lead to a huge outpouring of emotion and then everything will be better. I never had that experience – therapy was more complicated and difficult than that, but also more rewarding. I certainly don’t think of it as getting things out of my system: I have more in my system now than when I started.

 

The decision to stop was surprisingly easy. It just felt right. Life wasn’t perfect but I had the strength to deal with it. As the end approached I knew how important it was to end well, to walk out the door without regret.

 

People who know me well say the change has been enormous. They are probably right, but it’s a difficult thing to see objectively. Superficially, life hasn’t changed that much, but there has been a fundamental shift in how I react to things. My stress and anxiety levels are certainly much lower, I’ve become more open to taking risks, and more patient with other people.

 

My life now is messier, dirtier, happier, angrier, faster, less predictable and more confusing than it has ever been. For the first time it feels like there aren’t enough hours in the day for everything I want to do. But I do what I can and don’t worry about the rest. So far that seems to be working.

 

Written anonymously by a client in 2015

Working with Depression, led by Gill Bannister – 26th September 2015

On a clear, sunny autumnal Saturday last week, I was treated to a full day’s seminar on depression… the conflict of light and dark didn’t pass by un-noticed and in fact resulted in a feeling of optimism and lightness – a surprise considering the darkness and negativity of the topic.    Gill Bannister delivered her seminar with feeling and containment – two very important aspects of a therapist’s role when working with clients with depression.

Gill’s 30 years experience as a psychoanalytic psychotherapist working with depression in clients was delivered in a style in keeping with her classic training, enabling us to have time and space to think, to sit with ourselves and our difficult thoughts and feelings, allowing a process to occur.   Gill believes that depression is a result of a client experiencing loss.   The depressed client suffers from a lack of self esteem, often projecting a super-ego which is rejecting, despising and attacking.

The experiential element of the seminar was invaluable, thinking and sharing thoughts, Gill challenged us to confront our own assumptions, experiences and prejudices around depression.  A word which is now loaded with a vast array of interpretation and stigma.    We were guided through the day with exercises and discussion which enabled us to experience the core essence of working with depression in the therapeutic room – trying to get in touch with our client’s inner world.  By experiencing a 30 minute solo role play, I felt more connected and understanding of my client’s depression than I had done before and will be processing and using these insights future sessions with this particular client.

An enlightenment of depression…. most valuable.

See our future seminars at our website www.wendybramham.co.uk (seminars tab)

by: Jo Turner

29 September 2015

This seminar was assessed by attendees as 4.69 out of 5 for the overall quality of the event. The speaker was rated 4.75. Thank you to all who attended this and previous seminars, we appreciate your participation and your feedback.

Eye Movement Desensitization Reprocessing (EMDR) – seminar update

Psychotherapist, Hannah Cowan, writes: “At our seminar on Saturday, Sarah House introduced us to EMDR (Eye Movement Desensitization Reprocessing) by telling us how the founder, Francine Schapiro, noticed that after a walk in the park she felt more able to manage things that had been troubling her. She connected this to the frequent eye movements that occur when walking and went on to develop a system of therapy that used rapid movement of the eyes from left to right. The purpose of the eye movements is to keep a person anchored in the present whilst remembering a traumatic memory.  Additionally these movements help to connect the left and right sides of the brain which, following trauma, can become disconnected.”

Thank you to all who participated in the event, and for your feedback. Your average rating for both the event and the speaker was 4.5 out of 5!

Our next seminar, 13 June 2015, looks at the tricky issue of how to talk about sex in the therapy room. For more information on this and all forthcoming events, visit our website wendybramham.co.uk

Author:  Hannah Cowan
Editor: Wendy Bramham
April 2015

Christmas message

Christmas in the UK seems to become more manic and commercialised each year, whilst growing numbers of people suffer from loneliness and depression which can be exacerbated at this time of year. The Christmas-hype can obscure the real opportunity of holidays and celebrations, as I see it. These occasions help us pause and reflect, foster closer connections with those we love or within our communities, and encourage charitable actions. Additionally, the end of one calendar year and the start of another can nudge us to make adjustments in our lives to bring more health, joy and meaning.

