Women and Depression

Depression is a severe condition characterised by a significant change in mood, pleasure and motivation regarding our usual activities. Researchers have highlighted that women and depression are particularly linked: women are from two to three times more at risk to developing a depressive disorder during adolescence and adult life then men.

This data highlights the importance of spreading information and knowledge of this problem and promoting access to effective treatments.

Why are women more at risk? 

Many factors seem to contribute in increasing this risk.

First of all, biology plays an important role: there is a huge hormonal difference between men and women.

Sexual hormones have a direct impact on our psychological life and in particular on our emotions and motivational systems. Women experience very different fluctuations of these hormones during their life; specifically there are three periods in women’s life that involve intense hormonal fluctuations (and therefore a higher risk): puberty, puerperium and menopause. Indeed in pre-puberty and post-menopause, the risk for depression seems to be equal between genders.

Another important role is played by cultural and social factors.

Different specific social factors have been identified as contributing to an increased risk, such as taking on multiple roles, being mother of two or more kids under 14, experiencing a lack of social support, having a poor relationship with the partner, retirement, having experienced bereavement during infancy and being a caregiver.

In particular, the caregiver role is culturally more linked to women than men; interestingly, it seems that in Scandinavian countries, where gender equality is more acknowledged, the incidence of depression in women is lower.

Risky moments in a woman’s life

As written above, puberty, puerperium and menopause involve deep hormonal fluctuations in women and at the same time significant changes in roles and identities. These changes might not be so easy for every woman to adapt to; some of them, because of personal and genetical predisposition, may experience some difficulties and stress in dealing with these changes, thus bringing an impact on an already particular biological substrate.

Specifically, puberty implies deep biological, physical and psychological changes, with the girl experiencing more and more autonomy and responsibilities for the first time. Furthermore, a specific kind of depression is linked to the menstrual cycle, called premenstrual dysphoric disorder.

Puerperium and the first year of motherhood are also very delicate moments in a woman’s life.
Indeed pregnancy can be associated with physical and psychological stress, and becoming a mother for some of them may bring not only joy and happiness but also feelings of loss of independence, extreme responsibilities and sometimes very high expectations about themselves.

In these instances, experiencing depressive symptoms is normal and transient (the so-called baby blues); but for about 10% of women these symptoms may turn into a postpartum depression. This kind of depression has a particular importance, as it might prevent the new mom to fully fulfil her new role and it might impact on the quality of the attachment bonding with the baby.

Menopause is also a very risky moment, in particular the pre-menopause period. This life moment is characterised by an irregular cycle, muscle and articular pains, sleep problems and endocrine changes. Furthermore, beyond these physical changes, menopause may be difficult to deal with because of its own personal meaning and other significant events may contribute in a negative way, as not having satisfactory working activities, friendships or relationships.

How to use this information

The recognition of the link among women and depression represents an important tool. Knowing that women have a higher risk of developing a depressive disorder and that there are defined moments in a woman’s life that specifically raise this risk, should allow us to keep an eye particularly open and to promptly react if depressive signs show up in order to receive appropriate treatment.

At the same time, if you have a previous history of depression and you are about to go through one of these delicate moments mentioned above, keeping both eyes open is important.

In either circumstance, depression can be faced and managed with an appropriate support. Depending on the symptom’s severity, psychotherapy and/or psychiatric support are highly recommended.

Communication

How many times have you found yourself asking: “Why is my boyfriend not getting that?” or “I said X and she understood Y. I don’t understand… I thought it was clear!”

Communication is a fundamental component of our social interactions; but no matter how important it is, it can be a source of misunderstandings and conflicts.

The art of communicating may seem so easy to learn but it can easily get tricky, especially when the content of the message implies feelings, emotions, fears and expectations about relationships. When emotions and delicate issues are involved, it is very easy to communicate in a not-so-efficient way and at the same time to misinterpret what the other person is telling us.

Why does this happen? 

First of all it is important to distinguish between two elements of communication that are always involved in each piece of information we share: non-verbal and verbal communication.

