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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Dealing with rejection



What makes Priyanka Chopra rejected by the wives of her co actors? Is there really a flaw in her character or is she a victim of the wives’ insecurities. Decide yourself in the article dealing with rejection.
Rejection is experienced as a deep blow to self esteem as it involves blaming you as a person. It is difficult to deal with it because it conveys the message of non-acceptance and that there is something wrong with you and you are not good enough or worse still there is something wrong with you, that you will never change and that you do not belong to this group and you’ve done something wrong or unacceptable. This leaves you with a deep sense of helplessness. There is nothing that you can do to change another person’s biases and perceptions and you are left to deal with all these emotions yourself. More often than not, these perceptions are often backed by societal or religious norms justifying the persons rejection.
Often people who are a victim of rejection keep going in circles feeling victimized and angry and are unable to get over it easily. Psychotherapy helps such individuals to differentiate between what is intrinsic to themselves and that which is not. This goes a long way in handling difficult emotions of rejection. By understanding ones ownself and how one uses psychological defense of projection and introjection one realizes that the emotions thrown into him by the person rejecting actually form the dark and unknown side of the rejecting individual’s personality which is unfortunately being flashed onto your character screen. Although not aware, the person has sense that he can succumb to these very biases and therefore fights it externally whenever he sees it. Unfortunately in the process does not cure himself and accumulates greater fear of the same biases. Therefore no logical argument is able to convince the person to give them up. The reason being, if they give up these biases, maybe there is a fear that he will have to face it within himself. After all isn’t it much easier to fight the devil on an external screen than to have him within yourself.
Equipped with this understanding by experiencing it within ones ownself, the individual is able to detach oneself from the influences of these negative emotions projected on him by the world and is able to restore his self esteem. Of course talking about these emotions forms the initial part of the cathartic therapy but psychotherapy does not stop at that alone. In fact if the therapist is unable to take the client beyond catharsis, the client keeps experiencing the wound in his mind but is unable to come out of it.
Understanding the mechanisms of rejection and knowing that it is never, and I repeat, never warranted or earned are the most fundamental keys to safeguarding your self esteem and sense of self worth. This is a choice. You have to make a choice about how you are going to understand the messages of rejection you receive everyday, and how you are going to, or not going to, integrate these messages into your psyche.
Remember that facing your fears, expressing and sharing your experience, no matter how shameful, is vital in overcoming the aloneness that rejection creates and which sustains its impact.
Make a choice today to focus on the dynamic you and your untapped potential and you will be unscathed by any experiences of rejection.

SURVING CANCER



Being diagnosed with cancer affects a patient not just physiologically but also psychologically, and has a deep impact on the emotional status of the patient and his family for an extended period of time. And while there are treatments for the physiological symptoms of the patient, dealing with the psychological trauma associated with cancer is another story altogether. Cancer is an experience of repeated traumas and for undetermined length, unlike an accident. The patient may experience posttraumatic stress disorder (PTSD) symptoms anytime from diagnosis through completion of treatment and cancer recurrence.

As is seen in the case of our Indian skipper Yuvraj Singh how the misdiagnosis and then the reconfirmation of the cancer must have been a series of highs and lows. Especially for a sportsperson who works under tremendous pressure to be fit and putting out an outstanding performance, trauma such as this can be doubly difficult psychologically rather than physically. Any ones guess would be whether he will be able to return to the stadium fit enough to play his best innings. Here is a glimpse of what he might be undergoing…

Although, the end of treatment is often marked with a sense of relief, accomplishment, and even joy in having gotten through a difficult experience. Yet for many cancer survivors, it is also a stressful time filled with new routines to learn, as well as mixed feelings about what they’ve just gone through. Many people find themselves unsure of how to move forward, wondering, “Now what?” Therefore, effects of PTSD are long-lasting and serious. It does not end with the end of the treatment. It may affect the patient’s ability to have a normal lifestyle and may interfere with personal relationships, education, and employment even after the patient is ‘cured’. Because avoiding places and persons associated with cancer is part of PTSD, the syndrome may prevent the patient from seeking medical treatment or psychotherapy. It is therefore important that cancer survivors and their family receive information about the possible psychological effects of their cancer experience and early treatment of symptoms of PTSD.

