Below is a wonderful blog written by my good friend and colleague from Seraph Psychotherapy, based in Hull. I am sharing this with her permission as depression is something I have been thinking about a lot recently. January is a notorious time for people to identify with symptoms of depression as it is a time when many think about making changes, address health and lifestyle issues and comes straight off the back of the holidays, which for some can be fraught with stress and tension or for others herald the end of a tough year. It is a time when we remember those we have lost, those who struggle and perhaps are forced or encouraged to spend time with people we would not otherwise choose to. There is also less natural sunlight and once the bright lights of Christmas are dispensed with the dark days and long nights can themselves lead to feelings of sadness and for some, depression.

What is depression and who experiences it?

Written by Alex Carling on December 16, 2013

There are mixed findings about the prevalence of depression, in a workshop delivered by and an article written by Mark Widdowson, which are the references for this blog, he states that The Office of National Statistics (2000) in the UK, reported that 2.8% of the population experienced a depressive episode whilst 9.2% experienced mixed anxiety and depression in 2000. I’ve decided to write this blog as I find that people are still unsure about what it is exactly. From my experience, people mainly associate it with sadness and lack of interest but there’s more; so read on if you want to understand it for yourself or a loved one, a little better. I’ve tried to stay away from the psychological language and kept it brief in hope that the blog will be approachable and you can connect with it.

Development:

Transactional Analysis (TA) theory suggests that we all, in the earlier years of our life, make decisions about ourselves, others and the world and it is these decisions that shape our behaviours in how we exist with others and get our needs met; TA also promotes that these behaviours can be changed. In the context of depression, people tend to report that they have had parental figures that have lacked in emotional warmth and affection; when a child grows up with high levels of criticism and low levels of praise it is understandable how they would develop negative images of the self, others and the world. If they have an ingrained feeling of ‘being bad’ that ‘life is hard’ and perhaps ‘others expect too much of me’ their internal world is over-come with guilt, blame and shame. Without the positive relationships that would help that child or young person recover and learn different ways of being, these behaviours have a high chance of being present in adulthood and thus presenting in depression. I must say that not all those who are depressed have had this experience.

Emotions:

I guess this area is the one people are most familiar with; those with depression experience prolonged negative and difficult emotions and a deficit of positive emotion.

Being able to regulate our emotions is essential for functioning internally with ourselves and externally with others; to stimulate and cultivate different emotions whilst being able to reduce emotion in various situations is what is meant by regulation, this is a conscious or nonconscious process.

Depression inhibits one’s ability to regulate their emotions, they can’t snap out of it, it is as though there has been a blanket placed to cover all positive emotions which leads to avoidance of interaction and activities, which will increase their negative thoughts and feelings about themselves; thus reinforcing the whole system. People with depression are more likely to experience anger and hostility over those who do not have depression. Due to their impaired ability to regulate, a loss of control and entrapment are associated with depression and the desire to escape their entrapment is often a thought process which is engaged in compulsively.

Thoughts:

If we link this area to what is written in the development part; if the individual has feelings of inadequacy, failure and worthlessness this will inevitably tarnish their experiences in that they will view their experiences as negative, they may have negative expectations, remember only the negatives and only pay attention to things like criticism, leaving praise unnoticed or inaccessible to memory recall. This process again, maintains the depression.

‘Extensive evidence indicates that depressed individuals hold more negative self-views, blame themselves more than others for negative events, are more pessimistic for themselves than others, and are more adversely affected by self-reflection than non-depressed individuals.’

(Wisco, 2009:382)

Treatment:

As a TA practitioner, I acknowledge the importance of anti-depressants in providing the individual with the ability to cope, in that it inhibits the negative and pervasive feelings mentioned so far. I think that psychotherapy has many qualities to offer those suffering from depression. A practitioner can facilitate the client to identify the source of negative messages that, throughout the years, the client has made part of who they are, as though it is their own voice that has always spoke the harmful words, they have knowledge of various theories that are so brilliant (in my opinion) at being able to depict the behaviours people engage in and the feelings and behaviours of others that they invite, the client will then have an awareness, a deeper understanding and the option of change. This sounds very simplistic I know, though within a relationship with a therapist, a client can walk away with the information they need to make an informed choice, armed with permissions to change or think differently, or hope for a positive outcome; as the client consistently attends, they will eventually start to replace their old critical messages and frame of thinking with the positive ones from the therapist and success will reinforce the change.

Thank you to Mark Widdowson for sharing his wisdom in this area at this years North East Transactional Analysis Conference.