Verbal communication refers to the content of the message that is shared through language while non-verbal communication refers to the information delivered through our body (e.g. the distance from our interlocutor, our body language, etc.) and our paralinguistic (e.g. the tone of our voice, volume, speed, etc.).

Those two elements aren’t always on the same page: many times the two elements are discordant.

I guess that being mad at someone but not wanting to share it with that person happens to everyone; it is very likely that even if the content of our communication was not “aggressive”, our body and our tone of voice were signalling this anger and the other person very likely recognised it.

Scientists showed indeed that the majority of the information is delivered through non-verbal signals and only a very small percentage through verbal ones. This means that when we interpret a message we give much more importance to how the person is delivering it then to the effective verbal content.

Furthermore, communicating emotion-related information in an ambiguous and vague way (e.g. omitting information) may represent another source of misunderstandings. In front of a vague but important communication or when a potential threat is perceived, it is very easy to interpret the message applying our own personal meanings and symbols, especially when we experience intense emotional states. This means that we may apply our own interpretations based on our personal history, on our deepest fears or on our personal beliefs. In these instances the risk of misinterpreting or distorting information is right behind the corner, as well as the risk of consequently behaving in a defensive way, either attacking the interlocutor or maybe leaving the conversation. In each case these reactions worsen the communication process.

Very often many problems in relationships and in couples are triggered by distortions in communication (expressing information or either interpreting it) and in many cases just a few expedients could help preventing misunderstandings.

Either you feel like having often troubles expressing yourself or interpreting what your partner is telling you, don’t worry because communication is an art that can be learnt and improved.

Psychotherapy can help you with this issue, making you learn and experience an assertive style of communication, recognise what are the automatic personal interpretations that you tend to apply and learn how to better manage them.

Thought and Obsession

An Obsession can be defined as a frequent, intrusive and distressful thought.

Our mind and our thoughts are not always under our complete rational control, even if we would like them to be. We can’t always decide rationally which thoughts or images are allowed to come to our mind. Indeed we produce constantly a very large number of thoughts, some of them pertinent to our lives, work, relationships, etc. and some of them not pertinent, sometimes even weird, which can pop up in our mind even when we are focused on something else. It happened to all of us, while working or studying, to start thinking about something else without being totally aware of it (e.g. the grocery list, weekend activities, etc. etc.).

Sometimes the thoughts that pop up may be “weird”; this means that sometimes we can make thoughts that are definitely not congruent and maybe opposite to what we normally think or how we usually behave.

It can happen for example to have an aggressive thought, or a pervert or a deeply heretic one, maybe a homosexual thought if we are straight (or vice versa), or to think something really bad about a person that we love or that something really bad could happen… The potential list is very long, but the main feature is that these thoughts imply a scenario that is deeply feared by the person.

Usually since these thoughts are so far away from our beliefs and lifestyle, we don’t give too much importance to them and they tend to spontaneously disappear. But for some of us these thoughts cause intense anxiety and distress, they tend to pop up with a much higher frequency and they don’t disappear as fast as it happens for other people.

The anxiety caused by these thoughts is so intense that it interferes with the person’s daily functioning and he/she, in the attempt to find relief, may try to suppress them, to create rituals that can help to calm them down, to ask for reassurances or to avoid situations or people related to the thought. Also the list of rituals is potentially very long.

What is happening? And why?

If you recognise yourself or a person close to you in the dynamics explained above, it may be possible that you have developed an obsessive compulsive disorder (OCD).

OCD is a serious and subtle disorder that tends not be recognised in the first place, as the person is often very ashamed of having these bad thoughts. In the long-term, OCD may make the person feel like a slave, controlled and dominated by obsessions and compulsions. If you think that this is your case, then consulting a specialist is highly recommended.

People with OCD, compared to others, tend to be very emotionally shaken by the bad thoughts described above, because these thoughts are totally incompatible with their core personal beliefs and the chance of these thoughts becoming “reality” is therefore to be avoided in every possible instance.
If however we can’t control which thoughts pop up in our mind, we can work on our attitude towards them and our consequent behaviours.