Also, as a patient, they may have been so busy learning about their diagnosis, working with the medical team, and going through treatment that they didn’t fully feel the emotional impact of the diagnosis until after end of the treatment. It’s common for many cancer survivors to have a variety of complex and often conflicting feelings about their diagnosis, treatment, and recovery. It is normal to feel relieved that treatment is over, yet angry or sad about having gone through such a serious illness. Or, they may feel guilty about surviving a diagnosis that other people do not. The patient may also feel anxious and fearful about the cancer coming back, or worried that the treatment didn’t work. It is normal, too, to feel confused about what they’ve been through and to be concerned about the future. Family and friends can provide much comfort and support during this time. However, survivors often feel a bit isolated from loved ones and the world around them. Loved ones usually mean well, but they might not be fully aware of all the emotional challenges that can arise for you after overwhelming, interfering with your day-to-day activities and even your health.
Another concern faced by many cancer survivors is the realization that life after their diagnosis and treatment never really goes back to what it was before cancer. Many survivors find they are not able to return to their old “normal” life but must adapt to a “new normal.” Understanding what your new normal is can take time. This process may involve: Reflecting on what you’ve been through. Identifying changes you might want to make in your life. Recognizing what you’ve learned and what’s changed about yourself. Re-evaluating personal relationships or professional goals.
Discovering new ways of finding meaning and fulfillment.
In India, we find that patients usually resort to prayer, fasting, performing ceremonies in order to deal with their illness as against proactively seeking information from the doctor, reading up on the net and medical journals, exercising, eating healthy, meditating or seeking professional help to deal with their emotions. (Stress and Coping amongst infertile women Research conducted by Dimple Shah for Mumbai University, 1994.). Although these actions mimic active coping mechanisms, in essence it is passive coping mechanisms resigning pessimistically and blaming fate for their misfortune and instilling deep fear and helplessness, therefore unable to relieve the person of stress. Patients and their family needs to be informed of these inactive and potentially stress inducing coping mechanisms and be guided to utilize proactive coping mechanisms mentioned above from the beginning.

Therapies used to treat PTSD are those used for other trauma victims. Treatment may involve more than one type of therapy. Feelings of sorrow, grief, hopelessness; coupled with mood swings, fear of losing life, leaving behind loved ones and anxiety and depression are very common amongst patients fighting against cancer. Serious psychosocial distress was seen 40% more among cancer survivors of 5 years or more than in those who have never had cancer. About 10% develop major depressive disorder; others experience an adjustment disorder. In young adult cancer survivors, one small study found that 20% of participants met the full clinical diagnosis of post-traumatic stress disorder (PTSD), and 45% to 95% displayed at least one symptom of PTSD. Survivors of adult cancer are at an increased risk of suicidal ideology (having thoughts about suicide), while as many as 13% of childhood cancer survivors experience suicidal ideology.

The prognosis of cancer it is proven scientifically that an emotionally stable person reacts better to the medication and treatment modalities of cancer. This is where a person’s inner strength becomes paramount. Yet it is expected that the person who has been diagnosed with cancer will initially at least crumble under the stress of the trauma. Here the key is, the support system that has a tremendous impact to help the patient bounce back to fighting cancer is the family and friends. Psychotherapy from the time of diagnosis to surgery and post treatment is crucial in providing this supporting network. When one member of a family has cancer, the whole family is affected and, in fact, psychotherapists consider these family members to be “secondary patients.” Cancer affects an entire family, not only because there are genetic links to cancer and cancer risk, but because when one member of a family has cancer the whole family must deal with the illness.

The therapist focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient. Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Some of these methods include helping the patient understand symptoms, teaching coping and stress management skills (such as relaxation training), teaching the patient to reward upsetting thoughts, and helping the patient become less sensitive to upsetting triggers. Therapist may also use group work and introspective art therapy help the patient express their emotions. Sometimes having someone paying attention to the painful emotions itself is healing and patients show tremendous resilience once they are able to confide in someone who can demonstrate strength to listen to their pain, which family members are unable to do so at that point of time.

Most importantly cancer trauma, like other life threatening traumas bring back the past and often unconscious hurts and losses and therefore the psychological effect appears long lasting and compounded. Often people close to the patient find the person overreacting and are unable to understand where they are coming from. They feel hurt, angry and confused. But if you make an effort to understand that these emotions of hurt, anger and confusion that you are experiencing are not really incident related or even yours; that they belong to the person who is suffering from cancer you will be better able to deal with both the patient and the emotions thrown into you. Doing this is not as easy as it sounds and this is also where the psychotherapists step in. Psychotherapists help the family to experience and deal with these emotions that are thrown into them and also help them make better response choices. Therefore the psychological treatment on which the prognosis of cancer depends is strengthened using multifaceted psychotherapy approaches. It is beneficial to start with these sessions from the time of diagnosis and continue till post treatment; as although we expect psychological reactions to emerge within the first three months of diagnosis, there is no fixed rule and if not brought into the forefront of therapy may remain suppressed and resurface later on after many years, often with unconceivable strength.
Follow up article on Yuvraj singhs recovery from cancer
https://revivallife.wordpress.com/2012/04/14/surviving-cancer-2/

ACID ATTACK AND ITS IMPACT



In a male chauvinistic world, woman is considered to be the property of man. Be it a spurned lover, a suspecting husband or a man who is shooed away when he wants a relationship, each feels humiliated and wants to take revenge against the woman. The easiest way to hurt the woman in such instances is throwing acid on her. It makes the man feel immensely and rather sadistically satisfied if the woman is disfigured. Experts believe that the foremost reasons behind this barbaric act are easy availability of acids and illiteracy among the masses. The overwhelming majority of the victims are women, and many of them are below 18 years of age. These attacks are often the result of family and land dispute, dowry demands or a desire for revenge. There are umpteen instances in history of how women were treated in times of war or conflict. With the advent of industrialization and inventions, acid has come handy to these egotists in their bid to disfigure women. Acid throwing could well be described as the attempt to control or subjugate women.