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‘Real treatment, he says, requires an intimacy between therapist and patient that is born from a solid bond of trust.’

Below is an article I came across, written by Barbara Jamison, in which she reviews some of Yalom’s ideas, discussed in his book ‘The Gift of Therapy’ in which he extols the virtues of the therapist’s willingness to reveal himself and fully engage in the therapeutic relationship.

Letting the Patient Matter: Some Thoughts on Irvin Yalom’s View of The Therapeutic Relationship

by Barbara Jamison

In his recent book The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, psychiatrist and writer Irvin Yalom recalls a poignant encounter with one of his cancer patients. The woman is embarrassed by her hair loss after chemotherapy, and during one of her therapy sessions, she reveals that she would like a sign from Yalom that her baldness does not repulse him. Yalom, who has always admired this patient for the intelligence that illuminates her features, tells her he’s not repulsed at all. In fact, he asks if he can act on his impulse to run his fingers through the lovely gray strands of hair remaining on her head. The result is a warm, intimate moment that is cathartic for both.

Such moments, related in his latest book, The Gift of Therapy, serve as vivid arguments for breaking down the walls that separate patient and therapist. Directed to a new generation of therapists and their patients, Yalom is a keen advocate for unmasking the therapist. One of the main reasons that patients fall into despair is that they are unable to sustain gratifying relationships. According to Yalom, therapy is their opportunity to establish a healthy give-and-take with an empathetic counselor; one who is not afraid to show his or her own vulnerabilities.

Opening the Secret Door

A professor emeritus of psychiatry at Stanford University and the author of several widely read books and novels on psychotherapy including the best-selling therapeutic memoir Love’s Executioner and various classic textbooks on group psychotherapy and existential psychotherapy. Yalom’s insight into this world throws open the secret door to therapy, both for counselors and the patients who visit them.

What we see behind Yalom’s door is a far cry from the stereotype of a therapist. From comic strips to Hollywood features, the analyst is often portrayed seated behind a desk or a notebook, literally out of reach and out of sight of the person being analyzed.

As patients, we perceive that person sitting across from us as a powerful and impenetrable figure, yet we’re expected to reveal ourselves up to their scrutiny.

As patients, we perceive that person sitting across from us as a powerful and impenetrable figure, yet we’re expected to reveal ourselves up to their scrutiny. Within the charged atmosphere of the 50-minute therapeutic hour, our psyches are exposed, while the therapist maintains an enigmatic mask.

This may be the traditional model of psychoanalysis, but Yalom challenges it as ineffective and ultimately unhealthy. Real treatment, he says, requires an intimacy between therapist and patient that is born from a solid bond of trust. After all, a patient regularly entrusts a therapist with intimate revelations, so the therapist must be able to respond with true spontaneous empathy rather than stock therapeutic phrases. Nor does empathy evolve in a vacuum. “Friendship between therapist and patient is a necessary condition in the process of therapy,” says Yalom, and he encourages the therapist to ‘let the patient know that he or she matters to you’.

Irvin Yalom’s work and ideas have been hugely influential in my own practice and have served to inform my own opinions of what matters most in the therapeutic relationship and what heals.

katycounsellingherts@outlook.com

07950 345363

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‘You shouldn’t feel that way’

I have lost count of the number of times I have heard people recite experiences that begin and end with the summation, ‘You should not feel that way’.

For me, I lump that phrase alongside ‘Cheer up, it might never happen’ or ‘Pull yourself together’. A client of mine once even reported being told by his DR, ‘you should try being more like me. I don’t do that’. Once I had picked my jaw back up from the floor I remember searching within myself for something to say, anything that would have resembled a sentence more constructive, more empathetic, more sage……The likelihood is there would have been many things I could have said that would have improved upon the DR’s remark yet the startling fact remained there were none I could think of that would alter the client’s experience or reality at that time or indeed his experience on the whole. That was a full two years ago and I’m still none the wiser.

Here is what I have learned though (sometimes dragged kicking and screaming I might add). As someone who identifies as a compulsive caretaker, with a finite need to look after and care for others it is often hard to accept the limitations of my profession and at the same time I have to acknowledge that there are limitations to both the service I offer and any service offered by any therapist or mental health professional and/or mental health service. Theories are flawed and techniques don’t always work. Life gets in the way, people leave, people get sick, we get sick, we feel better, we feel worse. I am sure that cuts like a knife to the egotistical among us. I have to admit to being a little dented myself by my own admission. I spent a long time in training and continue to do so, to better myself and to learn more so I can offer more and continue to evolve this thing that I have started. Sometimes it is enlightening and sometimes it is like wading through thick dense treacle. It has also been costly, both financially and socially and so to acknowledge I don’t now have the answers in the form of a miracle cure or a magic wand or an instruction manual pains me to say. It is actually less the saying it that hurts and takes affect than the need I now deem inevitable; to accept it. Because it is true. Hell, people say things that they don’t mean all the time, don’t they? It is internalising and accepting that are hardest………

And then I swing full circle, back to being in love with what I do. It is so simple and so complex all at the same time because there I remind myself of what is important in the process, of what does work, of what can cure and what can change and it really is nothing short of miraculous at times. Acceptance.