I recently attended a special carol concert in the privileged setting of Marlborough College’s chapel, in aid of Hope & Homes for Children, a charity that helps find homes for children in Europe and Africa who have no parents and who are living in institutionalised care. How easy it is to take our blessings for granted!

Bringing the tree homeWe all at Wendy Bramham Therapy wish our clients, colleagues and friends a peaceful Christmas-time and a healthy, joyful 2015.

Wendy Bramham MBACP (Snr Accred)
Psychotherapist & Counselling Supervisor
Proprietor & Clinic Director

Unlocking the Secrets of Dreams” with Matthew Harwood, Nov 2014

This seminar was akin to being in the theatre watching an absorbing drama unfold!  Matthew Harwood treated us to a fascinating and crystal-clear presentation of how he worked with a former client’s particular dream to help the client free himself from outmoded attitudes and a long-standing depression.

We learned that it is possible for just one sentence of a dream to provoke an hour’s worth of investigation and produce a powerful “aha” moment of insight that can create profound change at a cellular level. Like adding a drop of wine to water, we remain changed forever.

Science tells us that we all dream for about two hours per night, whether or not we remember our dreams. Dreams produce words and images that are metaphors ….. they are direct messages from our unconscious that can “compensate” for, and illuminate, our conscious (often unbalanced) attitudes.  Depression can often signify a fear of living, but when we remember a dream it is a sign that we are ready for change, and to have the courage to live.  By asking the right sorts of questions which enable the client to give descriptive definitions (prior to their associations) of the objects, characters and places in their dreams, Matthew showed us that it is possible to unlock their central dilemma and blind spots.

In the words of Carl Jung:

In each of us there is another whom we do not know. He speaks to us in our dreams and tells us how differently he sees us from the way we see ourselves. [CG Jung: Collected Works Vol 10 para 325]

It was wonderful to learn how to work in such a creative way with our clients.

Wendy Bramham
25/11/14

Dynamic Interpersonal Therapy – DIT: Seminar feedback, September 2014

At our seminar on Saturday Beni Woolmer presented a rich and stimulating presentation on DIT – a 16 week model of psychodynamic therapy, now used widely in the NHS for depression and anxiety.  It is great news that the medical profession are learning more widely about therapies in addition to CBT!  I personally have researched, learned about and used in my practice many different models of therapy over the past 20 years and I return over and over again to psychodynamic theory as incisive… and possibly the hardest to learn and use well as a practitioner.
DIT offers an intensive therapy that is highly focussed and structured.  It can illuminate how symptoms, interpersonal functioning, mood and behaviour can be driven by unconscious (and unexamined) psychic patterns.  In our seminar Beni – very capably and with great knowledge and experience – taught us how DIT develops a very focused strategy to help the client learn about and modify one central interpersonal problem which might be causing symptoms such as depression or anxiety. DIT helps the client think differently about themselves (their self image and their feelings/thought)s as well as how they view others, and to modify their interpersonal behaviour. The therapy aims to help clients become aware of his/her fears relating to unconscious feelings and feared consequences of change, and how s/he unconsciously manages these fears.
DIT is not suitable for all clients, and can be demanding for the client as well as the therapist. We learned about criteria for assessment, eg the client’s ability to be reflective (including his/her relationship with the therapist) and to tolerate a degree of mental pain.
We are delighted to have received very positive feedback from this seminar, with an average score from all participants of 4.75 out of 5 for the speaker, and 4.6 out of 5 as an overall assessment of the event. A big thank you to all who participated.
Our next event with William Bloom is sold old, but there are still tickets available for our day with Sir Richard Bowlby on Attachment Theory on 7 November in Newbury. See our website for more details: newburytherapy.com
Wendy Bramham
September 2014
Recommended reading:
Brief Dynamic Interpersonal Therapy: A Clinician’s Guide
by Alessandra Lemma, Mary Target and Peter Fonagy
Oxford University Press, 2011
Robin Williams

