Depression Treatment Options


However the client should be aware of the treatment options so that he /she can discuss with the consultant. Broadly speaking, the treatment of depression rests on two factors Medication, and Psychotherapy or Counselling.

  • Medication is required for moderate and severe depressive disorder cases.
  • Counseling and psychotherapy serves as an edge in treating depression and need to be started simultaneously along with medicines.
  • You should continue the full course of psychotherapy even if you are feeling better to prevent a relapse.
  • Suddenly stopping antidepressants can precipitate a relapse. Medication needs be tapered gradually under your doctor’s supervision.

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MYTHS ABOUT MARITAL COUNSELLING


1. TALKING ABOUT MY PROBLEMS WILL MAKE IT APPEAR BIGGER THAN NORMAL AND CAUSE MORE RIFTS.
Just like when a wound when cleaned causes more pain, so does talking about your hurt does. Talking about the problems brings about catharsis and a release of emotions. This can be perceived as threatening initially but is an essential step in healing.

2. PROBLEMS SHOULD BE LEFT ALONE. WHEN THEY ARE LEFT ALONE, THEY WILL AUTOMATICALLY DISAPPEAR.
Wounds when left unattended to are likely to form abscess and increase the pain. Similarly emotional wounds do not disappear over time. They need to be addressed carefully to avoid further problems or even amputation in worse case scenario.

3. ALL MARRIAGES HAVE HITCHES 2 YEAR HITCH, 5 YEAR HITCH, 7 YEAR HITCH AND 10 YEAR HITCH. IF I AM ABLE TO KEEP UP THE MARRIAGE THROUGH THIS, THE MARRIAGE WILL SURVIVE.
Dragging along with negative emotions actually leads to further damage to the relationship. Emotional content of one incident adds on the next and carries on till it becomes unbearable.

4. IF I TALK ABOUT MY PROBLEMS TO MY FAMILY AND FRIENDS, IT WILL CAUSE THEM UNNECESSARY PAIN. IGNORANCE IS BLISS
People listen and trust non verbal or body language more than verbal messages. It is of no surprise that 80% of our communication is non verbal. Family and friends, if they are closely bounded, therefore will already have some idea about the problems. Keeping it hidden from them not only isolates you, but causes greater anxiety and even conveys a message to them that you do not trust them. In effect your efforts to keep them from being in pain actually cause more damage to your relationship with them and ultimately greater pain to both. Sharing pain with the family gets each other closer.

5. NO ONE CAN HELP ME IN A MARITAL RELATIONSHIP. I HAVE TO WORK IT OUT MYSELF.
This is self induced pain and helplessness. This belief is the language of a victim who at an unconscious level prefers to remain as a victim. There is no basis to this belief.

6. IF MY PARTNER IS NOT WILLING TO WORK AT THE MARRIAGE, NOTHING WILL CHANGE FOR US. I ALONE CAN NOT BRING CHANGE IN MY MARRIAGE.
Marriage is a relationship between two dynamic individuals. Changes in one lead to changes in the other. It has a ripple effect on the other. It is also a well known fact that one can only bring out changes in oneself and any attempt to change another is a foolish act. In my 10 years of practice I have worked with numerous marital conflicts and more often than not only one person consults for therapy as the other is either unwilling to come for therapy. Relationship has been resurrected despite only one member being present.

7. I AM NOT RESPONSIBLE FOR THE BREAKDOWN IN THE RELATIONSHIP; IT IS FATE OR FAULT OF THE PARTNER.
Blaming fate is an unconscious unwillingness on our part to bring about changes in our self. Change in any aspect is perceived and experienced as stressful and therefore unwelcome. However we verbally say that we are willing to work on the marriage, there is a resistance to change in a similar manner and its outward manifestations are in the form of helplessness to fate or blame on our partner. Our age old saying “taali ek haath se nahin bajti” goes a long way to explain this phenomenon.

8. HAPPINESS IN OUR MARRIAGE IS DEPENDENT ON CHANGING NEGATIVE HABITS OF THE OTHER PERSON.
Taking on the responsibility of change in your self is the first step to healing a marriage. Any attempts to change the other is seen as an evaluative, judgmental and a corrective act and therefore sabotaged at the first chance. I have more often than not worked with only one individual with equally effective results and in as much time.