Acceptance.

It is all there is. You cannot change a circumstance by pretending it doesn’t exist, that it doesn’t matter, that it isn’t that way for you. Because it is. You can’t change the way you feel with all the will in the world by becoming something else someone else deems more suitable. You cannot run from who and how you are at times (though this will always remain an appealing prospect to some I am sure. I even include myself in that bracket). Acceptance is what has to happen in order to move on, to change, to grow, to survive.

If you have found someone who is prepared to take your hand and try and see the world in the way that you do, hold on to that. It can be a rare commodity for some. And if you havn’t yet and are still looking, take your own hand for a while. Never listen to anyone who tells you what you should or shouldn’t feel, even if that someone is you. Be as you are because by being as you are and accepting yourself you are giving yourself the greatest gift there is. If you feel lousy, you feel lousy. If you feel elated, you feel elated. If you feel like it’s all too much and you want it to stop honour that. You don’t have to act on it. Acceptance and acknowledgement are wildly different than action. Maybe things will be better tomorrow. Maybe they will be worse. Maybe nothing will change. Regardless next time someone tells you that you shouldn’t feel a certain way thank them, and remind them that you still do or if you don’t have the strength to disagree then nod and walk away, remembering to remind yourself that you still do.

Just because they won’t acknowledge what the world is like for you doesn’t mean that you have to stop acknowledging what it is like for yourself.

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I have spent a lot of time this week, talking with clients about how they like to be recognised by others and the familiar ways in which they look for this recognition that can be both healthy and unhealthy in it’s application. I wanted to share here an essay I wrote a few years back about recognition (or as we say in Transactional Analysis speak, Strokes). Strokes are really important to us all. Have you ever noticed how a dog can look so content when you stroke him in that one special place? Normally behind the ears! If you have learnt to get your Strokes in an unhealthy way, therapy can be a time to address this and create some change so you can allow yourself to receive positive Strokes or recognition too.

I hope you will find the information below useful.

Strokes and Why They Matter.

Transactional Analysis employs the term ‘strokes’ to denote any form of social inter-action where another’s presence is recognised. Therefore any transaction is also an exchange of strokes. While the general term ‘stroking’ might be used to imply close, physical contact, in reality and practise it may present in a number of varied forms. Berne maintained that, due to the very nature of our creation and early childhood, strokes were something required by every individual and something leading to feelings of depravation if not received. An individual’s need for strokes is highlighted in his book ‘Games People Play’ where he writes; ‘If you are not stroked, your spinal cord will shrivel up. Hence, after the period of close intimacy with the mother is over, the individual for the rest of his life is confronted with a dilemma upon whose horns his destiny and survival are continually being tossed.One horn is the social, psychological and biological forces which stand in the way of continued physical intimacy in the infant style; the other is his perpetual striving for its attainment’. (Berne, Games People Play, 1964, p14)

Berne adopted the word ‘strokes’ because it referred to the infants need to be physically touched however it is also a need present in the individual as a grown-up. Berne, described certain hungers,  universally experience by all, and one of these is recognition hunger, the need to be recognised. Since physical stroking is not always an option for the grown-up, he learns to substitute certain other forms of recognition, such as a compliment or a wave of the hand, for the physical need to be stroked. Berne also acknowledged the individuals need for stimulation, both physical and mental and referred to this as stimulation hunger. A stroke, therefore, in the simplest of terms is a transaction which provides the individual with either stimulation or recognition.