Cognitive behavioural psychotherapy is the form of therapy highly recommended to treat this disorder by the National Institute for Health and Care Excellence.

Our mind often plays bad tricks on our discerning and rational abilities, without us being aware of what is happening.

Cognitive biases are a form of cognitive ‘errors’ or shortcuts leading us to evaluate situations, events or people in a distorted and almost irrational way in a very short period of time.

To read my entire article published on Counselling Directory, click here.

Sadness or depression?

Nowadays the word ‘depression’ has been so fully absorbed into our daily language that it is often incorrectly used to describe normal sadness.

Sometimes it may occur that intense sadness makes us wonder whether it is a normal and transitory feeling or there is more about what is perceived as sorrow, such as real depression. In this instance, it is important to be aware of it and in case the boundary is crossed, seek appropriate help as depression is an actual disease which should be dealt with as soon as possible.

Let’s have a look then at the differences between sadness and depression.

The differences between sadness and depression

Sadness is an emotion that we often experience in our everyday life and that is usually categorised as a ‘negative’ and ‘unwanted’ feeling. Sadness is generally caused by missing out on our aims or goals which seem no longer achievable. Depending on how important the goal is and its specific meaning to us, we may experience a more or less intense feeling of sadness. For example, the intensity of the sense of sadness will be very different if applied to an unsuccessful application for a temporary and maybe not-so-wanted job as opposed to the instance of not getting our dream-life position.

Usually sadness is linked to specific events or thoughts, is time-limited and doesn’t prevent us from experiencing positive feelings if happy and joyous events occur. Furthermore, it doesn’t have a significant influence on our biological rhythms and daily functioning.

On the contrary, depression brings consistent and identifiable changes and symptoms in our habits and lasts for longer. First of all, a wake-up call related to a depressive episode occurs if the symptoms and low mood persist for at least a period of two weeks, in which they manifest most of the time and most of the days.

The core symptoms are severely low mood and lack of interest in the activities that used to stir up a positive response within ourselves, such as a sense of interest and engagement. When depressed, we are no longer interested in and motivated to undertake activities or hobbies as they no longer bring us any sense of pleasure. We may also feel like we have no energy for them at all. We may not care at all about going out, hanging out with friends, spending time with our partner (engaging in sexual activity as well), going to work, playing our favourite sport, etc. It may even occur that we neglect self-caring tasks. Low mood and a lack of interest will make us perceive the world as emotionally dull and grey, as though colours no longer exist.

As mentioned above, depression brings changes in our biological rhythms as well.

Different types of change in sleep habits, appetite and motor activity are reported. As a matter of fact, sleep problems or a tendency to sleep in can be observed as well as significantly increased or reduced appetite (and therefore weight gain or weight loss) and retardation or agitation related to motor activity.
Cognitively speaking, we may suffer from concentration problems, have trouble making decisions and often feel guilty, unworthy and hopeless about the future. In particular, the future may be perceived as an infinite extension of a worthless today. Several cognitive biases tend to maintain this hopelessness-related point of view.

As you can see, depression manifests in different ways with different symptoms, but the common denominator is a significant change in the functioning of the person, intense, strong and long-lasting symptoms and a significant impact on everyday life.

What to do

If you have the feeling that your low mood may not be linked to momentary sadness, keep an eye on it and if you recognise yourself in the aforementioned symptoms, consult a specialist. A psychotherapist, and in mild or severe cases a psychiatrist, can help you understand and tackle the issue.

Health anxiety

Health anxiety is very often underestimated. Let’s see what happens in the mind of an hypochondriac.

A little tingling in our cheek, an anomalous heart beat, maybe slightly faster then usual, a pain in our back that doesn’t seem to leave, a particular ache in a muscle… and in a blink of an eye we are immediately alerted, fully focused on our bodily signals scanning any potential change.

So many worries come to our mind: what is this? Am I having a heart attack? Is this cancer? Or maybe an aneurysm? All raised by a tremendous amount of anxiety.