Victims of attacks not only undergo severe physical trauma but also traumatic changes in the way they feel and think. Psychological trauma is caused by both what the terror victims suffer during the attack, as they feel their skin burning away, and what they suffer after the attack with respect to the disfigurement or disabilities they have to live with for the rest of their lives. Victims suffer psychological symptoms such as depression, insomnia, nightmares, paranoia, and/or fear of facing the outside world, headaches, weakness and tiredness, difficulty in concentrating and remembering things, etc. They feel perpetually depressed, ashamed, worried and lonely. Usually, acid burn victims suffer severe psychological symptoms for years, if not forever, because they are constantly reminded of the violent act by their physical scars. The feeling of lack of hope and worth may never leave them.

Social and Economic Consequences
Acid burn victims face a lifetime of discrimination from society and they often become lonely. They are embarrassed as they think people may stare or laugh at them, and may hesitate to leave their homes fearing adverse reactions from the outside world. Victims who are not married are not likely to get married and those who have suffered serious disabilities because of an attack, like blindness, will not find jobs and earn a living. Discrimination from other people, or disabilities such as blindness, makes it very difficult for victims to fend for themselves and they become dependent on others for food and money.
It has, therefore, been argued that acid attacks need to be classified as a separate offence and harsher punishment needs to be prescribed. It has been further stated that the new law must include guidelines for handling/supporting victims economically, socially and psychologically, and provide compensation. In fact since acid is so readily available across the counter in medical and other stores, acid attacks are a relatively cheap and effective way of committing acts of violence against women. Buying hydrochloric acid is as easy and cheap as buying a bar of soap; a litre of acid costs anywhere between Rs. 16 and Rs. 25.
There is, however, no law to regulate acid sales except for the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 (amended in 2000), and this only applies to industrial situations. Furthermore, there are no regular inspections and stock checking for acid sales as there are for explosives. It has been argued by some that controlling or regulating acid sales is an impossible task, as acid is used for many things including car batteries, etc. Thus, the deterrence should come in the form of stringent laws that punish the perpetrators. However, Bangladesh, a country with the highest incident rate of acid attacks, has passed a law in 2002 to control acid sales. Thus, acid violence can be tackled on both fronts simultaneously with harsher punishment on the perpetrator and control over the sale of acid to stop it from getting into the hands of criminals. International commerce of sulphuric acid is controlled under the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988, which lists sulphuric acid under Table II of the convention, as a chemical frequently used in the illicit manufacture of narcotic drugs or psychotropic substances.
Nitric or sulphuric acid has a catastrophic effect on human flesh. It causes the skin tissue to melt, often exposing the bones below the flesh, sometimes even dissolving the bone. When acid attacks the eyes, it damages them permanently. Many acid attacks survivors have lost the use of one or both eyes. But the scars left by acid are not just skin deep. In addition to the inevitable psychological trauma, some survivors also face social isolation and ostracism that further damage their self-esteem and seriously undermine their professional and personal futures. Women who have survived acid attacks have great difficulty in finding work and, if unmarried (as many victims tend to be), have very little chance of ever getting married. In a country like India this has serious social and economic consequences. The New York Times (Dec, 26, 2001) reports that kerosene as well as acid has fast become the weapons of choice for attacks on wives in India. The major victim of attacked is Women(47%) and Men(26%). Children(27%) could not escape from the attack. Sometimes domestic animals or birds are also victimized. The sad fact is that women who have been victimised by these attacks are mostly at the hands of someone known and close to them.
Landmark Judgement
Referring to the compensation to acid victims, the Law Commission, headed by Justice A.R. Lakshmanan, quoted the landmark judgement of the Honourable High Court of Kerala in the State of Karnataka in the Jalahalli Police Station vs. Joseph Rodrigues case (decided on 22 August 2006) wherein the accused was convicted under Section 307 of the IPC and sentenced to imprisonment for life. A compensation of Rs. 2,00,000, in addition to the trial court fine of Rs. 3,00,000, was to be paid by the accused to the victim’s parents. The acid attack deeply scarred the victim’s physical appearance, changed the colour and appearance of her face and left her blind. However, in many cases throughout India, punishment often did not take into account the deliberate and gruesome nature of the attack but only rested on technicalities of injuries. It is apt to recall here that the Law Commission also proposed a law known as ‘Criminal Injuries Compensation Act’ to be enacted as a separate law by the government. This law intends to provide both interim and final monetary compensation to victims of certain acts of violence like rape, sexual assault, acid attacks, etc., and should provide for their medical and other expenses relating to rehabilitation, loss of earnings, etc. Any compensation already received by the victim can be taken into account while computing compensation under this Act.

