Featured

What is happening to therapy?

This is the post excerpt.

IMG_5029

I have been trying, this past ten years or so, to do therapy without using any jargon. No words such as depression or bipolar,  nothing like inner child or soul or inner critic or sentences like, “You can be anything you like”,  or  ” Do whatever feels right for you.” To be frank, I disliked all of that anyway. It sounded like brainwashing combined with  wishful thinking, and who knows,  is any of that “true” at all?

So, I try to stick to ordinary verbs – doing words – and adjectives. If you push “Depression” out of the room, longing and sadness will usually take its place. Tell me about your longing and your grief. We can talk about that. And tell me about your loss of power too.

Yesterday I was at a creative workshop. A lovely older woman, a teacher of English, spoke about her agony when having to take big decisions as she does not trust herself, and she is sad about a life that is lacking in joy.  “It is because of the lack of love in your life” , a successful therapist replied. “Yes”, the teacher responded, agony on her face, “that is exactly what I don’t have.”

Here is my take on it: When you are a small child,  you will explore. You will do your best to discover things and to have joy.  You will only be stopped for three main reasons: 1) Absence of opportunity (a barren environment) 2) Rigid rules and boundaries (don’t make a mess, be clean, be tidy, be dutiful) and/or 3) Overprotection.

When you are an adult, you cannot wait for trust and love to be there before you begin to explore and to experience joy.  You cannot waste more time mourning for what you do  and did not have. You may have to wait for ever and then more if you want to have  before you begin living. You begin by risking, by taking chances, by taking a walk on the wild side. You will learn to trust and to love once you are out there –

 

 

 

 

 

 

 

 

 

Depression I. Uncomfortable facts:


A. Medication & Genetics

I have procrastinated writing about depression. It is such a monumental field: How do I cover this vast field in a few short essays? Here is a short piece about the most often heard untruth as well as the most honest route to ‘cure’.

The most frequently overheard misunderstanding:

1. It is a genetically transferred illness.  My father had it; my grandmother had it, so now I have it. We have to take pills for the rest of our lives, and that is all there is to it. It is an illness, just like diabetes. You don’t feel ashamed if you have diabetes, so why should you feel bad about having depression? You can’t help it.

This type of reasoning is understandable. It takes the personal out of the particular, and makes it easy to engage with: We all understand about a clearly defined illness (diabetes, high blood pressure, epilepsy). Medication is simple to administer (if not that simple to adhere to). This helps family members to take themselves out of the equation (it is inside the person after all) – providing a protective shield that quarantines against personal, familial and social liability.

I suffer from depression myself. Many of my family members do. It is not a crippling depression; we function fairly well in spite of it, some even becoming high achievers, despite the chronic dysthymia that runs through our family line (dysthymia is the old-fashioned term for low-grade depression. It stems from by Hippocrates, meaning despondency /or a tendency to be despondent/despair – literally, bad soul. In current medical terms it is known as Persistent depressive disorder).

Well then, it must be genetic. Yes and No. Yes, but No.

So is it genetic? Probably. Somewhat. This one is tricky to pinpoint, as we know that genes respond to an environment. We know, for example, that rat mothers who are trained to be anxious (by consistently evoking anxiety in them), not only have anxious pups, but that their pups also have anxious pups. So here we have something that did not exist before, being trained into the genes. But it is not as simple as that either, because anxious mothers react differently to their offspring than non-anxious mothers do, so that their reactions are also transferred through learning, and learning gets wired into our brain. Thus it is not that easy to discern genetics and learning, given genes also get triggered in specific environments. Taking this argument into consideration, unlearning and not triggering a gene could therefore also happen. In other words, we could reverse the anxiety in the rat pups – and in their pups.

The most truthful answer is that depression is most probably genetic and environmental: In other words, a gene to be triggered needed to pre-exist, but it also required an environment to trigger it. As the trigger usually happens early, the environment is most usually familial as well as societal.

A. Typical familial triggers: A loss that cannot be properly grieved, nor restored.

This can be a real loss (death, stable & secure environment, disability, etc) or a psychological one: power, spontaneity, emotional stability, love.

B. A wider loss: It can also be the loss of something more abstract, but equally vital: meaning, true connectedness, authenticity, truth, depth, spirituality, creativity, and engagement.

C. And more modern/societal: The loss of childhood, the loss of security, of certainty, of community, and of time spent in nature.

2. The most ineffective way to treat it: With medicine.

No, this is not my personal opinion because I am anti-medicine. I do not tell people with diabetes or high blood pressure not to take their pills. But, as any medical practitioner will tell you  – with exasperation, or resignation, depending on how long they have been in practice – the problem is that many people with diabetes continue with their unhealthy lifestyles, even when they become blind, or a foot has to be amputated. That persons will high blood pressure will not exercise, or keep their weight down, despite being told to do so repeatedly.

Research has conclusively shown by now that a) anti-depressants on their own will not –cannot – cure you of depression, and that b) at least one third of people do not respond to anti-depressants positively, and a significant percentage will respond negatively, that is, become more depressed. The long and the short of it: Anti-depressants can help in the short term, and may even be vital for that initial kick-start that you need, but if you do not make the necessary lifestyle changes, you will remain depressed.  This I can guarantee you. The same goes with anxiolytics (anti-anxiety meds). Depression and anxiety, by the way, are twins.

3. The best cure is the hardest one. Its name is truth.

To be objective about ourselves is probably thé most difficult task that we can undertake. I had a wonderful friend who died prematurely of cancer. I still miss him. One day he said, “All life is based on a white lie. Without it we could not function.”  This may be true, but for a person with depression, the only way out, is through the gates of honesty.  If we are not honest about own lives, we will not overcome it. In our family for example, we have generations of unloving stepmothers. How could this not have impacted on us? (Small wonder that is such a prominent feature in fairy tales). But, important as this is, and it is, it is still only á backdrop.  There are many more: You have to go through the entire ABC above, and unpack them one by one.

