Here at counselling connections this week we were talking about how an episode of depression and in particular how it is treated can represent an opportunity. That may see like an odd thing to say because nobody would willingly choose to have depression. The point is that we often find that depression can occur at a crossroads in life. It is probably accurate to say that an episode of depression can eventually lead to making great changes.
Depression is experienced in different ways. People often describe a loss of interest in life and specifically a loss of appetite for food and sex. Concentration can become difficult and simple tasks which we would have carried out without giving them a second thought can suddenly appear quite difficult. This can have the effect of shaking our confidence further. Sleep often becomes a problem with clients reporting that it can be difficult to get off to sleep or that they wake in the middle of the night. These symptoms are often accompanied by a general low mood.
Low mood can vary quite a lot from person to person. At times someone will describe a low mood which is quite persistent, which doesn’t really lift but which is not severe enough to stop the person from working or interacting with others. This kind of low mood is sometimes present for a long time before deciding to talk to someone about it. At other times mood levels are sufficiently low as to be quite debilitating. It is not unusual for someone to be quite self-critical at times like this and unfortunately this can make an already gloomy outlook on life appear worse.
All of these symptoms are telling us that at a very fundamental level inside us we have become dissatisfied with how our life has evolved. We can drift somewhat into a position in life where our job or lifestyle or key relationships just don’t match up with how we imagined they were going to be. We may have developed strong internal beliefs say in fair play or reward for hard work and honest effort. And these might meet again and again with frustration and rebuttal in the world. Our depression offers us a chance to re-evaluate all these kind of beliefs and presents us with an opportunity to change.
This is easier said than done and we would not have developed a depression in the first instance if we hadn’t been trying really hard for some time to make things work out. We also have to face, perhaps for the first time our internal critic. This figure in our imagination has likely been the cause of many a plan being abandoned and many an opportunity for contentment missed. This is the internalised version of a harsh parent or other significant person from our past. And sometimes rather than confront the idea that ‘I can’t do this’ it is just easier either to give up or not try at all. This kind of behaviour becomes very fixed and can be difficult to change.
Change is brought about by becoming aware of our internal beliefs and standards. It is about getting to know and understand ourselves at a very fundamental level. It becomes possible to challenge our fears and misconceptions about our own capabilities. Sometimes during therapy and following a depression we have to face our own anger at others or at the world for how things turned out. This is in fact a very healthy process and is part of getting to really know our deepest self. Armed with this self knowledge and with realistic expectations of the challenges we may face along the way we can again set about living life and trying to find a balance in our relationships; in love and in work; with all aspects of the world outside.
Counselling Connections, Dundalk.

In previous posts we have referred to the experience of PTSD following childbirth and we now turn our attention to Postnatal Depression. In the days following the birth of your baby, it is not unusual to experience some degree of mood swings. However, it is the mildness or severity of these which determines what category one falls into. There are three main kinds of mood swings namely ‘The Baby Blues’, Postnatal Depression or Puerperal Psychosis.

In its mildest form, the Baby Blues is unpleasant for new mothers who may have been caught unawares with tearfulness, irritability and feeling vulnerable somewhere between day two and day four following childbirth. It is thought that this is due to the drop in hormone levels at this time and it resolves itself within a few weeks. Puerperal psychosis is a severe form of mental illness, where a woman loses all contact with reality following the birth of her child. This is very rare, affecting 1 in 500 and requires hospital admission and psychiatric treatment. Mothers can make a full recovery with professional help and family support.