UNDERSTANDING THE RELATIONSHIP BETWEEN FOOD AND EMOTIONS



We subconsciously associate food with nurturing. Tasty food brings about a sense of deep gratification and we associate it with filling a hungry gap, rewarding ourselves for effort spent or simply a good social time.

Due to our strong mind-body connection we literally program our living cells moment to moment via our thoughts and especially our feelings. If you find yourself running for something to eat every time you feel emotionally upset, disappointed or hurt, you might be a comfort eater and use food to lift your mood. If you are really keen on changing negative food habits, the place to begin is to understand what food represents emotionally to you. Without this, any diet change will only be temporary and but fail to induce life style change and the weight will eventually come back.

Comfort foods, like chocolate and biscuits or starchy foods, increase the body’s natural feel-good neurotransmitter, seretonin. Unfortunately like all quick fixes and addictions, the instant gratification is soon followed by a strong sense of guilt and feeling like a failure, which brings on depression. Thus for a person suffering from depression related obesity, you need to take care of the depression first or simultaneously with the diet regime inorder to ensure successful weight reduction and maintainence.

Just as, common cold cannot be cured by treating only the symptoms of cold such as sneezing or irritation in the nostril but requires the infection to be taken care of first and the symptoms will cease on its own. Similarly diets without understanding the reason for the obesity are sure to fail. The saying goes that inside every fat person is a thin person dying to come out. Psychologists call this inner person your “inner child” which probably needed a lot of cover up at some point in time in order to deal with difficult life circumstances. If we connect with this inner child and become aware of what causes him/her to run for the fridge in the first place, we can start to reprogram ourselves by tending to our real hurts and needs instead.

Take “LILA” for example, who was sexually abused as a child. She grew up to be an attractive and voluptuous woman. Yet every time a man leered at her she felt shame and repulsion. Lila started eating, subconsciously motivated to put on weight as a barrier between her and the outside world and also to hide her curvaceous figure in order to avoid lecherous stares. Yet at the same time she has grown accustomed to using her sexuality to control and manipulate men.
Lila’s primal need is for respect, love and healthy affection from an intimate relationship, yet she is programmed to associate intimacy with sexuality and thereby she keeps compromising herself sexually in order to get her basic needs for love “fulfilled”. This discrepancy between her need for respect and love versus her tendency to self-sacrifice in sexual behavior increases her sense of shame and the need for her inner child to resort to various defense mechanisms as well as her compulsive eating disorder.
Lila needs to honor and respect herself by focusing on what really makes her happy. She needs to practice hobbies and develop talents where she could meet men who share the same interests and value her for other qualities than just her (physical) body. Lila also needs to change her attitude towards men as sexual predators in order to break free from meeting the “wrong” type of men who perpetuate her one-sided perception and overemphasis on sexuality. Thus the cycle keeps on repeating itself and keeps her entrapped in her negative habits.

For many people, like Lila, food has become a means to self-destructive behavior or self-punishment. Research indicates that sexual abuse victims often feel responsible, shame and guilt for the abuse. In order to cope with these emotions our mind unconsciously replays them in various circumstances in hope to resolve this trauma. Thus, in Lila’s case self punishment is an unconscious motive attained and re experienced via obesity.

There is another unconscious motive. Obesity also makes her appear not so attractive and therefore less likely to be sexually abused. Thus we derive some benefit from our seemingly troubling behavior. That is, “symptoms” or “issues” can be construed as both “maladaptive” and “adaptive”. At first glance, symptoms look maladaptive, but closer scrutiny reveals that in some way, the individual “benefits” from them. That is, in some way the individual is protected by her “symptoms”. In effect, the “symptoms” represent a solution to a problem, albeit a far-from-ideal solution. The maladaptive aspects of “unwanted” behaviors are easy to recognize.

We need to ask ourselves what it is that we dislike so much in ourselves that we need to punish ourselves. Why are we so hard on ourselves that the simple bit of self-discipline required to stop eating when we are full, becomes such a difficult task that we would rather abandon all reason and give over to our rebellious inner child? By becoming aware of how and when we felt trapped under excessive discipline and criticism in our past, we can break the pattern of such an unnecessary authority that we’ve subconsciously internalized. Pay attention to your real needs. Are they really excessive or out of line? Wouldn’t a different approach of gentle encouragement and the focus on our good qualities have better results in our behavior?