9. ONCE THE RELATIONSHIP IS TARRED, THINGS WILL NEVER BE THE SAME FOR US.
The basis of this is negative thinking and the focus on what is not there. We can spend our time on focusing on how there is a speck on the drawing sheet or paint something so beautiful that the speck although there does not catch our attention. How we view things, a glass half full or a glass half empty is the premise of our belief in working out a marriage.

10. TRUE LOVE IS MAGICAL.
This is a powerful and omnipotent belief that love is magical. Therefore one can not really work on it or create it. It is either there or not there. If damaged, one can not create it. The fact is marriage or any relationship is not magical. We all need to work on it and resurrect it from time to time. Communication is therefore a crucial element in its survival. Even the purest form of unconditional love of a mother and child needs efforts to keep it alive. There is nothing magical about it. Any mother will tell you how she struggled with her child and that only conscious effort and good communication helped.

11. GOING TO A COUNSELOR WILL ACTUALLY SPOIL THINGS FOR US FURTHER.
Many clients feel that going to a counselor will spoil things for them yes, many have experienced this too. Counseling is good; unethical practice in the name of counseling can have devastating effects. You need to be careful in choosing the type of marital counseling you are opting for.
Also, one may be aware that the marriage is not working out and may fear discovering that during the counseling. Some clients opt not to go for counseling as their fear of discovering this is higher than their pain. Some realize this in the middle of therapy and tend to push the blame onto the counseling sessions. Remember it is always your choice what you want. There is nothing right or wrong about it.
To avoid disappointments check out these basic premise of counseling before you enter therapy sessions:
• Consult a person who is non judgmental and non directive in his approach. We do not want it to be a verbal court battle in the counselors room where the counselor decides who is right and who is wrong.
• Another crucial element of counseling is confidentiality and therefore for any marriage counselor to take counseling sessions together with both the clients can actually do more harm than good. It actually turns out to be the power experienced by the counselor himself when he sits on a judgment on who is right and who is wrong.
• The counselor needs to empathize and work with you as an individual. If he is able to take you to a different level working with you, things automatically improve. The interest of the client is at the forefront in a session.
• Explore how comfortable are you with the changes in your life and decide for yourself what are your comfort zone. A good counselor can help you work on this.

USING PLAY THERAPY TO DEAL WITH ENURESIS (BED WETTING) & ENCOPRESIS (SOILING OF CLOTHES)


Rahul was 12 years old when he was referred for bed wetting (enuresis) and passing stools (encopresis). He was referred by the family doctor who found a non medication approach to his bedwetting and encopresis a better solution, especially considering the long term side effects of the medicines and the fact that there were no physiological causes to his problem.
His problem had escalated soon after they had shifted into this new house. Parents didn’t think that shifting house could have been the reason for the same as he always wanted to shift back to this house. In fact he had many friends here and would initially quickly finish off his homework to go down to play. But soon he started wetting his bed in the night more often and the ‘accidents’ at school too increased.
By the time he started with play therapy, he was regularly wetting his bed in the night and the soiling his pants at least once a month. Rahul was so unsure of his own bowel movements that he refused to go for school trips or for a sleep over at his friends or cousins house. Off late he was fearful of going to school too, as he was now teased for being a sissy boy. At home too, he would play with his play station for hours on end and would be generally. His parents had tried every thing from making him visit the toilet at bed time and before going to school to more frequent visits when outside, but to no vain. Normally an active boy was now unsure and irritated most of the times.
During the case history on enquiring about any traumatic history the parents recalled that just before they had shifted the house he lost his grand mother and around that time the van in which the school children traveled had met with an accident. Although no one was injured Rahul had recounted the incident in great detail. They found it difficult to believe that these could again be the reasons as it was not the first time he was dealing with a loss of a grand parent or meeting with an accident. In fact he had lost his grand father the previous year, to whom he was more attached. Since his grandmother suffered from Alzheimer he hardly ever interacted with her over the years.
Bedwetting is considered to be problematic for children only above 6 years of age. Till about 5 it is considered normal if the child occasionally wets the bed. Usually children have considerable bowel control by the age of 4 and do not soil their clothes. Enuresis can be primary (the child did not grow out of using diapers) or secondary (child stopped wetting beds but suddenly after a period of time started wetting them again, as in Rahul’s case).
It is often connected to psychological issues of emotional stress / anxiety. Often the causes remain unknown to both the child and the therapist. Therefore using cognitive or reasoning approach is difficult with these children and it is not in their awareness or consciousness. Also emotions of shame and guilt are quite complex for the children to express verbally. This coupled with threats or punishment from parents (who feel an extreme sense of concern and frustration dealing with this problem) can become quite traumatic for the child. Play therapy, being dynamic, non directive and symbolic allows the child to reenact and work out his emotional issues leading to the problem in a safe and trusting environment without having to get into verbal communication. This is further supported by some parenting sessions where parents are usually asked to bring about certain changes in the child’s routine to support the sessions proves extremely effective.
The following are some of the changes that parents are requested to introduce:
• Having liquids at least 4 – 5 hours before the bed time.
• Setting up alarms at regular intervals and encouraging Rahul to visit the toilet.
• Keeping an extra pair of clothes and bed sheets so that Rahul need not wake his parents every time he had an accident.
• Not humiliating / threatening / asking too many questions to the child to rectify his behaviours .

