Depression in a 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.
This blog has been adapted from an article originally published by BACP in the Private Practice Magazine in March 2017.
How to keep sex alive
Summer might only just be upon us but it is the season of weddings nonetheless. Many couples are experiencing the results of much planning and anticipation as they come to their big day. Many hopes and expectations abound as to what their life together will be like – the unknown of the journey ahead for many at this stage is exciting and yet possibly unnerving.
But what of those years ahead – one of the questions I am asked a lot in counselling is ‘How do we keep our relationship and particularly sex alive?’ Sex in the first couple of years of a relationship is passionate, urgent and much wanted for most couples. But then the ordinariness of life sets in – the familiarity, the pressures of work, young children bring time pressures and sleepless nights and suddenly years down the line couples take each other for granted and sex gradually becomes something that moves way down the list of importance, or it even becomes a matter of conflict for the couple.
So here are some tips for how to keep your sex alive after those early years in a relationship. Broadly speaking, sex will be better if you are more fully yourself, and if you are emotionally more connected to your partner..
1. Spending all your free time together can stifle difference and individuality. Those elements are needed for good sex in a long-term relationship. Pursue some separate interests – it is healthier for you both to be able to be fully yourselves and keeps some mystery and interest between you.
2. Show appreciation and say thank you to your partner. Daniel Keltner is quoted in the Observer saying that studies show that romantic partners who express gratitude are more than three times less likely to break up. The warmth and good feeling that is generated by simple gestures of goodwill can make an amazing difference to sex.
3. Stay emotionally in tune with your partner – check out how they are and take time to talk. Being connected emotionally is a starting point to being connected physically.
4. Take time to have fun together – play tennis – go dancing – enjoy a movie – or make time for a weekend break. Fun outside the bedroom can lead to more fun within.
5. Make the bedroom a digital free zone.
6. Schedule sex. Let go of the idea that the best sex is spontaneous. There can be fun in the anticipation.
7. Remember to kiss your partner and take time about it. It is a way of building real intimacy between a couple.
8. Try something new – surprise your partner. Don’t just use the same routine and path that you know works. Familiarity can become dull, and sexual arousal can be enhanced by a fresh approach.
9. Finally don’t look back to the past – enjoy who you are now both individually and as a couple and look forward to new and life-enhancing times together.
The Yes Brain Child - Daniel Siegel and Tina Payne Bryson
In my experience as a therapist Mother’s Day raises all kinds of questions and emotions for my clients. Frequently their own childhood experiences of being mothered will continue to impact them and is affecting how they are in their current relationship. Equally too it will raise questions about their own parenting skills and, in some cases, the parenting skills of those closest to them. To take one example - nowadays many older people are helping out caring for their grandchildren on a regular basis and this brings the challenges of seeing them being parented in a different way. Likewise parents can struggle with feelings stemming from not having their own way of parenting respected and valued by the older generation.
In that context a book that I have found helpful to a number of parents in recent months has been ‘The Yes Brain Child’. Its authors, Dr. Daniel Siegel and Dr. Tina Payne Bryson, who specialise in the fields of psychiatry and paediatric and adolescent psychotherapy, are fascinated by the ways in which the brains of children develop.
Beginning from the hopes that most parents want for their children – happiness, emotional strength, academic success, social skills, a strong sense of self and more – they argue that there are ways in which any parent can help their child to develop a ‘Yes Brain’ – a brain that provides a perspective characterised by
“Balance: the ability to manage emotions and behaviour, so kids are less likely to flip their lids and lose control;
Resilience: the ability to bounce back when life’s inevitable problems and struggles arise;
Insight: the ability to look within and understand themselves, then use what they learn to make good decisions and be more in control of their lives;
Empathy: the ability to understand the perspective of another, then care enough to take action to make things better when appropriate.” (Welcome page x)
The book is written in a way that is very readable with its concepts made easily to any reader, by outlining strategies to help in its different areas.
One of the models, which I find very helpful, is the focus on the three zones your child may experience at any given moment. When the child is in balance they are in the Green Zone – but given a conflict or something not going their way – they may move into the Red Zone and lose control, or move into the Blue Zone and shut down. The aim is, of course, to widen the window of the Green Zone and to help children build resilience and find strategies for maintaining their balance within it.
Although the book is written for parents or grandparents, there are of course applications for these tools in our own adult relationships. How often do we move into the Red Zone (and fly off the handle) with our partners or retreat into the Blue Zone (and withdraw)? When we want to ‘have a go’ at our partners – rather than just being the ‘player’ in a fight, can we learn to stand back and with insight become a ‘spectator’ and make a different choice to communicate our frustration or disappointment.
If you are interested in finding out more, then I would encourage you to give yourself or your partner or a friend a copy for Mother’s Day – its good effects will last longer than flowers or chocolates or even breakfast in bed!