Counselling

Depression and anxiety often go hand-in-hand, with one leading to the other. Depression is a mood disorder and characterised by persistent feelings of hopelessness, helplessness, sadness, finding it difficult to enjoy activities you used to, changes in sleep and appetite, feeling tired all the time without a clear cause, struggling to concentrate or make decisions, feeling worthless or guilty for no reason, and, in extreme cases, thoughts of or attempting suicide.

Experiencing certain symptoms of depression can be a normal reaction to various life circumstances or situations, but is considered diagnosable as a disorder if it lasts for more than two weeks. Very often, it also has a negative effect on school/work and relationships. Not being able to sleep, study or work can result in anxiety, which may then increase feelings of guilt, hopelessness, helplessness, impact on sleep, etc., and the cycle continues.

Most people have worries or concerns on a daily basis, but anxiety and anxiety disorders are characterised by experiencing these to the extreme and in excess for at least six months on an almost daily basis. Some of this anxiety may be related to specific situations, places or people, but may also be generalised and about nothing in particular. You may feel restless, tire easily, find it difficult to focus or concentrate, be irritable, have stiff or tense muscles and have disturbed sleep. Not being able to control the anxiety or worry, perform adequate at school or work, inadequate sleep or even physical symptoms without any apparent cause may result in feelings of hopelessness, helplessness and other symptoms associated with depression.

Both depression and anxiety can be ascribed to biological/physiological/genetic and/or environmental/social/interpersonal factors, and research has shown that the best outcomes are reached with a combination of psychotropic (medication) and psychotherapy (counselling) treatment. I provide counselling from a biopsychosocial perspective which means that I take into account a client’s physical, psychological and social background in my assessment and approach to counselling.

I once attended a CPD workshop where I learned that the reactions or feelings we have after suffering trauma or a traumatic event (sudden death of a loved one, natural disasters, war, violence, abuse, etc.) is a normal reaction to an abnormal situation. Some emotions associated with trauma are shock, horror, disbelief, overwhelm, anger, helplessness, depression, anxiety, grief, etc. Physiological reactions include shaking, shivering, increased heart rate, change in senses, muscle tension or spasm, fatigue, hyper-arousal, difficulty eating and sleeping, etc. Trauma is usually associated with a single event (but may be repetitive and continuous) and can lead to PTSD if not addressed within six months. The initial emotional and physiological symptoms of trauma tend to continue in the case of PTSD that is then characterised by psychological and behavioural changes, such as reliving the event (“flashbacks), distressing and intrusive memories of the event, avoiding certain things, situations or places associated with the event, having negative thoughts about yourself, other people or the world, feeling detached from others, losing interest in activities you used to enjoy, hypervigilance, irritability, anger, reckless behaviour, and problems sleeping.

As with depression and anxiety, I take a biopsychosocial approach when it comes to counselling trauma and PTSD.

In the past, ED has been mainly associated with white teenage girls or young women, but research has shown that it is prevalent among all races, genders and age groups. ED can take the form of Anorexia Nervosa (characterised mainly by restricting intake of food), Bulimia Nervosa (characterised mainly by eating a large amount of food in a very short time and then purging) and Binge Eating Disorder (characterised mainly by consuming a large amount of food without any compensatory behaviour such as purging). It is not always easy to identify whether someone has an eating disorder, just by looking at them, particularly when it comes to Bulimia and, in some instances, also Anorexia, where someone may only be considered slightly underweight or normal weight. A person does not have to be in hospital or close to dying in order to have an ED, as it impacts on almost all facets of life, including school/work, interpersonal relationships, mood and general functioning. Many people who die as a result of ED, do so not necessarily as a result of its physiological impact, but because of its psychological toll, i.e. suicide.

As with many mental health problems, ED can have a genetic and/or environmental cause, and is often also associated with anxiety, depression, trauma or PTSD. It is therefore important to consider biological, psychological and social influences when it comes to counselling these conditions.

Grief and loss are most commonly associated with the death of a loved one (family member, friend, partner) or even a pet. However, grieving and sadness can also be associated with a number of other life events/changes, such as matriculating or leaving school, leaving home, changing jobs, the end of relationships, losing employment, children leaving home, relocating, or retirement, to name but a few. What is common to all these situations, is that a loss or change in the familiar takes place, and adapting to the “new normal” can be challenging at times.

According to Elisabeth Kübler-Ross, a Swiss American psychiatrist, grief can take the form of five stages, namely denial, anger, bargaining, depression and, eventually, acceptance. Denial initially helps one to survive the loss we have experienced, but is not helpful in the long run. Anger is frequently underpinned by many other emotions, particularly pain, and can be directed at people, situations, circumstances or a higher power. Bargaining can occur before (e.g. I will never be angry with my sick daughter again if only she can live) or after a loss (If only I had loved my partner more, they would not have left). Depression comes when one starts to realise the finality of the loss and experience the helplessness associated with not being able to change or get back what one has lost. The final stage refers to accepting what one has lost and that this loss is permanent, but does not mean forgetting, “being okay” or carrying on with life as though the loss never happened. It rather refers to living a “new normal” and starting to live again.

It is important to remember that these five stages are not necessarily linear or dependent on first completing the one before moving on to the next. One can therefore move between stages at any time, some stages may take longer than others, and some stages may have to be revisited. In the end, the goal of the process of going through the five stages is to learn how to live the best life in spite of having suffered a loss.