Another reason why we put on weight is when our nurturing needs as an infant, baby or child were not met. Our mother may, unintentionally and very well meaning, either fed us too often and too much or too seldom and little or simply the wrong kinds of food in order to entice us to do something or to reward us. This lack of being in sync with the child’s natural needs, may lead the child to experience anxiety and the inability to perceive the natural call of hunger and sense of satiety.

Often this goes hand in hand with an overprotective or controlling mother towards whom we always feel indebted or striving to please in our behavior. Our inner child feels neglected and not understood, so we grow up trying to please through our “doing” instead of realizing how lovable we are in just “being” ourselves.
Are you able to say “No” when you don’t feel up to a request? We might struggle to communicate our feelings and needs and have problems with our personal boundaries allowing people to take advantage of us and then becoming resentful afterwards. And guess what, the quickest relief again becomes the fridge or some stacked chocolate bar.
There are many more reasons why people become obese. What I am suggesting is that before we look for the quickest and easiest diet available to lose weight, we must first make sure we are happy wholesome human beings, and love the body that we’re in despite it’s extra few bulges and curves.

Next time you run for the fridge, ask yourself:
 How do I feel right now?
 What is my reason for wanting to eat something?
 Is the food that I am about to consume really beneficial and nourishing to my body or am I trying to substitute food for feeling hurt, frustrated, angry, disappointed, bored etc?

Have a notepad ready in the kitchen and write down your feelings and motivation for eating.
This simple exercise will break the habit of compulsive eating and will buy you those few extra minutes which enables your conscious mind to intervene.

The exercise above provides you with a framework for thinking about the meaning of a puzzling symptom. At first blush, these questions seem ludicrous to many people. However, over time, they begin to make sense. Answering these steps can be a wonderful beginning to changing an unwanted behavior or situation. Talk your fears over with a trusted friend. Develop a plan for overcoming your “symptom”. Give yourself a timeframe for overcoming your “symptom” or achieving your goal. If after your most assiduous efforts, you are unable to take any of these steps, consider seeking psychotherapy from an experienced clinician. We know enough about psychodynamics and unconscious motivations that most symptoms can be understood and effectively addressed.

DEALING WITH JEALOUSY IN YOUR MARRIAGE



As Akash explains his marital relationship, there are tears brimming in his eyes. He looks down, unable to look the therapists in eye as he talks about why his marriage was not consummated even though they had been married for nearly 4 years now. They met at a wedding and he was instantly drawn towards Alka. Before the week ended he proposed to Alka through a common family friend. Alka and Akash met a couple of times before they committed to get married. As they courted, Akash sensed that Alka seemed disinterested in him and he asked her about her lack of enthusiasm, but she brushed it aside. They got married shortly and didn’t get much time to discuss this further in all the wedding preparations.
The wedding night Alka seemed to be very scared of sexual intercourse and Akash thinking that she will overcome it as time goes by, focused on making her feel comfortable in his joint family. Despite Alka’s efforts to be an ideal wife and Akash’s efforts to break the ice between the family members and Alka, she was unable to mingle with her family. Soon there began arguments which turned into huge fights between his mother and Alka. Initially he tried to explain to Alka that his mother used strong words to express her disappointments and that if she just let things be, it would help bridge gaps. But Alka was unable to digest this and started withdrawing and/ or getting righteous whenever she was criticized. Often they would end up in an argument wherein Alka felt that Akash was unable to stand up for himself and her. She complained of feeling unprotected in the family environment and they decided to move out on their own to maintain peace, sanity and intimacy in his marriage.
He got the desired benefits and they became closer to each other in their own house. Alka also started coming out of her shell and shared her feelings of how she thought that Akash was very naïve and not smart. He felt extremely hurt initially but also started matching up with her expectations of a husband. So he started learning dance, grooming himself well and even life coaching for his business. They now seemed to share some fun moments, however he was perpetually falling short of her expectations. He seemed to have gotten out of his mothers rows of criticism only to fall in love with a person who only could match his mother in being critical.
Soon he started feeling insecure and jealous of all his friends and cousins who seemed to evoke respect and / or interest of his wife. He found himself often in the periphery of their life events and withdrew further into his depression. He would often wonder with whom his wife talks to when he was at office. So he started giving ‘surprises’ to his wife when she least expected to check on her activities. On one such visit, he found his cousin cum business partner and wife in a compromising position. This is when he totally lost his faith and he started hurling abuses at her and at the same time criticizing himself. She unable to bear the abuse in a no – love marriage decided to move out into a rented apartment by herself. This made him even more insecure. He started begging and pleading at times in hope of getting her back and at other times he would shower her with violent abuses.
He blamed himself viciously for the break up of the marriage at times in his therapy and at other times he felt absolutely justified as she seemed to have evoked / instigated all this. It was now at a point wherein he did not know how mend their marriage. He was unable to forgive or forget her. He felt like an animal and was ashamed and scared as well as angry. Let us look at some of the theories to understand how and what this jealousy is and how one can overcome it.
Jealousy is a complex monster that develops from the melding of three other emotions – fear, anger and love. Romantic jealousy can be defined as “a perception of a threat of loss of a valued relationship to a real or imagined rival”. Jealousy in committed relationships is cultural and universal as a boundary-setting mechanism to protect certain relationships as important and exclusive. to protect the relationship of physical intimacy and self-disclosure from trespassers. In fact, all committed relationships, where physical and emotional intimacy exists (including purely sexual relationships), will be subjected to jealousy. Early attachment problems with significant others are known to profoundly affect feeling secure in future relationships, particularly the capacity to initiate and maintain loving relationships in adulthood. Given that attachment relates to anxiety regulation, support, and intimacy, it is not surprising that attachment also relates to jealousy.
According to the attachment theory of love, an adult becomes a secure lover, avoidant lover or an anxious-ambivalent lover in his or her romantic relationships based on the quality of his or her childhood parental relationship. Secure lovers are people who are comfortable with intimacy and have no problems with others feeling close to them. In contrast, avoidant lovers feel uneasy when close to another person. They have difficulty trusting or depending upon a partner. The third type, anxious-ambivalent lovers want to desperately get close to a partner, but often find that the partner does not reciprocate the feeling. This insecure relationship is often due to too much anxiety within the relationship stemming from the feeling that the partner does not really love them.
When “paranoia” or extreme distrust, arises in a relationship there are many factors which can be causing it. It is absolutely necessary to understand where these feelings are coming from, or else it is easy to act out in the relationship, blame the partner, put all kinds of unhealthy demands upon him, and even believe that he is cheating on you when he is not. Not only does this destroy his trust in himself and good feelings about himself, but he can easily grow to feel there is no way he can please you, or make you secure and happy.

