Being depressed is being made hostage of a feeling of burden, obligation, continuous sadness and lack of pleasure. Aspects of life that used to create anxiety now seem to have morphed into a sense of helplessness and absence of emotion or, in other cases, the feeling of an ‘open wound’ located somewhere in the body which is impossible to situate. The world has become a fuzzy, black and white image. Significant others, partners, family, friends, rarely connect with us at a meaningful level and positive emotion is hard to come by.
On a less conscious note, depression emerges frequently as self-imposed chastisement or as a way of creating a protective cocoon against an outside world felt as hostile. People rarely go into a depression abruptly; rather, depression tends to creep gradually into one’s life. Working with a psychotherapist, in such cases, involves a detailed identification of relations and behaviours which keep depression going in the person’s life, as well as the build-up of small objectives that can start moving the person out of the state of emotional paralysis which depressed clients tend to start from.
For the client suffering from anxiety, frequently, the world starts coming across as a place filled with danger of various kinds. Sometimes, like something jumping out of nowhere, there is a feeling of enormous discomfort that takes over the person’s life, a feeling of eminent danger, a moment of loss of control expressed in tremors, cold sweat, palpitations, occasional lack of breath and anticipation of terrible consequences.
As a consequence of this feeling, the client starts avoiding places, situations and people associated with the dread of eminent danger. My clinical experience has shown that in cases of anxiety, quite often, the client is stuck in some kind of rigid role amidst family and friends; they neither know how to abandon these roles, nor do they know what choices need to be made for change to happen.
In plenty of clients, anxiety also comes about as difficulty in letting go of the will to control aspects of one’s life which are generally immune to that control. In psychotherapy, the work with the anxious client involves a detailed exploration of their personal circumstances, of their past learning about ideas of control, but also an exploration of the strategies that the client has put in place for managing anxiety. As a rule, the work progresses with letting go of old strategies that might be making the situation worse, revisiting ideas about control across different areas of life and adopting of new habits and behaviours, allowing for greater tranquillity when facing uncertainty.
In the last few years, I have experienced an increase of male clients in my practice. Several factors seem to be contributing to this. Very often a gap is found in the way the client was raised, expressed in behaviours and rigid beliefs around masculinity (‘boys don’t cry’) versus the emotional demands of contemporary times, requiring men to identify and express their emotions in a clear way. This gap between learned behaviour and adult demands can create contradiction and confusion in the male client. The client arrives at the office under the idea that they are failing – themselves and others – but without a clear idea of how they’re failing and why.
Psychotherapeutic work with male clients, amongst other aspects, consists of helping the client identify the key moments of their personal history in which certain beliefs and events formed their idea of what it means to be a man, opening the possibility to a new definition of what that means, to new choices and to new behaviours.
Couples Therapy & Family
“We didn’t think we would be that couple, until we became them”. Often, couples come to the office with a feeling of deep estrangement but without a clear understanding of how the relation has come to that point. A joint life expressed in rigid duty, multiple obligations and habits seems to have taken over, erasing the enchantment of the first encounters. When children are involved, the juggling of various roles adds to the weight of the assumptions each member of the couple carries about the other, like a distorted mirror.
Work with couples and families has a different format from individual therapies. With this type of client, I work with sets of 5 to 7 sessions spaced every two weeks, and a clear definition of goals. Couples may come to these sessions looking to improve their relationship or otherwise, looking for help separating from one another. Helping a couple to separate follows the same format of 5-7 sessions.
Family work is sometimes required when working with adolescents, particularly if an acute crisis requires joint conversations with parents in the room.
Adolescence is a phase of rapid development in every single way, from physical growth, to psychological development, to an increase in social tasks and obligations. Adolescence is also a phase marked by the dreams and aspirations which will guide the adolescent up to the adult stage, by and large contributing to their definition as a person. In the present day, in the highly unstable world that we are living in, issues of social inequality and climate change combine with the expected anxieties about the future that adolescents tend to feel.
Working with the adolescent is about helping them to individuate, that is, to understand who they are and what makes them tick as a person, what their dreams and aspirations are and how can they negotiate the person they are becoming in relation to parents and others of their generation. For the adolescent, therapy can work as an important protective barrier against peer pressure, as well as a guiding space in a world which is ever more confusing and saturated with information.
‘Expats’ and ‘Expat Couples’
Migration is both an opportunity for personal growth and a process suffused with difficulties. When we move to a new country or destination, we take with us a story of acquired behaviour and personal emotions. After a period of (hopefully) falling in love with a new place, we may start being haunted by negative feelings – sadness, anxiety or both – in relation to ourselves and those that are closest. At the same time, we start seeing that behaviour which we hoped we had left behind has started to creep in again, in our day-to-day life. This process can cause a profound questioning of our personal identity, with the need for psychotherapy.
On the other hand, the shrinking of the social network which happens in migration has consequences for everyone: individuals, couples and families. For a migrant couple the shrinking of their social network means that various stresses that could have been worked through with others (extended family and friends) must be worked within the couple unit, increasing the stress on the relation. In migrant couples with kids, the shared effects of the social network reduction, leading to fewer people helping out with children, are even more apparent. In such cases, psychotherapy can be a space for thinking how to form and expand the social network in the new destination, while we deal with the personal questions (or couples questions) brought from the previous destination.