Robin Williams

Many of us were shocked and saddened by the news of Robin Williams’ suicide in August 2014. In 2013 as part of BBC Wiltshire’s series on mental health, Wendy Bramham spoke about this devastating issue.  The following information offers a resource for people experiencing suicidal feelings; or for those bereaved by suicide; and for people who are attempting to help those affected by this issue.

What causes a person to feel suicidal?

Suicide may seem to be the only way to end severe mental pain; the only thing that’s left within the person’s control.  It may also be a way to convey desperate feelings to others. Most people who feel suicidal are actually quite confused and conflicted about the desire for death.  Most wish there was an alternative.

What causes it is usually a complex mix of factors that builds up into despair that becomes overwhelming.  It may be caused by a sudden crisis, a major setback or loss, but more typically there is a slower build-up over time.

Many kinds of emotional pain can lead to thoughts of suicide.  Each person responds and copes differently and uniquely to the myriad problems and crises we all encounter through life.  Each person has their own psychological and social history and genetic make up, which means that what is bearable to one person can be unbearable to another, and vice versa.

Tragic Statistics

This devastating problem is much more common than many of us realise.  Shockingly, in the UK suicide remains the most common form of death in men under the age of 35 (Mental Health Foundation and Department of Health).  It is the second largest killer of people worldwide between the ages of  16-19.  In the  last 45 years suicide rates have increased by 60% worldwide (source: World Health Organisation).).  It’s estimated that approximately 5% of people attempt suicide at least once in their life.  Men are 3 to 4 times more likely to kill themselves than women. However, unsuccessful attempts are more common in women and young people.   More people die by suicide each year than by murder and war combined.

Accusation of selfishness?

Some people accuse those who have committed suicide as selfish, and that they took the “easy way out”.  This is extremely hurtful and shows a lack of understanding of mental illness and the suffering that some people try to endure.  The following quote is taken from theguardian.com on 12 august by Dean Burnett who I think argues the point well:

“One of the main problems with mental illness is that it prevents you from thinking “normally” (although what that means is a discussion for another time).  A depression sufferer is not thinking like a non-sufferer in the same way that someone who is drowning is not “breathing air” like a person on land is.  (…..) The selfish accusation  implies that there are other options that the sufferer has, but has chosen suicide or that it’s the easy way out.  There are many ways to describe the sort of suffering that overrides a survival instinct that has evolved over millions of years,  but ‘easy’ is not an obvious one to go for. Perhaps none of it makes sense from a logical perspective but insisting on logical thinking from someone in the grips of a mental illness is like insisting that someone with a broken leg walks normally.  Logically you shouldn’t do that.”

Who is at risk?

Most important factors that put people at risk include mental disorders, such as depression, bipolar, schizophrenia, post-traumatic stress and obsessive-compulsive disorder (OCD).  The second biggest influencing factor is substance abuse.  Eg alcoholism is a factor in 15-60% of all suicides.

Having  depression or bipolar increases the risk of suicide by 20%.  Depression accounts for approximately 50% of suicides.  Those suffering from severe depression and feelings of hopelessness, and who have little or no social support are probably the most at risk.  Often people who are just recovering from depression are in fact more at risk of suicide, because it is then that they actually have the energy to carry out the act of suicide.

War veterans are a high risk category due to the mental trauma and physical ill-health from war.  Genetics and social-economic factors play a part too, eg poverty, discrimination, financial worries, unemployment, bereavement, social isolation.

Some medical conditions can trigger suicidal feelings, such as traumatic head injuries. A diagnosis of cancer can double the risk of suicide.  Such medical conditions can lead to depression and suicidal feelings, and carers should be aware of this.

