Trauma and loss
Traumatic events are by their very nature extraordinary in that they overwhelm the ordinary human adaptation's to life that give people a sense of control, connection and meaning. Traumatic reactions occur when neither fight or flight is possible such that the human system of self-defence becomes overwhelmed and disorganised. Traumatic events produce profound and lasting changes to physiological arousal, emotion, cognition and memory.
Not all people who have experienced trauma will develop PTSD or require treatment; some recover with the help of family, friends or other support. But many do require professional help to successfully recover from the symptoms which range from full- blown PTSD (for a detailed list of these symptoms consult the SADAG website) to more minor complaints such as sleeplessness, mild depression, anxiety and fears. These complaints might even be difficult to link directly to the trauma itself. Trauma is also not necessarily an isolated event, many people who seek therapy are suffering from ongoing trauma and stress in their lives. Psychotherapy focuses on recovery based on the empowerment of the survivor and the creation of new connections. Recovery takes place within the context of a safe relationship where the damaged capacities for trust, autonomy, initiative, competence, identity and intimacy are recreated and restored.
Loss is an inevitable part of life, and grief is a natural part of the healing process. The reasons for grief are many, such as the loss of a loved one, the loss of health, or the letting go of a long-held dream. Dealing with a significant loss can be one of the most difficult times in a person's life. The grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving. It is also important to note that the grief process is not linear, but is more often experienced in cycles. The course of grief is unpredictable and every individual’s experience of grief is unique.
But when grief takes over your life and you begin to feel hopeless, helpless, and worthless or unable to cope with work or school - then it's time to seek help. Unresolved grief can lead to complications such as depression, anxiety, substance abuse, and health problems. An important part of the healing process is allowing oneself to experience and accept all feelings that arise. Therapy offers a safe place where the client is listened to deeply and responsively and will involve a gradual process of reconstructing life out of loss.
Depression and bipolar mood disorders
Most people feel sad or irritable from time to time. A mood disorder however is more than just a passing emotion, you cannot just snap out of it at will and it can persist for a long time if it is not addressed. Depending on the severity of the mood disorder, psychotherapy can significantly reduce and sometimes even eliminate the symptoms. Other times, psychotherapy is best combined with medication.
Major Depressive Disorder
Some people describe depression as “living in a black hole” or having a feeling of impending doom. If you identify with several of the following signs and symptoms and they just won’t go away, you may be suffering from depression and may need professional help. Bear in mind that the list is far from complete and that the severity and number of symptoms will also vary from person to person and can change over time.
- you feel sad, empty or hopeless most of the time
- you feel worthless or experience excessive guilt
- you’ve lost interest in friends, activities, and things you used to enjoy
- you feel tired all the time
- your sleep and appetite has changed
- you can’t concentrate or find that previously easy tasks are now difficult
- you can’t control your negative thoughts, no matter how much you try
- you are much more irritable, short-tempered, or aggressive than usual
- you experience recurrent thoughts of death or suicide
Bipolar disorder often runs in families. In addition to the depressive lows described above, those with bipolardisorder will also shift into extreme highs or agitated states. The highs are called mania in bipolar I, or the lesssevere hypomania in bipolar II. These shifts are not mood swings. They usually don’t occur over a short periodbut rather over days, weeks, months or even years.
The depressed state can seem identical to a major depressive episode except that antidepressant medication can trigger a manic episode in those with bipolar. Individuals in the manic stage often experience:
- inflated self-esteem
- decreased need for sleep
- high energy and increased agitation
- racing thoughts
- pressure to keep talking
- set grand goals
- engage in risk-taking activities such as spending excessively or hypersexuality
People in this state make poor decisions that can cause major disruption in their personal and occupational lives. Medication can be effective in controlling these moods. Research has shown that patients taking medication to treat bipolar disorder are more likely to get well faster and stay well if they receive psychotherapy in conjunction with medication.
Family and parental mental health
Peripartum and postpartum depression
Being pregnant and giving birth to a child is a time of great celebration and hope, but it is also a time when women are very vulnerable. Depression and anxiety is common during pregnancy, and may affect as many as 40% of pregnant women in South Africa. Untreated this can develop into postpartum (post-natal) depression. Symptoms can range from extreme sadness and feeling like you have no connection with your baby, to severe anxiety and panic, to extreme irritability and anger and feeling like you may even hurt your baby. For a detailed list of these feelings and symptoms consult the PNDSA website.
Many women suffer in silence because they feel ashamed or guilty at being depressed when everyone around them is overjoyed. In addition, partners and families may not understand how the mother is feeling, and may try to tell her to "count your blessings”. Given the knock-on effects of postpartum depression to the emotional well-being of the mother, her baby and the family as a whole, early intervention and diagnosis is essential. Supportive psychotherapy which offers a holding environment for the mother together with psychoeducation is an effective treatment for peripartum and postnatal depression either alone or in conjunction with medication. Once the mother has sufficiently stabilised, the opportunity for more in-depth psychotherapy is recommended so as to protect against future episodes of depression.