The most efficient way to begin: Ask your best friends, your family, and then your colleagues. Ask them to be honest. Grin and bear it.

Much of depression is rooted in an overcompensation that had you compromise the very essence of your being. It is disempowerment combined with grief. The greatest grief: The loss of your vital, authentic self. The loss of the connection to that which is vital. No amount of pills or the distraction of your choice will extinguish the longing for something more vital. 

You have to put up a fight to get yourself back. Don’t give it up.

Available online:

To read: “Depression as a Social Disease”, by Michael Bader in Psychology Today  

To watch: John Hari on you tube: “Why disconnection is at the center of depression and anxiety today”

To research: The research on medication consists of a host of contradictory findings, opposing each other. Even reliable websites can contain directly contradictory research papers.

Here is a cautious reaction from the World Health Organization (WHO)

There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.

https://www.who.int/en/news-room/fact-sheets/detail/depression (19/03/2019)

Thriving 2

I send out a whats app:

“I am doing a small informal survey: Would you mind giving me 2 examples as a child when you felt like “thriving”. Mine, for example are, doing my homework on my own, and riding my bike from athletics back home.”

I have some ideas about thriving, but like to keep an open mind.  It is enjoyable to find patterns in people’s responses, especially when they are completely unaware of each other. The return messages fall into two categories.

Examples from Category One

I wanted to sing in the choir, but was told that I sing off-key. So I practiced and practiced, sometimes my mother would play the piano for me to sing, until I made it. I loved every moment of that choir.

From someone else

I was ten years old, and joined a gymnastic club. I was scared, as I was the only Coloured child there, and what if I could not do it? The trainer was kind, and to my relief I could do it.  Wednesday afternoons became the highlight of my week, and when I received my certificate at the end of the year, I felt really proud.

And another

I had some difficulty with Physics, until Mr M. came along and showed me logic; I felt completely in control and developed a new sense of independence.

From a woman

When my dad helped us to make bows and arrows, and we went swimming with him in the forest, although he could push us too hard to jump from a high ledge into the pool that has no bottom or slide down a slimy slope.

Category two

As cousins we enjoyed riding our bikes, even if it meant getting into trouble for not being home on time.

Saturdays in Mr M’s garage, playing table tennis. That’s where our table tennis club was.

Playing in the veld with kids from the neighbourhood.

Where we lived it was very hot. My cousin, my brother and I spent hours playing in the pool, with our dog for company. There was no adult supervision. Afterwards, ravenous with hunger, we would lie on our stomachs, eating watermelon with pieces of cheese.

What do we see here? Experiences of challenges overcome and of camaraderie, of gaining independence and of support & encouragement. It strikes me how physical and sensorial the majority of the examples are (Another person wrote about baking cakes on Sundays whilst her parents are sleeping).

A final example

I always dreamed of having a horse. Never thought it would be possible. My father made it realise. Saddling and riding and caring for my own horse gave me a great sense of independence and competency.

Here we see a great example of thriving: Where an individual with the right type of support, experiences independence and competency.  Physicality and the outdoors perfect the picture. The only thing missing, maybe, is the camaraderie.

So what do we have here?

Camaraderie, adventure, freedom, independence on the one side  – Overcoming fear, achieving incremental goals and pride in our accomplishments on the other.

One thing is for sure: supportive others that help you to reach your own goals are often (but not always) necessary, as long as they do not undermine your independence and your freedom.

Sounds like excellent parenting advice!

And a fine challenge to our own lives.

All this reminds me of Internal Motivation. This is how internal motivation is nourished. As we saw in a previous blog, internal motivation in essence depends on three capacities (these are innate to all children, if parents, teachers and siblings don’t interfere too much): Self-determination, perseverance to achieve own goals (self-discipline), and pleasure in the doing so.     

“Self’ 

“ I do it myself”.                 

Thriving vs. Surviving

It is a common human experience this; surviving rather than thriving. Many of us live like that: We are grateful for small islands of thriving amidst an ocean of surviving.

Living with satisfaction is an encompassing topic that covers a range of possibilities from “The Power of Positive Thinking” to “Man’s search for Meaning”, as well as a bookshop full of titles from “How to win Friends and Influence People” to  “Rich Dad Poor Dad”. I do not mean to bash these books; they are the result of a collective need for pointers in the right direction. The abundance of self-help slogans also attest to this, forming handrails to the shaky bridges that we have to cross daily over increasing divides.   With escalations in diversity, with ever-expanding uncertainties and divisions, combined with the invasion of compelling Internet posts, we have the inevitable decrease in communal wisdom and certainty, so that we have become increasingly distrustful, and at the same time needy.  What is to guide us in the land of Babel?

Who I am then? Another squeak in a world of tweets, so to speak. One more person trying to make sense of the Babylonian confusion. For adults, I have little advice – Find out what you like and do lots of it, is still the best advice I ever got. 

For parents I have two sources: My own experiences as a parent and my professional life working with children and their parents. I have made many mistakes over the years.  In my professional life I had the advantage of getting second chances, and of learning from experience so that I could get better over time. With my own children alas, by the time that I had realised my biggest mistakes, it was too late.

Secondly I read research. I confess that I like reading research.  When longitudinal research over different cultures bring out same research findings (in other words, if research about happiness in children in China reports similar variables to research done in Ethiopia, I begin to trust it a little. I am fortunate in that I am able to understand research designs, so that I can cast a critical eye on the processes that have been used).