Rahul began his play sessions. Initially he found it quite boring to play with toys that were around and often asked if he could carry his video games or whether there was access to computers. But slowly as the sessions progressed he started playing with animals, clay and balls. The therapist noticed that in most of his sessions he would give instructions to the therapist to follow. He would make loud noises and fight with the wild animals. With the clay he would often make snakes and then turn them into turbans which the therapist was instructed to wear and become the care taker of the animals. Some times he used the ball to knock down the animals. After many such sessions, he moved on to drawing. He initially drew only symmetric drawings but soon moved on to draw themes. Most of the themes again reflected anger, punishment and morality issues.
Around the 8th session, the mother mentioned that Rahul had wetted his bed only once and had soon woken up to change his clothes and the bedsheet. The therapist had given a list of instructions to the parents to follow. Soon after that Rahul showed greater interest in his play and also in the sessions.
After his summer break when he returned for the first session, he sent a message containing smiley face and to inform the therapist that they were on their way to the clinic. He seemed to have settled down with not a single mishap of soiling his clothes or wetting the bed. He had returned to his original confident self and seemed less tentative about things. Although he was apprehensive on the first day of school, he settled into his new routine pretty soon. On the follow up terminating sessions, the bedwetting and soiling behaviours had consistently shown improvement with no further accidents. His academic marks also returned to their earlier levels.

CHILDREN OF DIVORCED / SINGLE PARENTS



Vineeta lost her mother when she was a young adult; she pined for years, unable to overcome her grief over the loss of her parent. But when she underwent divorce, she was unable to understand her own 8 year old son, who was grieving the loss of his father. She struggled to understand why suddenly he was getting into trouble at home and at school, why were his grades falling although he was an intelligent child, why was he back answering and blaming her. Nothing made sense, but a sense that everything falling apart for them both was experienced. Maybe that is what a child feels when parents divorce/ separate. His entire world seems to come crashing down.

The movie Bal Ganesha which got everyone in the theatre to tears of joy when Ganesha showed his superior intelligence and circled his parents three times instead of taking three rounds around the world, winning the race against his younger brother. Little do we realize that this mythology is not about superior intelligence, rather it portrays the child’s perception of his parents, his world. For him, parents are at the center of his existence and therefore separation from one or both is experienced like death and a threat to his own survival.

Like any one who is fighting for their survival, children try out various options to survive this trauma, and attempt to reunite their parents. Like the Vineeta, who grieved for years over the loss of her mother, children do not give up hope of reuniting their parents for years after the separation. Parents who are anyways struggling to deal with their own emotions find it extremely difficult to deal with the emotions of the children. Children ask questions which seem impeccably correct putting the parents in a spot. “But why does he not like you? Maybe if you work hard and become smarter and thin, the way he wants you to, we can be together,” says a 7 year old boy to his mother. Or a 10 year old girl to her father “Why can’t you forgive her, maybe she did not mean the things she said to you. You forgive me every time I have lied, can’t you forgive her? For my sake please?”