About 15% of women in Ireland fall into the category of Postnatal Depression. This can begin as a form of baby blues that doesn’t lift but lingers on and gets worse. It can last for months and even years if undiagnosed. One of the problems with it is that women often don’t know what’s wrong and it can take a family member to notice that there is a problem. Symptoms can include crying, irritability, anxiety (sometimes manifesting as panic attacks), often not knowing exactly why. Loss of interest in yourself, your appearance and your relationships is common. This can manifest in social withdrawal, where you don’t want to see family or friends. You may experience loss of appetite and insomnia, finding it hard to sleep even when your baby is asleep. This results in tiredness and a subsequent inability to deal with the demands of motherhood. This coupled with not really feeling huge love for your baby can leave you feeling pretty awful about yourself. Self Esteem is often low as mothers feel they are not managing as well as others seem to do ( I am reminded at this point of the photo shoots in magazines portraying new mothers (and babies) as perfect, living in a perfect house with a perfect partner). Life isn’t like that but somehow the media’s portrayal of new motherhood sticks and we feel inadequate when we don’t match up to that standard. It is not unusual for some mothers to tip into obsessive behaviour like excessive tidying or some may develop an overwhelming fear (e.g. death).

The good news is that Postnatal Depression is treatable and you will recover. Like any illness, recovery takes time. It is important to concentrate on the practical aspects of daily living, like getting enough rest and eating well. Accepting help from others is a big part of this, reminding yourself that it is temporary. It can be difficult to admit that you need help but your recovery will be quicker if you do. Talking about your feelings to your partner, family, friends, GP or Public Health Nurse will certainly help. Some GPs may offer anti-depressant medication as part of treatment.

It would also be quite common for women experiencing postnatal depression to seek counselling as part of their treatment. Counselling can offer you a safe place to explore your feelings in a non-judgemental way, something that may be difficult to do with people close to you. For some there are other issues from their past complicating or impacting on their mood and recovery. These issues can be conscious or unconscious e.g. If a woman has lost her own mother she may feel this more at this time or if she has had an abusive childhood this may be affecting her at an unconscious level.

Support groups can be very helpful where you can meet with mothers who have had similar experiences to you, facilitated by a trained counsellor. Here at counselling connections we run groups for mothers who are suffering from PTSD and Postnatal depression where women share their experiences with each other. If you are a partner reading this and want to know how to help the first thing to do is get outside help. Remind your partner that this illness will pass and support her in whatever way you can practically and emotionally. This can be a trying time for you too and for your relationship but with the appropriate help, it will resolve.

One of the more common referrals to us here at Counselling Connections from General Practitioners is for anxiety disorders and panic attacks. The symptoms are often very physical with a racing heart and shortness of breath and this is why we are likely to go to the GP for a check up as a first port of call. And it is important to first rule out a physical cause for these symptoms. Sometimes other factors such as drug use or alcohol intake can exacerbate the condition. These have to be dealt with as part of the treatment. Anxiety can be associated with depression and your doctor will check to see if you are feeling depressed as part of considering the next step. Sometimes anti anxiety medication is prescribed and a referral for counselling is made.

At the beginning of the counselling process your trained and experienced counsellor or psychotherapist will first ask you about your own personal details and the major landmarks of your life. These may include losses and childhood events that stand out for you as being significant. If nothing strikes you as being important at this early stage that does not prevent progress as looking for underlying causes is actually the second part of a two pronged approach. The first part of the treatment is a cognitive behavioural therapy or CBT approach. This has proved most effective in dealing with symptoms of anxiety and panic attacks.

The initial work of the CBT is to learn to tune in to your own patterns of thought. In this way we can collaborate in challenging some of these thoughts and checking to see of they are appropriate to the situation in which they occur. Often it turns out that our thinking is actually making our anxiety much worse as we tend to make everything seem worse than it really is. We see a catastrophe where one doesn’t exist. We may think that people are looking at us and judging us whereas they may not be. Challenging these thoughts and understanding the part they play in our anxiety or feelings of panic represent the beginning of changing the way we think.

It is a very empowering process to take charge of our own thought patterns and get on top of our fears. Sometimes we will set ourselves goals as part of strengthening our belief in our ability to cope with our environment. These may involve deliberately placing ourselves in a situation which would have caused us anxiety in the past. It is important to approach these tasks slowly and to be respectful of the fear of overwhelming ourselves. That said, to achieve some successes in anxiety provoking situations helps to give a sense of confidence in the process and strengthen our self belief.