Here are my best parental guidelines, gleaned from my own failures and successes and from reading research:

  1. Have Fun. Do fun things. Create adventures. Plan adventures. Save money for exploits in nature.  Go OUT THERE.  The more often the better. In the case of children: At least once a day be outside for at least one hour. That is the minimum!
  2. Let your children be. LET them BE. Do not continuously monitor, organize, admonish, help or cuddle your child. For at least one hour per day: Let them do whatever it is that they are busy doing, and do not interrupt, interfere, guide – just keep yourself in check! Intrusion is the curse of our time, and a major cause of irritable children. Not spending enough time outside is another. They often go together.
  3. You are the boss. Yip. This is true. NO, you are not Hitler nor Mrs. Rottenmeier  (“You do so because I say so”), but you are the “calm, assertive leader” to quote another television character. It means you earn respect.  This clearly means that you have to demonstrate the exact behaviours that you are expecting from your children (here is where the self-help books come in really handy). Your child has little motivation, no self-control? How does yours look? Shows little respect?  I learnt this one the hard way: the strongest influence of all, overriding even all the best how-to practices, is how you are yourself. How you behave.   Check it out: Take one behavioural problem that a child of yours has. Now ask yourself: How do I fare on this dimension?

4. Which brings me to:Humor and compassion. Wherever you take these two, they add value and improvement. Want to insist on a rule being kept?  Want to make sure they do their homework/eat healthy meals?  Wherever you add humor and compassion, and combine this with calm assertive leadership, and practice what you preach, you will have far greater success, and believe me, far fewer future regrets. 

5. Make work pleasurable. No, I do not mean fun, I mean inherently satisfying. Without work our lives would be empty and meaningless. (Yes, plenty of research has shown this to be true). So make work time such an experience: Clear the table, make a pot of tea with some rusks, have an attractive holder with coloured pens, and sit down and work with your child. Ignore their sighs and moans (children can be just like dogs: even unconstructive behaviours can become reinforced if they are given sufficient attention). Emphasize that work is a privilege, that without it we would not only be destitute, we would also feel worthless and inferior. That, when all is said and done, work is what gives us purpose, and what makes of us constructive members of society. This takes us back to rule no 3: That you work on your own attitude!

This is as true for very clever children (who can rush off their work) as it is for children with learning difficulties: The former has to learn to savior their work (Ok not all of it, some work is simply tedious)- that depth brings satisfaction. The child who struggles has to experience that the setting of small incremental goals, and the achievement of these, can be truly satisfying. Let me reinforce this idea: When work is satisfying, it can compensate for a lot of what is missing in our lives. When work is unsatisfying, the rest of our lives can barely compensate. Which brings me to the next point:

6. Set the bar higher (or lower). We are all born with some level of inherent aptitude. Within our aptitudes there exists a range: a bottom level and a top level. Do not accept performance at the bottom level. It brings no cheer. Of course, some parents are wildly optimistic. Because primary school can be relatively easy, some parents believe their children to be way more talented than they really are. I am not sure how to help you get an accurate measure without having an official IQ test done. If your child goes to a good-enough school, you can usually get a fair measure by your child’s placement in class as well as how hard s/he has to work to get top results. A primary school child, who has to work really hard to get good results, is not a very clever child. A clever-enough child, for sure, but for such a child you want to play down disappointment in results: It is the pleasure that they get out of working that matters.  Which means that it is not the pleasure that you get out of doing their homework for them that brings them any satisfaction. This downgrades their experiences of autonomy, their feelings of competency, and last but certainly not least: releases them from accountability. If there is a golden thread running through children in various forms of trouble, it is: too little accountability. (This has been well researched too.)

7. All families have Meta themes. Unwritten rules. There are positives and negatives. The negative unspoken rules are the most feared aspects in a family. We don’t talk about negative things. We pretend we are happy. We avoid conflict. We all toe the line around X. We blame outside forces. We have a scapegoat whom we blame for everything. We all pretend we don’t know. These are the topics that we talk about in therapy that bring great relief. Simply airing them can help. At least talk about them to a good friend. And practice talking about them a little with your family. It will bring relief to you, and often releases tension in the family home. If you would like your children to talk to you about their troubles, then you must demonstrate to them that talking about troubles is something that happens in your family, and that it is fine and normal to do so.

These can become especially pernicious where real abuse and stepparents are involved. In essence they come down to pretending for the perceived stability of the group. Teenagers are usually excellent at pointing them out. Stirring the communal pot is an effective function of adolescents. It is a pity that they are often criticized for doing so. The most lively and warm families are able to have open conversations where even the Meta themes are open to gentle mockery and compassionate discussions.

8. We find pleasure and comfort in the company of our peers. This is human nature. Children most definitely do too. Not having close peer friendships must be one of saddest fates to befall any person, big or small. So we must aid our children in the best ways that we know how. This is often the main reason that children participate in group activities: to feel part of a group is an instinctual need. Art lessons, chess club, it does not really matter: Most important is to share regular interaction with peers.

 9. Rules: Rules regulate societies. Without any rules there would be overwhelming uncertainties. I have written in a previous blog about the immature and stressful expressions of power that emerge when children are in charge. Rules are there to help us have less stressful and more harmonious lives. Example: Children who go to bed at a set, reasonable time are more rested in the morning, resulting in less stressful early morning routines. Limiting unhealthy foods on a rule basis (no sweets during the week, for example), results not only in fewer illnesses (which are stressful in themselves), but also to less mood swings and better concentration.  RULES THAT CAUSE CONFLICT are the bad ones. These are usually the ones that are set in concrete, and where the aim is not harmony, better relationships and well being, but obedience and subservience. These are really toxic as they lead to either rebellion or depression (or both). They are smothering and take away joy and freedom: and either a fear or a hatred of authority.  If you Google authoritative vs. authoritarian parenting research, you will find great research on the benefits of authoritative parenting.

 10. Thriving is about daily experiences of joy and freedom and at the same time developing self-discipline and tenacity. If you can get this combination right, you will have won the jackpot. It is the Olympic gold medal of getting life right.

How can I interpret my own dreams? Five guidelines that are generally applicable to most of our dreams.