Media and internet can cause a copycat syndrome of suicide whereby it is romanticised or glorified.

Warning signs

Suicidal feelings are more likely to build up when a person feels they can’t talk about their feelings.  They may be experiencing or have experienced some of the following, which can also be signs and symptoms of depression:

  • withdrawal from friends, family and regular activities
  • isolation and hopelessness
  • sense of futility and meaningless
  • self-loathing (“everyone would be better off without me”)
  • loss of energy
  • major and sudden changes in personality or mood
  • big changes in sleeping and eating habits
  • difficulty in functioning, such as going to work, or cooking dinner
  • unusual neglect of personal appearance
  • feeling cut off from their body, feeling numb
  • impulsivity, lethargy or aggressiveness (especially in adolescents)

Obvious major warning signs include

  • talking about killing or harming oneself (it is a myth that people who talk about suicide don’t do it)
  • talking or writing a lot about death or dying
  • seeking out things that could be used in a suicide attempt, such as weapons and drugs.

The above signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide.

How to help someone who is suicidal

Talking about it can save a life.  Try not to feel embarrassed or afraid.  Talking about suicide won’t give the sufferer morbid thoughts – quite the opposite, it is the most helpful thing you can do.

However, it is not usually helpful to say things like “you should feel lucky because you’ve got a lovely house, job, family”, etc., or “that’s not enough of a reason to feel suicidal”.   The best way to help is by offering an empathetic, listening ear.   See notes below on “How to talk with  someone about suicide”.  Don’t take responsibility, however, for making the other person well. You can offer support, but you can’t get better for a suicidal person. He or she has to make a personal commitment to recovery. If you are helping a suicidal person, make sure you get support for yourself.

Practical steps:

  • Get professional help. Call a crisis line such as The Samaritans for advice and referrals.  Encourage the person to see a counsellor, or take them to a doctor’s appointment.
  • Follow-up on treatment. If the doctor prescribes medication, encourage them to take it.  Help to communicate about any side effects and be aware that it can be a trial and error process to find the right medication.
  • Be proactive. Don’t wait for the person to call you, or to return your calls. People who are severely depressed find it difficult to ask for help.  Drop by, call again, invite the person out.
  • Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.
  • Make a safety plan, help the person develop a set of steps if they feel suicidal, such as who they will call.  Include friends, family and crisis line numbers.
  • Remove potential means of suicide, such as pills, knives, razors, or firearms. If the person is likely to take an overdose, keep medications locked away or give out only as the person needs them.
  • Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by.

How to help yourself if you feel suicidal

Asking for help is not a sign of weakness but a sign of strength, wisdom and self-responsibility.  If we try to do everything on our own we will become mentally, physically and emotionally exhausted.

However, if you have suicidal thoughts it can feel impossible to tell your family and friends how bad you feel.  You may feel rage, fear, guilt and shame.  If you have been hurt by someone, it is natural to feel anger, and sometimes suicide can seem a way to get back at that person.  However, suicide is anger turned against ourselves.

The intense emotional pain that you’re experiencing right now can distort your thinking so it becomes harder to see possible solutions to problems, or to connect with those who can offer support.

It is important to work out with a professional counsellor why you feel the way you do.  Give this process time and commitment even after you begin to feel better.

Coping strategies:

  • Promise not to do anything right now.  Make a promise to yourself: “I will wait 24 hours and won’t do anything drastic during that time.” Or, wait a week. Wait and put some distance between your suicidal thoughts and suicidal action.
  • Avoid drugs and alcohol
  • Make your home safe. Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms.
  • Take hope – people do get through this.   Give yourself the time needed and don’t try to go it alone.
  • Speak to someone you trust, whether it be a friend, GP, clergyman, teacher, family member or therapistOr call a helpline such as The Samaritans.