(Image courtesy of africa FreeDigitalPhotos.net)

The strokes that we receive can be divided into several different categories, these being; verbal, non-verbal, positive, negative and conditional and unconditional. Verbal strokes can be anything from a quick ‘Hello’ between neighbours over the garden fence to a full blown conversation between good friends while non-verbal strokes range from a nod of the head to a hand shake or a hug. Generally most transactions, exchange of strokes, comprise both those of a verbal and those of a non-verbal nature. Positive strokes, by definition, are strokes that leave the recipient feeling good and provide a positive experience while those of a negative nature are exchanges that one may describe as painful in which the recipient is left feeling perhaps hurt or ‘not ok’. In ‘Games People Play’ Berne notes that ‘any social intercourse whatsoever has a biological advantage over no intercourse at all’. (Berne, Games People Play, 1964, p15) It may be clear to see why individuals would seek out positive strokes and steer away from negative ones, however this is not always the case. Given that the desired outcome of a stroke is the satisfaction of our stimulus or recognition hunger it appears not to matter whether the stimulus or recognition received is positive or negative. Think of a child that misbehaves in order to receive attention. The attention will more likely than not be of a negative nature, but any attention is better than no attention at all. If positive strokes are not forthcoming then one has to invent ways to receive negative ones. If a child has learnt that all he can do to provide himself with some form of recognition is behave badly he will continue to do so as, though he will not be left feeling good, he will have at least been recognised or stimulated in some way as opposed to being overlooked or stroke deprived. If we regard this theory in a clinical capacity it is important that when working with clients who demonstrate attention seeking behaviours, the therapist recognises the importance of paying attention to them. Though, perhaps not always healthy, these behaviours provide the therapist with an insight into the clients survival mechanisms, learnt from a young age, and thusly, even if these are to be worked on with a view to altering certain aspects of a clients behaviour, they should be acknowledged and respected. To this end it is important to recognise the difference between conditional strokes and unconditional strokes. In TA Today we are told that ‘a conditional stroke relates to what you do. An unconditional stroke relates to what you are’. (Stewart and Joines, TA Today, a new introduction to transactional analysis, 2006, p74) For example, ‘I love you when you are quiet and well mannered’ is a conditional stroke. It presupposes that love will be provided on the basis of good behaviour and adaptation to another’s demands. Whereas ‘I love you’, as a stroke, is unconditional, there is no demand or call for the recipient to provide anything in exchange for this stroke.

An important aspect of the work undertaken by a therapist trained in Transactional Analysis is the understanding of how a person gives and receives positive and negative strokes. Because, as infants, we test out behaviours in an attempt to see which ones provide us with strokes of any nature and equally because as adults we still have the same desire to be stroked, once we find which behaviours result in the receipt of strokes we are likely to repeat this behaviour. The more we repeat the behaviour, the more strokes we receive, thus reinforcing said behaviour. Adults will continually mould their behaviours to those that prove the most profitable in providing stokes. It becomes clear now to see why someone would continue to perpetuate behavioural patterns which appear to be damaging. If a person, from a young age has decided that they will seek out negative strokes as an alternative to feeling stroke deprived, as positive strokes were not forthcoming, they will continually find ways to provide themselves with negative strokes and as the stroking reinforces the behaviour that is stroked, so the cycle continues. It is then also possible to use this cycle to create new ways of seeking out strokes and breaking free of self harming patterns. If we were to begin to seek out positive strokes instead of negative strokes, as a grown-up, and we were to receive them with our new behaviour we would be then inclined to seek them out again, repeating this new behaviour. Changing unhealthy stroking patterns, therefore is possible and a very important goal to be undertaken by client and therapist.

Though, as Berne discovered, stroking is necessary for all individuals, it is not always something that all find easy to give or accept. In certain instances, especially if one comes from a background/family environment where positive stroking was scarce, they may find it near impossible to give any positive strokes themselves. As everybody is different everyone’s view on strokes is also. Some people may be willing to receive several negative strokes while others will find it hard to accept even one and become very hurt and upset. Some will prefer to receive conditional strokes, for example praise for a piece of work or a sporting achievement while others will desire to receive unconditional strokes. In addition to this most people will be used to getting certain strokes, positive or negative in nature and will become used to receiving these, however they may also additionally crave certain other strokes which they may seldom or never receive. For example a girl who is always complimented on her academic prowess with a verbal stroke may also crave a stroke in the form of a hug or a kiss from her mother or father. If she never receives this kind of stroke eventually she may altogether block out her need for it. This will continue into adulthood, unawares, but the need is still there underlying and unsatisfied. ‘In TA terms, we say that everybody has their preferred stroke quotient …….It’s as if each of us holds up a stroke filter between ourselves and incoming strokes. We filter out strokes selectively. We let in strokes that fit in with our preferred stroke quotient, and keep out those that don’t. In turn, our stroke quotient serves to maintain our existing picture of ourselves’. (Stewart and Joines, TA Today, a new introduction to transactional analysis, 2006, p77) Depending on their upbringing and circumstances some people may altogether filter out all positive strokes and only accept negative ones. Additionally some people with particularly troubles childhoods may find it impossible to accept any strokes at all and will have a water tight stroke filter that does not let in any strokes. Remembering what Berne has said about the spinal cord shrivelling it is then easy to see why it would be essential that they find ways of altering this and re configuring their stroke filters so they do not become completely withdrawn or depressed. Steiner said that ‘while it is possible to survive on minimal strokes, stroke scarcity is unhealthy both physically and emotionally’. (Steiner. Scripts People Live, 1974, p36)