Dreams speak in metaphor. This means that the events taking place in a dream should not be interpreted as reality.  Instead they offer sideways (and sometimes very obscure) reflections on something else that is happening in our lives and lifetimes. Somewhat like an idiom or a figure of speech would.  “A penny for your thoughts” and “at the drop of a hat”, clearly do not mean that you will be paid when you speak out, nor that a hat is to be dropped before an action is to occur.  Dream images work in the same way.  A person dying, water rising, a wondrous sexual encounter, a baby being born – these are metaphoric enactments – they are not real.  It is as if a short dramatised impersonation is taking place, where people and objects and activities are selected to represent themes from your life.  Your very own home theater, so to speak.

Five basic guidelines that will help you to benefit from your dreams:

  1. Dreams exaggerate.  Wildly. Dreams are experienced as alarmingly real. Take these facts into consideration when you engage with a dream. You will need to take a little distance from the emotionality of it all. It all feels so very real. Remember: It is not.
  2. Take note of the ways that you are behaving in your dreams. Most usually you will find that this is similar to how you respond in everyday life.   Dreams are really useful in that they can help you to identify your own nonproductive and self-limiting, and often habitual, responses to the challenges and opportunities that you face in real life. Dreams can be enormously helpful in this way. Take this as good advice, and to identify what would be better ways of responding in everyday life.
  3. The event (the “drama”) in the dream. For example: Water rising: This is an image that typically comes up at times of rising sadness/depression/anxiety. It is the combination of water (tears, grief/strong emotions) plus the fear of ‘drowning’, and the danger of being overwhelmed by it all. It is a double or triple metaphor: Your own emotions rising, drowning  (that is, not coping), and the fear of becoming overwhelmed. Note how I have taken the elements apart to make them work: If it happens in your own home, you can add a fourth possibility: that of your own home is being invaded – being ‘taken over’.   A new baby being born  often refers to the potential for new opportunity, new life, whereas death in a dream can refer to a big change. “death of the existing/the old”). Real death more often come in various disguises, from transformation to more ominous messages that I will deal with later. 

Do beware: There is no such thing as a complete dream dictionary. Your dream is tailor-made for you: You have tomake that little bit of an effort to form your own associations to whatever is being presented. Look for the theme, and then unpack it bit by bit, until you understand what is being presented.

4.Old injuries. Much like cold weather can activate old injuries, situations in the present can activate old wounds.  Felt unloved as a child? Watch how a snub in your current life awakens old feelings.  Watch out for these in your dreams. Many a nightmare can be defused by making the link between past and present.

5. Dreams comment on your present situation and offer better ways forward. This is the tricky part. What could/should I have done differently? What would be a solution to the problem in the dream? Driving too fast in a dream? Well, clearly in real life you have to slow down, to be more cautious.  If the solution does not represent something that you knew deep down anyway, I would recommend that you rather leave it. Dreams repeat themes anyway. The danger of misinterpretation is real. Any solution that requires drastic change should evoke great caution. It is here where people forget that dreams exaggerate and that the dream stories are metaphorical.  However, if you are able to bring a sane and rational mind to a dream, you will be able to pick up the life-giving advice that stand in opposition to a stubbornly persistent, habitual mind.

Do dreams play a part in the continuation of maladaptive human behaviours?

Why do eighty year olds still feel pain for having been inadequately parented,  and this despite having been not-so-good parents themselves? Why does human nature not improve over generations? It seems to me that human nature, unlike science and technology, is repeating itself. This led me to wonder – do dreams play a part in this? Let me hasten to add that I fully appreciate the healing and spiritual dimensions that dreams can express[1], but this is about a different question. I will write about the positive aspects in a follow-up piece.

A six-year old girl was brought to me by her parents. The mother was having a relationship with another, and was considering divorce. The parents whispered arguments behind their bedroom door.When their daughter asked them about this, they replied that it was adult business; she must not worry; they will sort things out. When I mentioned the whisperings to the six-year old, she looked at me with wide-eyed fear, and asked,But what does it mean? Does it mean murder?

I am reminded of this incident when a client brings a nightmare to a session, and asks, with trepidation:  But what does it mean?

What does it do to the human psyche to regularly experience anxiety and fear during dreaming? Similarly, what does it mean to be exposed, night after night, to our own fears and failures?  Content analysis of dreams shows that a significantly high percentage of dreams express negative experiences (failures, misfortunes,threats, self-negativity, and aggressive acts) (Domhoff, 2002).  Darwinian aetiology has dominated our thinking, including our search for meaning, over the past century. Because we have such a firm belief that, for behaviours to continue to exist, they must have a (positive) adaptive function, the search for the meaning of dreams has been consistently characterised by the search for the constructive intent and/or adaptive function of dreaming.  Dreams have, for example, been explained as compensatory or potential healing messages from the unconscious (Jung, 1964), sleep preserving or wish-fulfillment (Freud), guiding messages from God or the ancestors (for the function of religion see Bulkeley, for an overview of ancestral dream interpretation see my book (Frank, 2004), a biological necessity as yet to be clarified (Hadfield, Holmes, Jouvet), memory preservation (and more recently, as a somewhat contrived function between Freudian concepts and neurology (Solms).

In this article I would like to highlight a different feature of dreaming – one which does not appear to be benign, nor positively adaptive, but instead seems to reinforce negative memory, non-constructive coping styles and the continuation of  negative associations.

The three dreams below highlight different responses to anxiety-provoking events, and reflect the possibility that our coping styles in our dreams will be consistent with our habitual ways of coping in real life.  This would be consistent with the finding that the actions that occur in dreams are usually not bizarre, but could occur in real life.  It is also consistent with the hypothesis that the actions of the I-figure in the dream are consistent with the dreamer’s actions in real life. At the end of the article I ask the question whether our dreams can serve the function of keeping our anxieties, and by implication, our existing maladaptive responses, in place.