When an individual gives into these feelings of paranoia, (or extreme fear, suspiciousness and jealousy,) and begins to create more and more restrictions upon the partner, or demand more and more information about what he is doing, this is often the beginning of the end.

Loving another person does not mean possessing them, or having them there simply to help you feel better about yourself. This does not take their needs into account. It is not loving or respectful of them, of who they are.

In all relationships each individual needs time alone, time with friends and of course time together. When we take away a person’s individuality and freedom to enjoy all aspects of their lives and grow, we are not behaving in a loving way. Sooner or later the individual begins to feel it, and can feel trapped, misunderstood and blamed falsely. Naturally, they then often think of ways of getting out of a relationship such as this.
Much like infidelity, distrust can leave an indelible mark on a relationship and challenge even the strongest of marriages. Depending on a variety of circumstances, such as whether or not distrust and dishonesty have become a constant in the relationship, couples can work through past hurts to become closer together if both are committed to making positive changes.

If one requires that their partner take away the pain they are feeling, they will be disappointed sooner or later. They are looking in the wrong direction. No matter how loving a person is, no matter how solid the relationship, they cannot take away pain and confusion that exists within oneself. We have to take responsibility for our feelings and work them through on our own. Psychotherapy is an insight oriented process and helps couples achieve this. Do not hesitate to take professional help of a psychotherapist if you find yourself going around in circles.
Handling insecurity and jealousy in a relationship can be difficult. However, change is possible once you understand their underlying causes. In order to overcome insecurity, people need to:

* Be willing to be put in vulnerable positions in life where they might get hurt.
* Take risks to change their current behavior.
* Trust others enough to expose themselves to them, risking vulnerability and the possibility of being hurt.
* Have a healthy and humorous belief in themselves in order to overlook their exaggerated need for acceptance and approval.
* Take a rational approach to each problem they face so that they are no longer inhibited by debilitating fears or beliefs.
* Practice assertive behavior in their lives, earning respect and the acknowledgment of their rights.
* Arouse the courage to take small steps in learning to experience success and overcoming their lack of belief in self. Once the success is experienced, they can build on it to gain the courage to act out of a strong conviction in their self-goodness and worth.
* Break the barrier or outer shell of the self-doubt they have hidden behind and reach out to others. Breaking out of their “shells” requires letting go of past hurts (real or imagined) and moving on with life.
* Open themselves to the possibility of success and accomplishment. Visualize or make a prophecy of winning at life so their energies are focused in a growth direction.
* Reward themselves for who they are and capitalize on their strengths, attributes, skills and competencies.

Answer the following questions to handle insecurity:
a. What behavior traits signal my insecurity?
b. What happened in my past to make me insecure?
c. What are some of my beliefs that account for my insecurity?
d. What are some negative consequences I’ve experienced due to my insecurity?
e. What behavior traits do I need to develop in order to overcome my insecurity?