Mental illness of family members
The mental illness of a family member can have a profound affect on the well-being of any family. These families often have to deal with instability or unpredictability and often there is confusion in family roles, and children or other family members may have to take over many of the adult responsibilities. Families often have to accept a changed future and expectations. Where the illness impairs the person's ability to function and participate in the normal activities of daily life, families often struggle to accept the realities of an illness that is treatable, but not curable. In many ways families grieve for what might have been and find it difficult to focus on the possibilities that remain for their loved one. Psychotherapy not only provides psychoeducation on the illness in question, but it also provides a supportive environment within which the family are gradually able to work through their grief.
Psychologists who work with families usually see them as a unit - a unique social system with its own structure and patterns of communication. These patterns are determined by many things, including the parents' beliefs and values, the personalities of all family members as well as their different habits, perspectives and interpretations of events. What one member does or doesn’t do affects not only him or herself but everyone else in the family as well. In assessing both its strengths and weaknesses, family therapy enables all members of the family to understand and develop ways of assisting and supporting each other. It helps the family focus less on a particular member but rather on the family as a whole. It helps to identify conflicts and anxieties and helps the family develop strategies to resolve them. Learning respect, tolerance and attentive listening, especially during conflict, lays the basis for a healthy family emotional system which forms a strong foundation to work from when difficult circumstances arise.
Divorce is one of the most stressful events a person can experience in his/her lifetime. Where children are involved, this stress is compounded and the psychological well-being of the child is brought under the spotlight. When parents decide to divorce, they end their personal relationship as partners, but continue their relationship as parents. Most former spouses are able to establish a relatively conflict-free parenting relationship for the benefit of their children. However, many have difficulty in establishing a workable parenting relationship. Co-parent counselling (or individual counselling as the case may be) allows parents an opportunity to talk about the best interests of their children in a neutral environment and, when appropriate, to get input and advice. The focus in treatment is on the difficulties between the separated parents only as they relate to co-parenting. The goals are to help parents unburden their children by learning to manage their own emotions and anxieties. Parents learn to free themselves from dysfunctional, emotionally-charged communication and instead adopt a more clearly-defined, respectful, and dispassionate approach to problem-solving as it relates to parenting.
The term ‘personality disorder’ can sound very judgemental. Your personality is the core of your self, and to be told it is ‘disordered’ can be very upsetting and undermining. However, we all have traits of some personality disorder, but it is when these traits interfere with our daily functioning and relationships to a significant extent that we might be suffering from a personality disorder.
Diagnostically a personality disorder is described as an enduring pattern of inner experience and behaviour that deviates substantially from the norms of the individual's culture, is pervasive and inflexible, has an onset in early adulthood and leads to significant distress or impairment. Many of these patterns of behaviour are related to negative early childhood experiences. These experiences cause patterns of distorted thinking and beliefs that may have been understandable in childhood, but do not work in adult life. The goal of therapy is to explore these distortions, understand how they arose, and find effective ways to overcome their influence on your thinking and behaviour. Different types of psychological therapies have been shown to help people with personality disorders. However, there is no single approach that suits everyone and treatment should be tailored to the individual.
Interpersonal and relationship difficulties
Sometimes the very relationships that bring the most joy and fulfilment can also be the ones that can cause the most grief and anger. Interpersonal relationships become problematic when one or more of the participants has needs that are not met within the relationship. People can be difficult to deal with and we can react negatively to the stress that comes from these relationship challenges. You may be finding it hard to be at ease with other people and have difficulty forming open and caring relationships with people. The problem is that we tend to be so immersed in our ways of relating that it is really difficult to see and change them.
Psychotherapy and anger management skills can help with interpersonal problems. Psychotherapy can explore patterns and experiences in relationships and identify and understand problem areas, so you can determine ways to resolve the difficulties causing you distress. Self-knowledge is the key to establishing healthier relationships. In every therapeutic encounter, the client's whole world is present - all of the client's past relationships, all of the client's hopes and fears are present in the room. Often the same dysfunctional relationship styles will surface in the therapeutic relationship and rather than hamper the therapy, the problems are explored in the here-and- now and the insights are carried into the client's own relationships.
Adjustment or life-transition challenges
Whether it be parenthood, divorce, career changes, adolescence or simply a search for meaning, life throws out challenges that some of us struggle with to the point that we are unable to cope with these transitions. Adolescence for instance presents many challenges and identity related concerns as well as parental/peer conflict and adjustment difficulties. The ability to cope with these adjustments varies from person to person and what one person finds stressful may not be a problem for someone else. Often the stress in dealing with these issues builds to the extent that our normal coping mechanisms are overridden. There may be marked distress that seems out of proportion to the severity or intensity of the stressor. Often these individuals are told by others to "just get over it", but are unable to.
Therapy can provide a support system while adjusting to these challenges and at the same time exploring healthy coping strategies. Each individual’s reaction usually becomes understandable when one investigates the individual's personality and life events. Arriving at this understanding is helpful since it allows the individual to see why they responded in this way and what areas they need to work on. In addition, when people know that they do not cope well with change, consulting a therapist before any significant changes in life occur may be warranted.
In other areas, you may have reached a point in life where you experience an "existential crisis", where your ongoing search for substantial meaning throws you into deeper crises of meaning. There may be a need for greater self-knowledge brought on by disillusionment with life, or perhaps just a yearning for a different experience of life. Therapy can therefore provide a space within which to embark on a journey of self- exploration and personal growth.