When I began working with dreams I tried my best to have an open mind. Looking at my own dreams I was surprised to recognize all my own faults. Night after night, it seemed, there I was in my full incompetence, shame and fear – and with my typical style of coping.  The actions of the I in the dream responded, albeit often in an exaggerated form, in ways that were clearly recognizable in my everyday life. So I took my cues from my dreams and began to act more constructively, less neurotically in real life. How did my dreams respond? To my surprise my dreams continued for an extended period of time to reflect the old (more) neurotic self. This made me wonder – do our dreams tend to be resistant to change, to confirm neuroticism, to have a tendency for repetition compulsion, and in this way work against constructive change?

Dream one: The dream of a woman in her mid-fifties who comes to see me because of recurrent panic attacks. As she recounts the dream she looks terrified, and it seems to me that it feels very real to her, as if it represents a living nightmare.

 I am in a car with some people, they seem faintly familiar.  I think they are distant relations. The people at the back seem to be making out; when I look I realize to my horror that they are eating each other and somehow enjoying it.  Then someone starts chewing on my arm. I wake up severely shaken. I cannot fall asleep again. After about an hour I take a tranquilizer. In the morning when I have to get up for work I am groggy and still disturbed by the dream. What does it mean?

            The woman recounts a history of severe physical abuse during a marriage of twenty-two years. At the age of 45 she fled to a town 2000 miles away.  She appears to be suffering from post-traumatic stress, and it becomes increasingly clear that her nightly dreams are not helping to alleviate her distress, but instead are keeping her traumatic state of mind alert. The dreams also contribute to keep hyper-activating strategies in place.  We have to tell the dream consciousness that it is OK; that the danger is over. Some time on we have to take an assertive stance towards her dream-mind, and during a similar nightmare the woman manages to become conscious during the nightmare and to take a stand in the midst of a dream.  Slowly but surely, the nightmares become more benign, and she, in real life, can begin to relax her petrified state of mind. 

Dream two: A middle-aged professional man, who emigrated to England from South Africa eight years ago, still experiences difficulties with adapting to his new country. He tells me that he is still struggling to find his place, to feel familiar and to make good friends in England.  He recounts this recurring dream:

I have been sent back to boarding-school. Everything is strange and I do not recognise  anybody. I feel panicky. I cannot find my room and am lost in the corridors, which all seem strangely unfamiliar to me. Surely I should be able to find my way? I can not understand why there are no familiar faces or recognisable scenery.

The dream reinforces the dreamer’s sense of alienation. By doing so, his feelings of distress are reinforced. This acts to keep negative associations (of having been “sent back to boarding school”), and his pervading sense of “unfamiliarity”  in place.  The dreams also points to another ‘truth’: “I have been sent back to boarding school.  This had clearly been a negative experience of being out of control in his own life, a time when he was not consulted and was forced to stay in a place where he was miserable. He is in the UK however, out of his own volition. The fact that he is responding as if he is back in boarding school, needs to be challenged and his overwhelming sense of powerlessness then, has to be addressed in the here and now.

Dream three: The dream of a 17-year old adolescent who lived in a children’s home. She was part of a small group that I ran at the home. Group members were encouraged to bring dreams.

I find myself in a zone where there are many skeletons. The skeletons want to kill me. They want to turn me into a skeleton. I fight the skeletons as hard as I can. It is an enormous battle.  One skeleton manages to get me into a coffin, where he lies on top of me to prevent me from getting out. The dream shifts and I have managed, somehow, to magically get out. I stand outside the coffin. The dream ends there.

This girl is known for her fighting stance. She tends to respond to any sign of rejection or injury with a fighting response. When a new social worker failed to return her greeting, she verbalized aggression towards her, stating, “I don’t care, I will fuck her over, you will see.” When her younger sister was sent to a home for troubled youth (they are all aware that this is usually a dead-end solution), she denied feeling sad or troubled, but stated defiantly, “She deserves this, she was looking for it (meaning trouble), this will teach her.”  Her dreams confirm her view of the world as an adversarial, life-threatening space, where one has to fight and deny vulnerability to survive. The solution is magical, and has the effect of supporting her fantasies of magical rescue as opposed to constructive self-determined action.

Could it be that in our frequent and repetitive dreams, we link past and current concerns, re-experience past fears,  and reinforce maladaptive responses? Do dreams in this way keep our habituated cognitions, our coping styles – as well as our psychological complexes – in place? To speculate rather wildly; could this be the reason why childhood injuries follow us into old age? Why humans find change so difficult? If I have inherited distrust from my childhood, and my dreams keep reinforcing this at night, why would I believe differently? I find this way of thinking startling, but also helpful: Once we keep in mind that our regular anxiety dreams can also serve the function of reinforcing past injuries and fear-based response patterns[2],we can move to a position of alternative consciousness towards the dream. We can take into consideration that our dreams, as much as they can heal, can also keep old wounds festering. And boy, can they exaggerate!

“Thanks to you I had the most horrific nightmare last night”.

This is the remark of my friend Jan. I had been staying with them to write a book on dreams. Jan had declared on my arrival that, “I never dream.” Our daily discussions on the nature of dreams had, I surmise, lead to the breaking through of the dream contents into his consciousness.

Why did I laugh? Because it was no surprize that it was a nightmare.


[1] Dreams appear to be truthful, and to be experienced as independently generated: features that allow for trust where distrust has become the norm. This is especially true in work with high-risk adolescents and traumatized individuals. Dreams can be of great value at times of grief, when known reality is not sufficient to provide relief.   

[2] Recently I asked  a class of grade 9 learners (14-15 year old girls) to write down a most recent dream. 52.4% of the dreams depict assault or the threat of assault   28.6% Depicted ‘ominous’ content (e.g. “bubbling green stuff ”   that explodes in the science room, starts to flow down the corridor, and threatens the whole school). South Africa has one of the highest crime rates in the world. The majority of the girls seemed to carry fear, which was illustrated vividly at night. This would serve to keep their fears alive, and maybe even to embed them. 