On the subject of strokes, Steiner speaks in depth about what he coins The Stroke Economy, designed by the parent, and in turn, society at large, as a way or controlling the child and ultimately restricting the provision of strokes. ‘When strokes are then supplied, the price is high. Because the child already knows that strokes are essential to its survival it is prepared to behave in the ways demanded of him by his parents to obtain what he needs. As Berne pointed out …… control of stimulation is far more effective in manipulating human behaviour than brutality or punishment…..Most injunctions are enforced in young persons through the manipulation of strokes rather than through physical punishment; strokes become a tool of social control’. (Steiner. Scripts People Live, 1974, p110) The Stroke Economy is based on a set of five rules which parents teach their children. They are as follows; 1) Don’t give strokes if you have them to give. 2) Don’t ask for strokes when you need them. 3) Don’t accept strokes if you want them. 4) Don’t reject strokes when you don’t want them and 5) Don’t give yourself strokes. These five rules are injunctions and serve to enforce the stroke economy, ensuring stroke starvation. Thusly the free exchanging of strokes is under the control of the parental messages that have been passed down to the individual. ‘Most human beings live in a state of stroke deficit; that is, a situation in which they survive on a less-than-ideal diet of strokes’. (Steiner. Scripts People Live, 1974, p113)

(Image courtesy of bejim / FreeDigitalPhotos.net)

Steiner went on to propose that a desired objective of Transactional Analysis was to become able to disregard what we have already learnt about strokes from our parents and cultural upbringing and become aware that strokes are readily available in limitless supply, can be asked for whenever desired and that no matter how many we give to others we never run out. We can also give strokes to ourselves because there is no shame in that. In ‘Scripts People Live’ Steiner tells us that the single most common complaint of those who seek therapy is depression, ranging from the mild, banal form to the acutely severe. He insists that the therapists that ask their clients why they are suffering will find that most of them will say it is because they lack close, meaningful, loving relationships or that the ones they have are not satisfactory. Steiner believed that the approach for curing depression should be to teach the client how to procure the kind of strokes they desired from the kind of person they desired them from as this was what was missing. Because what we have learnt about strokes has come from our parents and decisions made in early childhood it is wholly possible that as an adult we can re-assess these decisions and change them. It is also the case that there is a certain sense of shame involved in needing something and not being able to achieve it. This is certainly the case with strokes. In actual fact, people have specific needs for specific strokes and it is important that they learn to ask for the kinds of strokes that they want to receive.

Strokes are a necessary facet of our existence. They are important for our physical and emotional wellbeing, our personal and professional development and our very survival itself. ‘A biological chain may be postulated leading from emotional and sensory deprivation through apathy to degenerative changes and death. In this sense, stimulus hunger has the same relationship to survival of the human organism as food hunger.’ (Berne, Games People Play, 1964, p13) By insisting that human contact or strokes are as essential to our survival as food and shelter Eric Berne, and in turn Claude Steiner, created a therapeutic approach in Transactional Analysis equipped to recognise and bring about change to unhealthy stroking patterns and behaviours perpetuating these patterns with a view to providing individuals with the ability to provide for themselves the strokes they need and the power to ask them of others.

If you want to find out more about how you can change unhealthy or negative patterns in your life please feel free to contact me.

katycounsellingherts@outlook.com

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‘An old Cherokee told his grandson,

“My son, there is a battle between two wolves inside us all. One is Evil. It is anger, jealousy, greed, resentment, inferiority, lies and ego. The other is Good. It is joy, peace, love, hope, humility, kindness, empathy, and truth.”

The boy thought about it and asked

“Grandfather, which wolf wins?”

The old man quietly replied,

“The one you feed.”‘

Cherokee Story

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Deep within the heart of all human beings lies the knowledge of our own eternity. It is this memory of our own eternity that lives as a kind of longing within each one of us. This longing seeks to relieve or fulfill itself through the acquisition of objects or the experience of intimacy in relationship, but what is truly being longed for is simply the knowing of our own being as it is.

Rupert Spira

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