In most cases the children tend to feel responsible for the divorce and try to change the behaviour and actions to please the other parent, like this 6 year old boy pleads to his mother, “lets go back home, I promise I will not make him angry and bother him for toys ever again or change the TV channels.” At times, in their attempt to get back the parents together, they may even get into negative behaviours such as lying, running away from home, cooking up stories, poor academic performance, and bedwetting, being irresponsible and stubborn etc. This problem is exaggerated if the child is very young and unable to communicate; or if he is entering his teens and feels confused and threatened about the volatile emotions characteristic of this age. Unable to deal with this confusion and inability to express their distress, children learn to bottle up emotions and thoughts, making communication all the more difficult. There seems to be a glass wall around them where you cannot hear what they are saying nor can they seem to understand what you are trying to communicate. Nothing seems to penetrate and touch them through this wall.

But there is a non threatening way to communicate to them, through the language of play. Play is a natural mode of communication of children. They can better emote their feelings unconsciously through play and therefore play becomes a powerful cathartic medium. It also provides an emotional distance to the children necessary to express threatening and negative emotions and thoughts. They cannot say that I don’t hate you mom for getting divorce but they can definitely express the same using a doll set or by beating at clay incessantly. Thus through the use of play, we can reach out to both the younger children and the teenagers alike.
This play way is used by a specially trained therapist to help children and parents better understand and deal with each others thoughts, feelings and behaviours. Unfortunately this is a language that we as parents, have long forgotten and need to relearn it in order to understand what our child is feeling to help them. Sometimes the Play Therapist also involves the parent to some of the structured play techniques which can help them bond better. This is what we did with Vineeta and her son. Through play materials we helped the child emote his anger and frustration. Once he had a name for the feelings, he was able to express it verbally. Vineeta on the other hand, when she was involved in the Play Therapy sessions, learned to better understand his emotions and respond appropriately to his needs.
The drawing in the picture was drawn by the child demonstrating his pain at the divorce as is seen by the heavy clouds, scratched sun and the two rivers which run parallel to each other like tears from the eyes. A Play therapist uses numerous play materials such as this to make such interpretations and convey it to the child, equipping the child with the ability to choose his reactions appropriately. It aims to increase resilience and self esteem within each child. Making him confident to face the future and challenges in life.

RAAVNA… Mystery of loving your captivator?


The last emotionally packed and paradoxical sequel of the film Raavana wherein Rajini, disillusioned and suspicions of her husband goes onto meet Veera, her captivator was quite baffling. Why would Rageeni need to confirm the truth with Veera, her abuser, whom she knew barely for 14 days as against her husband who loved her for so long? How will Rageeni deal with her conflicting emotions now if she decides to go back to her marriage? Although most of us who have seen the movie ‘understand’ Rageeni’s emotions; if we try and socially or logically analyze it, we will be at a dead end. While the situation doesn’t make sense from a social standpoint, does it make sense from a psychological viewpoint? The answer is – Yes…its called the Stockholm Syndrome!

Stockholm syndrome is a psychological shift that occurs in captives when they are threatened gravely but are shown acts of kindness by their captors. Captives who exhibit the syndrome tend to sympathize with and think highly of their captors. When subjected to prolonged captivity, these captives can develop a strong bond with their captors, in some cases including a sexual interest. Psychiatrist Frank Ochberg, widely credited with Stockholm Syndrome’s psychiatric definition, describes it as “a primitive gratitude for the gift of life,” not unlike that felt by an infant.

Is Stockholm Syndrome limited only to dramatic situations like kidnapping and hostage? Surprisingly, it is more common than people realize it to be. We all know it under the name of “Domestic Violence”. People are often amazed at their own psychological conditions and reactions. Having worked with couples for a number of years I come across many such cases in my clinical practice. Some of the most surprised and shocked individuals are those who have been involved in controlling and abusive relationships. When the relationship ends, they offer comments such as “I know what he’s done to me, but I still love him”, “I don’t know why, but I want him back”, or “I know it sounds crazy, but I miss her”. Recently I’ve heard “This doesn’t make sense. He’s got a new girlfriend and he’s abusing her too…but I’m jealous!” Friends and relatives are even more amazed and shocked when they hear these comments or witness their loved one returning to an abusive relationship.