Even in a loving and open relationship, it is normal to experience some paranoia or doubt. However, if you find yourself overwhelmed with distrust and suspicion, it’s time to confront your spouse. Whether he or she is guilty or not, it is important that you clear your conscience and put yourself at peace.
Confront your spouse but avoid making accusations at all costs. Your spouse will automatically react defensively, and if you are wrong, which you very well may be, you run the risk of making some painful and potentially permanent dents in your relationship. It is never a good idea to hurl unfounded accusations at your spouse. Instead, approach him or her with compassion and trust. Tell your spouse that you have been experiencing some worries in your relationship. Make sure and let your spouse know that you are approaching him or her out of love and a genuine concern for your relationship. It is extremely important that you do not attack them or judge them before finding out all of the facts. Specify what concerns you, keeping in mind not to accuse.
Accordingly, if your spouse is the one experiencing doubt, the most important thing to remember is that he or she is simply concerned out of love for you. Instead of immediately lashing out in defense, take time to consider what your spouse is saying and consider how it might make you feel if the situation were reversed. Instead of getting offended, be compassionate and empathetic. Your spouse will calm down when he or she sees that you have truly have nothing to hide. A defensive response, even if you are not guilty, makes you look as if you’re trying to divert attention from the issue at hand.
Doubt in a relationship has serious and obvious consequences, and you and your spouse must work together to eradicate these feelings and concerns. Jealousy is a very strong emotion and often a culprit in leading to marriage breakups. It helps if there are intense emotions and hurts to take help of a psychotherapist who can sit down with both of you to help each of you gain objective insights into your own thoughts, emotions and behaviours which are causing this drift in your marriage and help you both arrive at a solution.