If it happened to you, how would you behave?

It would be quite normal to gather information from books or the Internet about signs and symptoms of the disease you think you may have and very probably you will urgently book an appointment with your GP asking him/her to run several medical tests.

But what happens to some of us is that books and the Internet will provide much information and many negative scenarios that will scare us even more, and very likely we may focus only on the information that confirm our worries. Moreover, even if test results will show that nothing is wrong with our body, we will feel reassured only for a short period of time, until the next strange body signal appears, which will prompt us to request other specialist exams. And so on…

What is happening?

What was once a normal and understandable way to react to possible abnormal symptoms has become a pervasive and exaggerated way of dealing with our body, which creates intense distress in the person experiencing it and hence several negative consequences and limitations to their everyday life.

This is the so-called hypochondria or health anxiety, a distressful condition where a person’s beliefs and worries are often considered by others as imaginary or fake, making the person feel even more misunderstood and lonely.

On the contrary, health anxiety is a real problem, the person’s symptoms are real and the worries are extremely distressful.

Health anxiety treatment

The good news is that health anxiety can be treated and cognitive behavioural psychotherapy is the most recommended form of therapy in these instances. CBT can indeed help you in acknowledging and changing the cognitive misinterpretations that maintain the problem and in finding new coping mechanisms to better deal with anxiety.

Anxiety

We all agree that being anxious and suffering from anxiety is something that we would rather avoid in the first place.

Anxiety is an annoying condition and if its intensity raises, its symptoms may scare the person and bring forth the sensation of not being in control of our body reactions. Experiencing very intense anxiety symptoms in our body may be so terrifying that for many people it may become itself an experience to be very scared of.

In these instances we are talking about what is so called “fear of fear” itself. Fear of fear can bring more intense consequences than anxiety itself, leading the person to avoid any possible situation where they may feel the unwanted anxiety symptoms.

Fear of fear is a very powerful and delicate mechanism that in most cases maintains and/or worsens the initial situation.

The first step to overcome fear of fear is getting to know the enemy.

Let’s try to understand together what is happening to our body when we are so anxious and why.

Understanding the symptoms of anxiety

The first thing that is important to know is that anxiety is an emotion that in our evolutionary history derives from the most primitive emotion of fear, but it has appeared in the history of the human being only after the development of our superior cortical functions. Anxiety is indeed linked to the complex ability of our brain to make long-term plans and assumptions about what could possibly happen in the future; on the contrary fear is a more primitive and archaic instinctive that implies an immediate reaction to a threat in the “here-and-now”.

Secondly, anxiety, like fear, is related to the perception of a threat, and it activates the same brain pathways that are activated by its fellow emotion of fear. In both situations, the automatic reaction that is induced in our body is the fight-or-flight response: our body prepares itself to fight the threat or to run away to ensure survival.

Each symptom that is experienced when we are anxious can indeed be explained and understood in the fight-or-flight perspective.

Let’s see the most commons symptoms that we experience when we are anxious and their physiological explanations:

• Muscle tension: usually we feel our muscles contracted and rigid; if the anxious condition becomes prolonged in time, we may even feel some sort of pain. This happens because our body is preparing itself to fight the threat or to run away; as a consequence our muscles are in tension and ready to react immediately if it is necessary.
• Tachycardia or heart palpitations: our heart rate tends to increase so that our heart may pump more blood to our muscles and send more oxygen. This helps our muscles to be better prepared to react to the danger.
• Tingling or torpidity in our body’s extremities: we may feel tingling in our hands or feet. This happens because the majority of our blood flow becomes concentrated in our main muscles (for the reasons explained above) and not in the extremities. As a consequence this may be experienced as tingles, torpidity or cold hands and feet.
• Difficulty breathing: we may experience the sensation of having trouble breathing. This happens because the contraction of our muscles may counteract the expansion of our lungs.
• Air hunger: we may have the feeling of needing air. Very often during anxiety we experience hyperventilation; this means that we increase the number of breaths per minute but the quality our breathing worsens, as we tend to breath using only the higher parts of our lungs (thoracic breathing) and not our diaphragm. Hyperventilation introduces too much oxygen in our body, and the consequence is a worsening of the intensity of anxiety symptoms.
• Goose bumps: muscle contraction involves as well the skin, causing goose bumps.
• Stomach ache: very often we may experience stomach ache, as if someone punched us in our stomach, nausea or gastrointestinal problems. This happens because when the fight-or-flight response is activated, all the energy of our body is suddenly concentrated in facing the danger and digestion is interrupted, as it consumes a lot of energy that needs to be used to deal with the threat.
• Blurred vision: we may have the feeling that our vision is blurred during intense anxiety episodes. What happens is that pupils dilate in order to let more light come in the eye and have a better sight of the danger. Our eyes focus better on details and peripheral vision worsens, giving us the feeling of blurred vision.
• Dizziness and giddiness: we may experience those symptoms as a consequence of hyperventilation. As written above, hyperventilation brings more oxygen in our body. The consequence is the vaso constrictions of some brain blood vessels, so even if more oxygen is introduced in our body, our brain receives less of it and the consequence may be dizziness.

These are the most common symptoms that we may experience when we are anxious. As you can read, each of them has a specific physiological explanation related to the physiological reactions caused by the perception of a threat.

Taking care of your emotional states is a very important way of taking care of yourself.

Anxiety treatment

If you suffer from a serious anxiety condition, gathering information about what is going on is the first step but it doesn’t substitute specialist help. Psychotherapy and counselling can help you in better handling anxiety symptoms, dealing with hyperventilation and facing the perceived threats that foster your anxiety.

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder, affecting around 11% of the general population, that tends to be chronic and is certainly bothersome. Even if usually no inflammation or tissues alteration is present, IBS may be a very disturbing and distressing condition, that significantly worsens a person’s quality.

Irritable Bowel Symptoms

People suffering from IBS may experience a great variety of symptoms:

• abdominal pain: its intensity is usually mild and not severe, it may follow food ingestion and stop after evacuation
• cramping and/or bloating
• constipation or diarrhea
• gas and/or mucus.

The risk factors of IBS are: being woman, being under 45, having a familiar history of IBS and having a mental health problem.

The causes of IBS are still unknown, but it is very likely that several concomitant factors may play a role.

Furthermore, stress seems to have an impact in worsening the syndrome. In particular, the stress condition caused by suffering from IBS may itself create a vicious cycle, fostering IBS symptoms and consequently creating more anxiety. Moreover, it seems that up to 70-90% of people suffering from IBS may experience psychological difficulties, more likely mood or anxiety disorders.

What is neuroscience telling us?

The tight relationship between our brain and our bowel is not a novelty, but in the last decade neuroscience has given us amazingly interesting new information about it.

It seems that our brain and our guts are in constant communication, both influencing each other through top-down and bottom-up processes. But we are not talking only about digestion-related information: our guts have been defined by scientist M. Gershon like a real “second brain”.

Our “second brain” contains indeed around 100 millions of neurons that are responsible for digestion but also for making us experience the so called “gut feelings”, such as “butterflies” in the stomach. Furthermore, it seems that those feelings can have an influence on our mental states even if no conscious thought or decision-making can be undertaken by our second brain. In particular it seems that some specific macrobiota in our guts may impact the functions of our central nervous system; in mice, an impact on anxiety and stress-related behaviours has been found.

Can psychotherapy help?

If you suffer from IBS and you believe you are suffering from anxiety and stress, you may consider taking care of this to avoid a worsening of your IBS.

Research has showed high comorbidities of anxiety and mood disorders in IBS patients, the problematic vicious cycle that anxiety may create and the consequent risk of perceiving a poor quality of life.

Psychotherapy may help you with the aforementioned psychological issues, as our mind and our bowel are so deeply interconnected.

Furthermore, research has showed promising results on the efficacy of psychotherapy, in particular cognitive behavioural therapy and therapies involving relaxation techniques, in improving IBS symptoms, anxiety and the patient’s quality of life.