REFERENCES

Bulkeley, K. http://www.kellybulkeley.org

Domhoff, G.W. (2003) The Scientific Study of Dreams. Washington: APA

Frank, E. (2004) The book of dreams. Cape Town: Human & Rousseau

Freud, S.  (1953) The Interpretation Of Dreams. London: Penguin Books

Jung, C.G. (1963) Memories,Dreams, Reflections. London: Random House

Payne, J. D & Nadel, L. “Sleep, dreams, and memory consolidation: The role of the stress hormone cortisol”. In Learning & Memory. 2004 Nov; 11(6): 671–678. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC534695/

Solms, M. http://psychoanalysis.org.uk/articles/the-interpretation-of-dreams-and-the-neurosciences-mark-solms

Letter to a young woman, home from a Clinic.

Dear Samantha

“First impressions count”.

My first impression as I look through the car window: Steely. Broken.

Two oppositional realities.

I notice a small internal movement; a sharp intake of breath. And have the immediate thought that I must meet you as an individual. You had arrived, pale and retracted, sitting at the back in your mother’s car. Strange this sense that I had to take on two individuals, as my practice is based on healing the relationship between a mother and a child.

You spoke openly. The outer shell that people build around themselves out of necessity had broken. This left you so vulnerable that any arrow shot now, would have shattered the tiny part of you that could still relate to me. It was as if I found myself in the presence of a severely wounded animal.

How did it come to this Samantha?

As your story unfolded, my heart broke a little. I am used to sad stories. I hear them every day. It was your bravery that got to me. Especially given how exposed you had remained for so (too) many years, without someone taking matters firmly in hand, so that your life could be simpler, better, more normal. You were magnanimous about your parents’ well-intentioned, but misguided attempts to help you. With each year passing grievously, that inevitable twin development happened: Escape from the world (who would not want to, given such a reality), and then, inevitably, the more maleficent one: A voice inside your head that, as frightening as it was, it was at least, some kind of a reliable ‘ally’. “Someone” who understood your pain and your suffering.

This is what happens when adults are unable to help growing children who are in deep distress. Sometimes they want to help, but do so in ways that keep the problem in place or that make it worse. These adults do not mean badly, they are either out of their depths or are themselves hurting badly.

Now it is time for healing

Healing means “new”, different, not as before. It means different and not as before for all of you: Your parents, your brother and yourself. It means that you finally have someone who understands and accepts your reality, and who takes it seriously. It means no more lies. It also means that the change that happens now, is towards your best interests.It means changing your mind, and your daily self-soothing habits.

It means saying goodbye to the voice in your head. This last one is hard, and we will begin by changing the conversation that you have with it, so that you begin to have equal power to it. It means resurrecting or inventing helpful images that can be called upon in times of distress.

But you won’t be alone anymore: We walk together. And in time, you and your mother and you and your father and you and your brother, will be able to walk a different path. If this is not possible, then still you won’t be alone, because as you change, life will open up in different ways for you, so that helpful friendships can develop.

Seven steps towards healing

  1. If we were not cared for in the ways that we needed when we were little, these unmet needs remain pressing inside of us. Mostly, we react in one of two ways, “It doesn’t matter, I don’t need anybody”. Or the opposite; being clingy, having a desperate neediness that either puts people right off, or attracts people with similar unmet needs. Our task is to get you to a place where you need others (we all do), but not to be overwhelmed or driven by that need. What you have to do for now: Press Pause. For now you must rely on professional people to hold you and support you. They are the stepping-stones towards another livelier, more intimate connected shore.
  1. When the beckoning voice inside your head becomes strong, engage with it. Tell it that you have changed your mind, that you have chosen life, and that it can either help you in your quest or, in case it cannot do that, you give it permission to recede.
  2. Evoke an image of its opposite. What would be an image of life, of healing for you? It may be vague at first, but make it real by drawing, or sculpting, or taking a photo, or cutting out an image in a magazine of it. Make it grow in your mind as an image of life and hope.
  3. Every single day, do something normal that you have either stopped doing, or something entirely new. Plan for this. Have it in your diary.
  4. During this activity try your level best not to think about your problem. Practice to interrupt sad thinking. Remember the 2.5 minute rule: If you can distract yourself for two-and-a half minutes from your usual thinking, you will be able to interrupt that negative train of thought that runs away with you. Remember: Rumination (thinking about something over and over and over) is one of the main channels keeping despair in place. I do not mean that you must change your negative thoughts into positive ones. For now, take time to think about something neutral. For example, you are busy baking, and you begin to think about how sad it is that you are not doing it together with someone else, or for someone else. So you stop that thought, and look at the dough to see what the consistency is, and you take a look to see what the temperature on the thermometer is, and look around the kitchen until you see something that you really like, or something that you would really like to change… whatever is concrete and real around you, there you place your eyes and your thoughts.
  1. Whatever you do, don’t give up. You don’t want to get up out of bed? Just get up. You don’t want to walk the dogs? Just walk the dogs. You don’t want to do something normal today? Just do something normal today. Think of all the mountain climbers who wanted to just lie down in the snow when they thought they could go no further, and didn’t. Of all the ballet dancers, who thought they could not take another step, and did.
  2. Be glad and give credit. Most of all to yourself. For all the years that you still had hope, and dreams. For the battles that you have fought. For the cards that were dealt to you, and that despite them, what you still wanted what was something inherently alive and bountiful. That is something good. Deep in your innermost core, you know that. Believe with all your heart, that this is achievable: being alive and being glad. 

 

 

 

 

How to respond to a young person in you care once they return from rehab or a clinic.  The precarious balance between caring and confronting.

Alice

 All parents of growing children have to find a balance between discipline and freedom. These are value-based decisions, and a familiar source of conflict between parents. You do want your children to be able to take care of themselves once they grow up, yet you also want them to feel cared for and free when they are at home. When are you being too harsh, and when are you overindulgent?

An adolescent or a young adult comes home from a rehabilitation centre or a psychiatric clinic, and this question moves to the foreground. It can become a daily – if not an hourly- dilemma.

Must I wake him up if he sleeps late? Can I insist that he does the cooking, or is that asking too much?