EMOTIONS EXPERIENCED DURING DIVORCE



Question: I have been married for the past 26 years. We applied for divorce 3 months ago, after our younger daughter got married, a mere formality which was on our agenda for many years. Both of us are strong headed and disagreed on almost every thing from the beginning of our marriage. We lived our own separate lives cordially living under the same roof for the sake of our 2 daughters for the past 18 years. Although we are not best of friends we are neither bitter with each other. Socially, emotionally as well as financially I have been independent in my marriage and had been looking forward to the divorce. So when it finally when we filed I was very relieved. But off late I am finding myself on edge, irritable and depressed. I don’t see any reason for the same. My business is doing better than ever before and I have done all the things I have longed to do for so many years but couldn’t do. Last evening, I was at a close friends place to celebrate her promotion and I suddenly broke down into tears seeing how her entire family was there to celebrate with her. I experienced deep loneliness and sadness. I was really shocked about the way I felt. I don’t understand why the pain when I am so looking forward to the divorce. Please help.
Mrs Dixit
Answer: Divorce is not only ending a marriage technically but also of all the wishes of having a happy family and an eternal need of being connected deeply to someone special for ever. This loss exists at an emotional plane irrespective of whether you are logically justified in taking divorce or not. Along with this loss, come all other similar losses of the past thereby making it appear out of proportion. You are bound to feel lonely, depressed and angry as it is not only the loss of the marriage but a cumulative loss of your life time wish to be happily married ever, a companion with whom you have deep connection, of being loved unconditionally, the house that you’ve been living in, the social status of a married woman and the loss of your family after the marriage of your younger daughter that you are dealing with and may be many more losses of the childhood. It is natural to mourn all these losses and you need to give your self time to heal. Denying these emotions will only lead to further such unpredicted outbursts till you are ready to face them. Having someone, a close friend or family to listen to you will also help. If these persist for over a year and half, or they get worse do consider taking professional help.
Following article provides information on the emotions and its stages during divorce which generally people go through:
1. Grief and Sorrow
Being sad when a marriage ends is natural. Although it’s painful, grief is a healthy emotional response to the loss of an important relationship. We are hardwired to feel it, and it wouldn’t be reasonable to expect otherwise. While sorrow and grief can be very hard to handle, most people do understand and accept the inevitability of these feelings.
We know from research, theoretical writings, and personal experience with thousands of people going through divorces that though the emotional impact of a divorce is as severe as that of a death in the immediate family, the grief and recovery process does have a beginning, middle, and end. Though they may seem endless, the pain and confusion surrounding separation and divorce do gradually lighten and finally go away — for most people over a period of eighteen months to three or four years following the marital separation, though recovery can be quicker or slower.
• Denial: “This is not happening to me. It’s all a misunderstanding. It’s just a midlife crisis. We can work it out.”
• Anger and resentment: “How can he [she] do this to me? What did I ever do to deserve this? This is not fair!”
• Bargaining: “If you’ll stay, I’ll change” or “If I agree to do it [money, childrearing, sex, whatever] your way, can we get back together?”
• Depression: “This is really happening, I can’t do anything about it, and I don’t think I can bear it.”
• Acceptance: “Okay, this is how it is, and I’d rather accept it and move on than wallow in the past.”
Understanding these stages can be very helpful when it comes to talking about divorce and decision making. It’s important to know that when you are in the early stages of this grief and recovery process, it can be challenging to think clearly or to make decisions at all, much less to make them well. Identifying your present stage of grief and being aware of it is an important step toward ensuring that you will make the best choices you can.
2. Guilt and Shame
Experiencing guilt and shame is also a normal reaction to the end of a marriage. These feelings arise when we feel a sense of failure — of not having fulfilled our own or our community’s expectations. In the case of divorce, people often feel guilt and/or shame because they have failed to stay married for life. That’s partly a matter of personal expectations — not fulfilling the promises made to a spouse — and also partly a matter of not fulfilling what our culture seems to expect from us. If our culture’s expectations about marriage and divorce are reasonable — if they fit well with how people actually behave in that culture — and we don’t measure up, the guilt and shame felt at the time of divorce may be appropriate. If the culture’s expectations don’t match well with the reality of marriage and divorce as people actually live it, the guilt and shame can be much more problematic — difficult to see clearly, difficult to acknowledge, difficult to manage in a divorce. In addition, there are some marriages in which one or both partners have engaged in extremes of betrayal, deceit, or even criminal behavior that almost always involve feelings of guilt and shame.
Regardless of whether the feelings arise from not having met one’s own or the culture’s ideals or from actual wrongdoing, we know that for many individuals, guilt and shame can be so painful that they change very quickly into other, more tolerable feelings, such as anger or depression — often without the person’s even knowing that the guilt and shame are there. This is why it is so common in divorce for each partner to blame the other and why it can be so difficult for divorcing partners to accept responsibility for their own part in a failed marriage.
We’ve encountered few divorcing people who find it easy to see or accept their own feelings of guilt and shame. These powerfully negative feelings often remain under the radar, hidden and invisible, where they do the most harm. Strong feelings of guilt or shame can make it difficult or impossible to take in more balanced information, to maintain your perspective, and to consider realistically your best alternatives for how to resolve problems.
Guilt can cause spouses to feel they have no right to ask for what they need in a divorce, causing them to negotiate unbalanced, unrealistic settlements they later regret. Family lawyers have a saying that “guilt has a short half-life,” and because guilt is such an uncomfortable feeling, it can easily transform into anger. We often see people who have negotiated guilt-driven agreements having second thoughts and going back to court to try to set aside imprudent settlements.
Similarly, shame often transforms into blame, anger, or rage directed at the spouse. Bitter fights over children or property can be propelled by feelings like these, which needs to go somewhere, goes into fights over matters that courts are permitted to make orders about.
3. Fear and Anxiety
Fear and anxiety are common because of our hardwired “fight-or-flight” instinct. Our bodies react to stresses (such as an angry phone call from a spouse) by using physical alarm mechanisms that haven’t changed since our ancestors had to react instantly to avoid being eaten by saber-toothed tigers. You react to stress physiologically in the following ways:
Your heart speeds up, and adrenaline pours into your bloodstream Your adrenaline makes your heart contract more forcefully and may cause you to feel a pounding sensation in your head You may feel hot flashes of energy Your attention homes in on the event that triggered the strong feelings, limiting your ability to take in new information When people are under chronic and severe stress, they may have anxiety attacks, in which they tremble and their heart pounds. Or they may be paralyzed by almost overwhelming feelings of fear that seem to come out of nowhere. We work with many people who experience these feelings as their marriages end. People who feel overwhelmed or confused in this way tend to fall back upon old habits of thought and action rather than looking intelligently at the facts of their situation and weighing the best choices for the future.
4. Old Arguments Die Hard
As marriages become troubled, couples often rely on old habits of dealing with differences that lead to fights rather than solutions. If those old habits didn’t lead to constructive solutions during the marriage, they will surely yield no better results during the divorce. In addition, people feeling anxious and fearful may resist pressure to move forward and resolve divorce-related issues because of feeling unready, while their spouses may be impatient, seeing no reason why the divorce wasn’t over months ago. Bitter fights in the divorce courts often stem from differences such as these.
Unfortunately, both our court system and our culture at large encourage us to take action in divorces based on how we feel when we are at the bottom of the emotional roller coaster, when we are most gripped by anxiety, fear, grief, guilt, and shame. After all, that’s when most people are moved to make the first call to a divorce lawyer. As a result, people are encouraged to make shortsighted choices based on emotional reactions that do not take into account anyone’s long-term best interests. The resulting “bad divorces” harm everyone and serve no one well. They are very costly; they fail to plan intelligently for the future; and they inflict psychological scars on both the adults and the children. This can be avoided by consciously working on the divorce keeping ones personal prejudices away.

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.