How to talk with someone who is (or might be) suicidal

Following text is taken from http://beta.helpguide.org/mental/suicide.  Adapted from: Metanoia.org

Ways to start a conversation about suicide:

·         I have been feeling concerned about you lately.

·         Recently, I have noticed some differences in you and wondered how you are doing.

·         I wanted to check in with you because you haven’t seemed yourself lately.

Questions you can ask:

·         When did you begin feeling like this?

·         Did something happen that made you start feeling this way?

·         How can I best support you right now?

·         Have you thought about getting help?

What you can say that helps:

·         You are not alone in this. I’m here for you.

·         You may not believe it now, but the way you’re feeling will change.

·         I may not be able to understand exactly how you feel, but I care about you and want to help.

·         When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.

When talking to a suicidal person

Do:

·         Be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it.

·         Listen. Let the suicidal person unload despair, ventilate anger. No matter how negative the conversation seems, the fact that it exists is a positive sign.

·         Be sympathetic, non-judgmental, patient, calm, accepting. Your friend or family member is doing the right thing by talking about his/her feelings.

·         Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you.

·         If the person says things like, “I’m so depressed, I can’t go on,” ask the question: “Are you having thoughts of suicide?” You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.

But don’t:

·         Argue with the suicidal person. Avoid saying things like: “You have so much to live for,” “Your suicide will hurt your family,” or “Look on the bright side.”

·         Act shocked, lecture on the value of life, or say that suicide is wrong.

·         Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.

·         Offer ways to fix their problems, or give advice, or make them feel like they have to justify their suicidal feelings. It is not about how bad the problem is, but how badly it’s hurting your friend or loved one.

·         Blame yourself. You can’t “fix” someone’s depression. Your loved one’s happiness, or lack thereof, is not your responsibility.

How to help someone who is bereaved by suicide

Bereavement by suicide can be more complicated because it is common for people to feel confused or guilty that they didn’t know the extent to which the person was suffering, and that they were not able to help.  They may also feel angry and disappointed with the person who committed suicide.  Because of stigma, they may feel they can’t talk about either the mental illness (if this was a factor) or suicide, adding to feelings of isolation.  Bereavement by suicide often carries feelings of deep shame. Following information is taken from sane.org

Common responses:

I don’t know what to say.

·         If not sure what to say, ask ‘ How are you feeling today? ‘

·         Tell the person you’re not sure what to say. Being honest will help to build trust

·         Try to listen 80% of the time and talk 20% of the time

·         Avoid making unhelpful statements such as, ‘It’s God’s will’ or ‘Time heals all wounds’.

I don’t want to make it worse for them. By allowing the person to express their grief you will be helping. Nothing you do can take away the sadness, but it is important to be there for them.

·         Allow tears or accept no tears

·         Understand that the way the person expresses grief may be different from the way you would express it

·         Don’t take anger personally.

They have lots of family and friends around. They don’t need me. People with lots of friends and family still need support from others. It’s important to have grief acknowledged by friends and colleagues so the person doesn’t begin to feel isolated.

They need help from a professional. There is nothing I can do. While professional help can be very important, don’t underestimate the importance of friendship when someone is grieving. You can do things a professional person can’t such as going for walks, cooking a meal or being there in the evenings and on weekends, remembering the birthday and anniversaries of the person who died.

I’m not sure what to say about the mental illness. Ask the bereaved person how they feel about this and reassure them you are happy to talk about mental illness if they want. Seek out some information so you know something of what the person may have been experiencing. Be compassionate and understanding about difficulties it may have caused in their relationship, and encourage them to talk to a bereavement counsellor if they are not coping or do not feel they can talk to anyone else.

 Useful Contact Numbers

Survivors of Bereavement by Suicide – 0844 561 6855

Samaritans –  08457 90 90 90

by: Wendy Bramham
Written as a resource for listeners of BBC Wiltshire mental health series, October 2013
Updated August 2014