At the end of this section there are guidelines for all parents who find themselves in the quagmire of dependency versus independence.

This blog is in the form of a letter to the parent of a 17-year old.

My next blog will contain the letter to the 17-year old.

The letters are about the essentials, which in themselves are quite a lot.

Every single aspect that I write about matters.

Do try to trust me on this one, I write from experience.

Dear Robin

My heart goes out to you as I write this letter. One of the many things that I have learnt over the years is that, when a child breaks, there is at least one parent breaking too. It can happen suddenly, like a glass falling out of your hand, but more usually the suspense has built up over time, with dread having settled in your heart. Inevitably, one day something essential breaks, and the walls come crushing down.

When I first saw Samantha, she had minimal contact with reality. She had been hanging onto a fragile thread for far too long, and it broke at last. In some ways, this was a relief. You had been hoping for a small miracle – a nice boyfriend, something of interest out there that would focus her attention, maybe a different school or just a teenage phase that would pass. And then we were sitting in my room, facing this reality: My child is too badly broken to be fixed by a ‘normal’ intervention. You were on the route that you have been terrified of all this time: Seeing psychiatrists and placing your child in a clinic. Your child being diagnosed with a mental disorder. You face the shame, and the fear, and the guilt.

But here we are, and Samantha, for now, is out of danger. Yet, as you understand so well, out of the clinic does not mean out of danger. The decisions that the two of you take over the next two years are the crucial ones. You get that, and it wakes you up at night: What if you do the wrong thing? Should you have reacted like you did today?

I have written down some home truths – signposts along the tricky path.

  1. By now you probably suffer from burn out. A parent who has been stressed for a lengthy period of time, has depleted resources. Please, please take care of yourself. Physically. Do not let yourself go. It will make you feel worse, I promise. Spend your precious money on your hair, your face, new clothes, a hobby, a course, whatever makes you, singularly, feel that life is worth living and that you are more than your child’s problems.
  2. It is also your fault. Accept that. But it is not only your fault. Accept that too. The part that you can change is the part that was your fault. Do not, whatever happens, repeat that! Overindulgent? Overcritical? Avoidant? Depressed, alienated, aggressive or addicted yourself? And what about your marriage? The atmosphere at home? Somewhere there is an area of your life that is in need of a makeover. Ask your child, s/he will tell you. If you want your child to change, demonstrate that change yourself. So many parents want their child to change; yet do not understand how very difficult this can be for the child, because the parents keep on doing exactly the same. It will also help you to understand how difficult change is.
  1. You can’t do this alone. Talk about it. The more you talk about it, the less ashamed you will feel. Ask your closest friends for their honest opinions and advice. Tell your boss. Ask for help from friends and family. Insist that her father helps you. This is good for her too. Acknowledge that you need help, also to Samantha.
  2. You do have to decide what are the minimum requirements that will enable Samantha to move forward.. Decide on these together with her therapist, the family therapist, the psychiatrist, Samantha’s sister and her father. It is important that we all agree to stick to these conditions. I have learnt over the years that when you face a real battle, you need to deploy a squad.

Minimum conditions that we have already agreed on:

  • Samantha will stay with her father and stepmother every weekend from Saturday afternoon–Sunday afternoon. This is as much for you as for her. For you, so that you can regain some strength, and for her, so that she does not become overly dependent on you again.
  • Samantha will receive pocket money: enough so that she can pay for her own transport, toiletries, phone time and one fashion magazine per month, but not so much that she will be tempted to stay at home forever! She has to be somewhat uncomfortable without being overstressed. Neither you, nor any other family member will provide her with any additional money.
  • Samantha will get up by 10.00 every morning. This means that yes, you wake her up cheerfully, open the curtains, and open the door when it is time. Do insist that she gets up. She has agreed to this and it is in her best interest.
  • She is allowed a maximum of 120 minutes on the Internet or television every day. No more. Please adhere to this limit yourself.

If you want Samantha to improve you have to adhere to these fundamentals. There are no exceptions. It is not for ever, it is for six months, thereafter we will reconvene.

Occasionally you may “lose it” That is fine, and it may even be helpful. An occasional melt down is allowed! It is a natural outlet when under severe stress. Definition of occasional: No more than once a month. If you find yourself at the end of your limit more often, talk to a friend and/or get help.

  1. Do not overindulge Samantha’s problem. By this I mean do not focus on her problem and her moods to the exclusion of the rest of her personality. When you can see that she is in great distress, you can hold her and say reassuringly, “I am sorry, “I know you that you are having a rough time, but we will pull through. You have come a long way, and together we will make it.”

Practice listening up to a maximum of 20 minutes, and with the exception of her sharing some new personal information with you, after 20 minutes change the topic gently but firmly. The general guideline is 5-10 minutes of sympathetic listening – do not skip this part- followed by practical rebalancing.

Not speaking about plays an important role in keeping people unbalanced. Some families talk too much about the problem, others too little. You have to take your own measure and create a balance. Both are important: being able to speak about – and be listened to – and being able to not always speak about, and to focus on something else.

We know that a psychological problem is also maintained by a) an overemphasis on the problem b) an overemphasis on “me” and c) an overemphasis on emotions.

And that activities that have nothing to do with a problem are important, as they help us to focus on something outside of ourselves, and gives us something else to talk about. (It can become habitual, and really tedious and unhelpful to talk about personal problems all the time.)

Remember what I said about changing your own habits! Samantha will try out all the habitual responses that the two of you have built up over the years. “But mom, I am too sad to go out today.” Do not fall for old habits my dear!   You don’t have to be harsh, just firm and not indulgent. “I know, but Auntie Sue is expecting you. Go and enjoy, give her my regards.”

Whatever it is that she does, make sure that it gets her out of the house, and gives you a small break.

Do not fretfully enquire on return if she was ok. You have to pretend normal! Ask about auntie Sue.