There will be times where we may be faced with thoughts such as ‘I will never do this’ or ‘I am no good’. Oftentimes thoughts like these can be traced back to things that a significant person may have said to us repeatedly at times during our childhood. And moving into dealing with these represents the second part of the two-part therapy. Here we begin to get in touch with the root causes of our anxieties and the core beliefs which we have developed about ourselves. It is important to state here that core beliefs are learned and as such they can be unlearned and replaced with newer, more appropriate ones.

We are often asked how long this process takes and the truth is that it is difficult to say with any accuracy. Initially it would be expected that a therapy like this would last somewhere in the region of three months. As you move into the second phase of the therapy as we have described it becomes more of a journey and we would not attempt to put a time limit on that. You can take time take to explore areas of your life and to consider major events and relationships again and maybe re-order them in your mind and choose to respond differently to things in the future. In this way the practice of knowing yourself and your hopes and fears can become an integrated way of being for you. You wouldn’t expect anxiety or panic to become a feature of life again once this practice becomes established.
Counselling Connections, Dundalk.

We tend to think of mothers and babies when we think of birth trauma but what of Fathers? How do Fathers deal with the aftermath of traumatic birth? When birth goes well a Father can feel empowered by the experience, in which he may have been largely involved. This often serves to bring the couple closer together, bonded by this unique experience. However, the opposite can also be true and men can be left feeling isolated and alienated from their partner and baby through the experience of traumatic birth.

For the most part, men are encouraged to be actively involved in their partner’s care, if this is what the couple want. But men may also be asked to take a back seat by hospital personnel if there are complications. This can leave men feeling powerless to protect their partner and baby at a most vulnerable time. They become onlookers in a drama, where a few minutes previously they were active participants. Men can be left feeling they have let their partners down, when choices in labour have been reduced by the nature of the sequence of events. He may feel that as the spokesperson on behalf of his wife/partner, he has been unsuccessful in having her wishes heard and followed through. This feeling of inadequacy can be further complicated where problems with the baby necessitate a visit to the special care baby unit. Men can feel torn between staying with their partner on the delivery suite and going with the baby to ensure all is well, while all the time feeling neither choice is the right one.

Antenatal preparation in the form of parentcraft classes can help shape expectations and can help men to familiarise themselves with what they may encounter on the delivery suite. Men are often witness to instrumental deliveries i.e. by vacuum or forceps, or they may accompany their partners into the theatre for caesarean sections. Seeing a baby born from this angle is very different from the experience the woman has. While in no way minimising the experience of the woman, it is also important to recognise that men may suffer a different kind of trauma in these situations, witness trauma. A man’s role in the birthing process is one of support, comfort and protection. When he has difficulty fulfilling this role through circumstances beyond his control, he can feel frustrated and worthless and frankly ‘less of a man’… This can further lead to low self-esteem and relationship difficulties. It is not uncommon for couples who have experienced a traumatic birth to have sexual problems as a result. While there may be physical and emotional issues on the part of the woman, a man can feel emotionally scarred and reluctant to cause his partner any physical pain or upset.

The dynamic of the couple relationship changes following the birth of the baby. Fathers who have witnessed something traumatic during the birthing process may find that they have difficulty bonding with their baby. The baby can be a reminder of all that went wrong, at what was supposed to be a happy time. He may also be left trying to deal with a traumatised wife, who is struggling herself, while coping with sleepless nights and trying to work. Although society generally views the birth of a baby as a happy time, it can be an extremely stressful and testing time for a couple. There seems to be very little room for couples to say how awful it is for them in these early weeks and months. While women tend to talk about their problems to other women, men are often left with no outlet, fearful of being perceived as weak if they are upset at what the experience of the birth of their child and the impact it has had on them. In the absence of support from family or friends, counselling will offer a safe place to vent these feelings and to learn how to incorporate your experience into your life, allowing you to move on. We at Counselling Connections also run a group for men who have been upset in any way by the pregnancy and birth of their baby. Here, men get to meet with other men who have similar experiences, leaving them feeling less isolated. Knowing there are others who feel the same way as you do and sharing those experiences can be powerful in helping you to deal with this kind of trauma.