Suggested links

Irritable Bowel Syndrom Network UK

Bibliography

Al-Asmakh, M; Anuar; Zadjali, F; Rafter, J;  Pettersson, S. “Gut microbial communities modulating brain development and function”. Gut Microbes 2012 Jul-Aug;3(4):366-73. Epub 2012 Jun 29.
Blanchard, E; Lackner, JM; Sanders, K; Krasner, S; Keefer, L; Payne, A; Gudleski, GD; Katz, L; Rowell, D; Sykes, M; Kuhn, E;  Gusmano, R; Carosella, AM; Firth, R;  Dulgar-Tulloch, L. “A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome”. Behavioural Research and Therapy, April 2007, vol 45(4):663-648.
Garakani, A; Win, T; Virk, S; Gupta, S; Kaplan, D; Masand, PS. “Comorbidity of Irritable Bowel Syndrome in Psychiatric Patients: A Review”. Am J Ther. 2003 Jan-Feb;10(1):61-7.
Kuo, B; Bhasin, M; Jacquart, J; Scult, MA; Slipp, L; Riklin, El, Lepoutre, V; Comosa, N; Norton, BA; Dassatti, A; Rosenblum, J; Thurler, AH; Surjanhata, BC; Hasheminejad, NN; Kagan, L; Slawsby, E; Rao, SR; Mackin, EA; Fricchione, GL; Benson, H, Libermann, TA; Korzenik, J; Denninger, JW. “Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease” PLoS One. 2015 Apr 30;10(4):e0123861. doi: 10.1371/journal.pone.0123861. eCollection 2015.

Working mothers

Being working mothers of toddlers is a fulfilling and challenging experience that no one really prepares us to face. Everything is on the move: every day the child grows up a little bit more, discovers new things, new behaviours and its personality is being shaped. This usually makes us want to spend as much time as we can watching them growing up, playing with them, discovering the world with them and enjoying everyday moments.

But after our maternity leave, work calls us back to real life and this can become tricky. Often young families live far from their relatives and taking up a part-time position is not always possible. Very often the only solutions are kindergartens or qualified nannies, and for new mums it can be quite hard to leave their toddlers with strangers for a whole day. As a matter of fact, this may set off a feeling of intense guilt, possibly making the moment of separation very distressful for both the mum and as a consequence the child. In fact, if our child realises the mother’s distress during the moment of separation, he may think that there is something wrong and probably something to be worried about.

What is guilt?

Guilt is a complex social emotion, that implies different cognitive evaluations. To experience guilt indeed it is necessary that at least two people are represented in one’s own mind. In particular, the person who feels guilty believes he may have potentially damaged or harmed another person (voluntarily or not) or have transgressed a moral or a social principle. As a consequence of guilt, the “guilty” person usually tries to restore a sort of balance with the “harmed” one, helping out the person or finding a way to expiate this unpleasant emotion.

Why would mums feel guilty?

As written above, very often it occurs that new mums experience maternity far away from their country of origin and without the support of the original and the extended family. In addition, the most common scenario is mums that work full-time, while simultaneously take care of housework, their partner and their baby. In summary, multitasking is not a choice but a duty! We have to cover so many roles in our daily life and we try to do it in a good way: we want to work well for ourselves/our boss/colleagues or clients, we want to be good partners and for sure we want to be the best mothers for our children. But while in the best case scenario we may be confident about our work and our relationship with our partner, being a new mum is for many a totally new experience that may lead to many doubts and thoughts.

Usually the most common thoughts of new mothers are: am I doing the right thing? Am I interpreting the signals that my baby is sending me in the right way? Is he/she OK in the kindergarten? Is it normal if he/she cries at separation? Am I a bad mother if I leave him/her there all day long? Will there be consequences if I don’t spend enough time with my baby?