  1. Loss of reality: If you see that Samantha is losing her footing, and drifting into unreality, interrupt her immediately. In the beginning you will have to be hyper vigilant. In time it will become less. Ask her an ordinary question (“Do you know where my keys are?”) and redirect her towards something ordinary, “ Won’t you please get dog food when you go the shop? I have been wondering if this dog food is causing her to scratch. Maybe we should try something different?” In other words, get her mind engaged with something that is concrete. And firmly based in the world of real.
  2. Stop any ‘weird’ behaviour in its tracks. It is alike to stopping a puppy from chewing your computer chord. She wants to paint her room black? The answer is “No”. Why? “ Because that is what unstable people do. Once you are stable, you can paint your room any colour you like.” She wants to paste strange writings on her wall. “No.” Why not? “Because we do not want the voices in your head to become real. You may think that they are helping you, but actually they keep you trapped, so no, we need to change them to normal. Then, you will see, you will have no desire to write them on your walls where they scare the wits out of me and keep you trapped in despair. So hey, out they go.” (A light humorous touch is always useful). She is drawing strange bloody claws?   “Samantha if you want to draw bloody claws, please do that with Elzan (therapist). In this house, please draw normal stuff. Draw the lounge, or the cat. Or your favourite positive fantasy or dream. In here, we have to do stuff that builds hope and life.”

One of the scariest things that has happened when people lose contact with reality, it that destructive autonomous forces seem to have taken control of their minds. The role of medicine is to keep the hallucinations under control. Our role is to bring her back to reality. To keep her grounded. We have to do this gently, but firmly.  Remember that the voices in her head are dark and seductive. Kindness and love is what she needs now. But also firm boundaries and small concrete daily responsibilities. What will a competent and resilient 17-year old be able to do? That is our end goal. We must be sure that the steps that she is taking every day will be towards that other safer shore.

  1. Have good times together. The more physical and sensorial, the better. Experiment with making your own pasta at home. repaint a room, watch an old-fashioned movie and cry, sort out the garage, take moderately difficult hikes, attend dance classes, music concerts.
  2. One of the reasons what happened, happened, is because something that should have been addressed long ago, has been suppressed for too long. It is the role of the therapist to take care of Samantha’s. Your role is to take care of your own. In my experience this is often something that has been passed on from your parents (who may have got it from their parents. It is the “sins” of the fathers and mothers, being passed on to their children). This may sound corny, but an adolescent in serious trouble, often helps us to see what are the bad habits or secrets that has been passed on from generation to generation. It can also show us what has been in desperate need of change in a marriage.

Three findings to keep in mind for a healthy balance between discipline and freedom

It is useful to remember that longitudinal research findings from all over the world have shown that people who are resilient and who can cope with adversity, have three characteristics in common:

A. A Sense of Belonging

The ability to be connected – to have meaningful relationships and to feel that you belong to a wider community, to feel that you are rooted in a community of which you are a valued member.

With this in mind, it becomes clear that rehabilitation must also include a reality check that addresses this. Often we have to begin by repairing family relationships.

Does your child feel that she is at home in the immediate family? If not, you will have to get help to repair relationships within the family. Family is our first port of call for a rooted sense of “home. It goes without saying that a house is not a home. So if you and s/he has to do a rethink about this, then this is where you begin.

If your house is already a home, then you cast your net wider. What person/ activity /group can your child join out there where s/he would be able to feel that s/he belongs?

Footnote: this obviously goes for you too!

Alienation is at the root of many a psychological problem.

A note on younger children: This is a strong need in young children. They love belonging to a wider family and a small community. This is not a time to be harsh on family members: children love having grandparents and cousins and regular people coming to visit.

 B. Self Determination

Self-determination. This one can be tricky. It is the most common excuse used. “You can’t tell me when to get up”. “Stop telling me what to do.” Is that not self-determination? No, that is subterfuge. It is a way of staying within the problem. Just as you have to change, your child has to, too.

It is clear that the choices that your child has made, has led her/him into trouble. So, you start out small. On what days would they prefer to prepare dinner/walk the dog? What classes would they like to take at the gym? In other words, the ground rules are set, but within the ground rules, they have choices, which will be respected.

Week by week, month by month, you have to make sure that healthy decisions are increasingly made by them, not by you. Some hiccups will occur along the way. Make sure that you address them immediately.

Love them a little bit more for every healthy decision made.

I wrote about self-determination and children, and more extensively on adults, in previous blogs on Emotion Regulation and Will.

 C. Creating and finding Meaning

Let me state this in its opposite: What is not meaningful?

In general: Watching television, playing games on your phone, eating when you are not hungry, cleaning house… anything that is used as a distraction.

Specific to you: Anything that does not make you feel satisfied on completion. Tidying your room can be a form of distraction or a meaningful activity: It depends on how you feel once you have completed the task.

Whatever gives one a deep inner feeling of satisfaction is meaningful.

We can look back on our lives, and pick out the times when we felt truly alive and connected. We can be honest about our inner yearnings, and resuscitate them. Ignoring inner longings is cause to many distractions, and believe me, a significant part of the original problem. So give your longings their due. And no, it will not be easy (bad habits have strong incentives), and it need not be a big enterprise, but at least you won’t be wasting so much of your life anymore.

Explore wider forms of meaning. Religion is experienced as deeply meaningful by many people. So are the arts and nature. A weekend in nature can have you feel as if an inner mechanism has been reset. So can attendance at an art event, whether a book reading, a modern dance concert, a visit to a museum or learning a craft. Whatever it may be, online courses are widely available. Instead of distracting yourself in your free time time, rather enroll and complete and on-line course.

A life that is experienced as meaningful, no matter the circumstances, provides resilience and energy and focus.

In my previous blogs on suicide, I have written more extensively on this.

For younger children: Most young children find shopping and eating in restaurants pretty meaningless. They find great meaning in imaginative play and freedom in the outdoors. Water and sand are their natural elements; combined with pretend play children enter a state of flow.