Stockholm Syndrome (SS) can also be found in family, romantic, and interpersonal relationships. The abuser may be a husband or wife, boyfriend or girlfriend, father or mother, or any other role in which the abuser is in a position of control or authority. In relationships with abusers, a birthday card, a gift (usually provided after a period of abuse), or a special treat are interpreted as not only positive, but evidence that the abuser is not “all bad” and may at some time correct his/her behavior. Abusers and controllers are often given positive credit for not abusing their partner, when the partner would have normally been subjected to verbal or physical abuse in a certain situation. An aggressive and jealous partner may normally become intimidating or abusive in certain social situations, as when an opposite-sex coworker waves in a crowd. After seeing the wave, the victim expects to be verbally battered and when it doesn’t happen, that “small kindness” is interpreted as a positive sign.

As relatives or friends of a victim involved with a controller or abuser, our normal reaction is to consider dramatic action. We become angry, resentful, and aggressive at times. A rule of thumb is that any aggression toward the controller/abuser will result in additional difficulties for your loved one. Try to remain calm and await an opportunity to show your love and support when your loved one needs it. Remember you can not help the victim till the victim does not decide to help himself / herself.

Taking the abuser’s perspective as a survival technique can become so intense that the victim actually develops anger toward those trying to help them. The abuser is already angry and resentful toward anyone who would provide the victim support, typically using multiple methods and manipulations to isolate the victim from others.

Any contact the victim has with supportive people in the community is met with accusations, threats, and/or violent outbursts. Victims then turn on their family – fearing family contact will cause additional violence and abuse in the home. At this point, victims curse their parents and friends, tell them not to call and stop interfering, and break off communication with others. Agreeing with the abuser/controller, supportive others are now viewed as “causing trouble” and must be avoided. Many victims threaten their family and friends with restraining orders if they continue to “interfere” or try to help the victim in their situation. On the surface it would appear that they have sided with the abuser/controller. In truth, they are trying to minimize contact situation that might make them a target of additional verbal abuse or intimidation. If a casual phone call from Mom prompts a two-hour temper outburst with threats and accusations – the victim quickly realizes it’s safer if Mom stops calling. If simply telling Mom to stop calling doesn’t work, for his or her own safety the victim may accuse Mom of attempting to ruin the relationship and demand that she stop calling.

In severe cases of Stockholm Syndrome in relationships, the victim may have difficulty leaving the abuser and may actually feel the abusive situation is their fault. Remember, the more you pressure the “victim” of the Loser/Abuser, the more you prove their point. Your loved one is being told the family is trying to ruin their wonderful relationship. Pressure in the form of contacts, comments, and communications will be used as evidence against you.

Your contacts with your loved one, no matter how routine and loving, may be met with anger and resentment. This is because each contact may prompt the Loser/Abuser to attack them verbally or emotionally. Try to maintain traditional and special contacts with your loved one – holidays, special occasions, etc. Keep your contacts short and brief, with no comments that can be used as evidence. Remember that there are many channels of communication. It’s important that we keep a channel open if at all possible. Communication channels might include phone calls, letters, cards, and e-mail. Scheduled monthly shopping trips or outings are helpful if possible. The goal is to maintain contact while your loved one is involved in the controlling/abusive relationship. Remember, the goal is contact, not pressure.

Don’t feel the victim’s behavior is against the family or friends. It may be a form of survival or a way of lowering stress. Victims may be very resistive, angry, and even hostile due to the complexity of their relationship with the controller/abuser. They may even curse, threaten, and accuse loved ones and friends. This hostile defensiveness is actually self-protection in the relationship – an attempt to avoid “trouble”.

The victim needs to know and feel they are not rejected because of their behavior. Keep in mind, they are painfully aware of their situation. They know they are being treated badly and/or controlled by their partner. Frequent reminders of this will only make them want less contact. We naturally avoid people who remind us of things or situations that are emotionally painful.

If the relationship has continued for over a year, they may require support and an exit plan before ending the relationship. Marriage and children further complicates their ability to leave the situation. When the victim decides to end the unhappy relationship, it’s important that they view loved ones as supportive, loving, and understanding – not a source of pressure, guilt, or aggression. The victim and the family may also require some counseling to undo the hurt, anger and guilt.

Relationship Studio… Rejuvenate and Enhance your Relations


Our closest relationships have a dramatic effect on our life…positive and negative.

Relationship Studio works with the couples at various stages in their life. Our sessions provide intensive learning experience and practical tool for strengthening your connection as a couple and building a deep mutual attraction and appreciation that can last a life time.

Invest in your relations now and the dividends can last you a life time!!

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