The direct consequence of those questions is obviously a strong sense of guilt. You may feel guilty at work because you left your kid at the kindergarten or you may even feel guilty towards your job if you spend a day at home with child because maybe he/she is sick…

Anyway, experiencing a bit of guilt is normal as we have so many roles and responsibilities, we try to do our best to multitask and doing everything in a perfect way is really difficult. Making mistakes is normal as well! When motherhood is a brand new experience, the only way to go forward is to put ourselves on the line and just try, make mistakes and learn from them.

But if you have the feeling that guilt is becoming overwhelming, it is generating too much anxiety, it is difficult to handle or it is affecting in a bad way the relationship with your child, then take a step back and try to think about what is happening.

Many times beyond a sense of intense guilt there is a strong sense of responsibility, an excessive perfectionism or fear of committing mistakes. Furthermore, often our own personal experiences as children may play a role as well, triggering old emotions and relational memories that may influence our attitude towards our child. And this influence may not be always positive.

If this happens, considering seeking the help of a psychotherapist may be a good choice, as it could help you deal with this sense of guilt and the aforementioned dynamics, as well better handling that special and unique relationship with your child.

Bereavement

Bereavement is an extremely touching experience, difficult to articulate in words. The normal reaction to losing a beloved person implies a mix of feelings that can vary from deep sadness to guilt, anger or emptiness. Usually the person experiences the tendency of spending some time by himself/herself in order to cry for the loss, remember the memories, realise what has happened and “adjust” his/her life with the absence of the departed one.

The five stages of grief

Even if psychologists support the theory of the Five Stages of Grief theorised by Elizabeth Kubler Ross, everyone has its own specific pattern of reaction. Usually we need a variable amount of time in order to cope with a loss and it is proportional to the intimate meaning and role that the departed person represented to us.

Often, the very first reaction to some shocking sad news is denial. Many times people remember that their first thoughts were: Are you serious? What are you talking about? That is not possible! Denial is a primitive and protective reaction and it can manifest in different forms: for someone denial can last only few minutes, for others it can last few hours or even days; the person can feel shocked, stunned, turned upside down without realising what is going on and without feeling the relative emotions yet. Denial can then be followed by anger: Why is this happening to me? Why him/her? It is not fair! Why did he/she leave? Anger is a protective reaction as well; our anger can be addressed to different objects or persons, even the beloved one.

After anger, the person usually enters the bargaining stage, when he/she starts to look for explanations and faults about what happened. The universal and most known stage is then the depressive one, when sadness and regrets are dominant. On the contrary, the last stage is characterised by acceptance: realising and accepting the death of the loved person is the first step to go back to reality.

Not everybody is able to reach the acceptance stage: it can happen, for many different reasons, that a person gets stuck in one of the previous stages and needs a little help to elaborate the loss.

What to do

If we have trouble in elaborating bereavement, time is not healing our wounds and we have the feeling of being trapped by intense and sometimes contradictory emotions, psychotherapy can be a useful tool to get past this.

This is for example what happened to one of my first patients and how therapy worked for her.

Maria’s experience

She was a lovely and smart lady over 80 years old, who I will call Maria here; she lost her husband a few years earlier and she was stuck in the depressive stage. Actually Maria didn’t just lose her husband, she had lost her unique, special and long-lasting love after 60 years of marriage, the person she totally relied on for almost all of her life. And she was not able even to think about her life without this precious man by her side. Maria was very depressed and felt lost; no antidepressant was helping her so she decided to start psychotherapy.

Psychotherapy supported her while going through almost all the stages of loss. Indeed she was not alone while she was crying all her tears, expressing all her anger towards her condition and her dead husband who left her alone, while passing through guilt and every regret and remorse. In the end psychotherapy helped her searching and strengthening her personal dispositions that could help her in coping with that difficult period. Little by little, Maria started reorganising her life, finding new ways, new goals and new meanings. After two years of therapy, Maria decided that it was time to end psychotherapy: she realised that she will always be missing her husband, that she could never forget him, but that she could focus on her nephews, her family and friends to feel better. And in that moment she felt that she could do it by herself.

This is a good example of how a psychotherapist can indeed help you express and understand your feelings, realise what is keeping you stuck in a particular stage of grief and prevent you from coping with your loss.