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High-functioning depression: Signs and self-care tips

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No part of this website, including the blog content may be copied, duplicated or reproduced in any manner without the author’s permission.

 

Any information, materials, and opinions on this blog do not constitute therapy or professional advice. If you need professional help, please contact a qualified mental health practitioner.

High-functioning depression: Signs and self-care tips

Are we a generation that is riddled with high-functioning depression; is depression endemic? I pose this question to start with, as it helps us interrogate what high-functioning depression is and investigate the impact it has on our 21st-century generation.

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We live in a fast-paced, capitalist world; everyone is in a rat race, chasing the next best thing, and striving. Resultantly, stress and burnout are rife, yet normalised, it’s a part of everyday life. We seldom pause and check in with ourselves, or our loved ones. There’s a warped notion that if one is getting up each day, keeps a job and earns a salary, they’re fine.

What we do not understand, is that some people are struggling internally and living with high-functioning depression, which is debilitating in many ways. Sadly, it often takes a person having a complete mental breakdown and psychic collapse for them, and the people around them, to have an appreciation of how work-related stress can lead to serious mental health problems – acute or chronic.

In my role as a therapist, I have encountered many people who come to therapy with chronic and debilitating mental health problems; the most common one is high-functioning depression. What is bothersome, is that some of these people are not even cognisant of their suffering from depression.


What is high-functioning depression?

High-functioning depression, also known as dysthymia, is a form of depression where the person experiences all the symptoms of depression, but they are typically milder. The symptoms tend to be chronic, low grade and don’t necessarily impair day-to-day functioning. As a result, people with high-functioning depression can carry on with their life as usual, and present as if all is well externally. At times, the sufferer may not even recognise that they have depression, albeit high-functioning, and so this is also easily missed by family, friends and health professionals.

People with high-functioning depression tend to struggle internally and, in many situations, present quite differently outwardly. For example, if they are aware of the low mood or what is often described as “being constantly in a funk”, they may mask their symptoms or become highly performative to disguise the depression. Therefore, it is easy for symptoms to be excused as one’s personality, or as dismissed as one being “moody”.

What are the symptoms of high-functioning depression?

Like frank depression, people with high-functioning depression experience:

  • chronic low mood
  • difficulties concentrating
  • brain fogginess
  • hopelessness and pessimism
  • sleep disturbances – lack of sleep, broken sleep, or sleeping too much
  • low energy levels and lethargy
  • low self-esteem and self-regard
  • poor appetite or increased appetite
  • mood swings (anger, guilt, frustration, sadness) and tearfulness
  • apathy – lack of interest and motivation
  • general sense of overwhelm and acopia
  • low libido

Risk of comorbidities

People with high-functioning depression are at a much higher risk of using narcotic drugs and alcohol as a form of self-medicating, to numb and/or elevate the low mood. This can create a vicious cycle, detrimental to a person’s mental health since alcohol is a depressant and narcotics are stimulants (exacerbating symptoms).

This is common and problematic in corporate environments, where there is a culture of drinking after work and social events where there is access to alcohol and narcotics. It’s not unusual for people who have depression to end up developing alcohol and substance misuse, which feeds into the depression, creating a vicious cycle.

Toxic work environments and high-functioning depression

Many companies are beginning to develop systems to promote mental well-being in the work environment, and there is a drive towards normalising mental health while reducing the stigma around mental illness. Employee Assistance Programmes (EAPs) are also drawn in to provide short-term therapy and support to employees who may be struggling with their mental health.

However, I believe that the main objective is often to get the employees back into work as quickly as possible and minimise loss. The reality of these high-pressured environments where performance is constantly monitored, is that employees are at a much higher risk of developing and living with high-functioning depression.

The work pressures lead to chronic stress, which easily turns to burnout. This can provoke secondary mental health problems, such as anxiety and depression, which can become chronic and low-grade high-functioning depression. Individuals in these environments are less likely to pay attention to their mental health, as their focus is on their work.

If they are less productive, they risk being engineered out, and being put on Performance Improvement Plans (PIP). Bumper bonuses and commissions also reinforce the culture of pushing one beyond capacity, risking their mental health. These environments tend to be highly competitive, and poor performance is associated with incompetence, which creates additional issues around one’s self-esteem and self-image. There is very little empathy for each other and it can be cutthroat.

The toxic cultures in these environments result in some people being pushed to their limits mentally; they continue working while experiencing depressive symptoms. Not attending to these symptoms is what turns into high-functioning depression, where a person is functioning but struggles internally. The stigma around mental health also acts as a barrier for these individuals to access help. Taking time off for mental health can be seen as a sign of weakness or failure.

Suicide and high-functioning depression

Social media and the digital world have given us access to news from different parts of the world. It’s not unusual to read about people who lost their loved ones to suicide, where the individual’s struggles went unnoticed by those around them. Many stories that continue to shock the world are those of celebrities and entertainers reported to have died by suicide: Robin Williams, John McAfee, Alexander McQueen, Stephen “tWitch” Boss, and Kurt Cobain, to mention but a few.

How is it possible that these people, who seem to be coping well with life in the public eye, entertaining others, end their lives? I believe this indicates that they may be struggling internally, and experiencing high-functioning depression, seemingly coping on the outside. Living with this contradiction between the internal and external world can be a real struggle as one lives in duality. Ending one’s life ends up being the solution, albeit a painful one for those left behind.

Many studies have confirmed a correlation between depression and suicide. The World Health Organization (WHO) estimates that 90% of all suicide victims have some kind of mental health condition, depression being primary. People with depression are more likely to end their lives by suicide than any other illness. This is not to exclude anxiety, which often co-exists with depression.


Self-care tips

Identifying symptoms of high-functioning depression is key. If you suspect that you have high-function depression, there are some ways to manage your mental health:

  • Have a routine and give yourself time to rest and a regular sleep pattern.
  • Exercise, making time for physical activity and mastery activities – endorphins and dopamine are natural sources of the feel-good boost!
  • Engage in hobbies and do things that give you pleasure and meaning.
  • Maintain a healthy diet and hydrate your body – a healthy body is a healthy mind.
  • Have time out from gadgets and social media to allow your body and mind to reset.
  • Spend time in nature to regulate your nervous system and reconnect with yourself.
  • Learn to create boundaries if going out means drinking and using narcotics.
  • Keep in touch with family, friends and people who drive you.
  • Surround yourself with people who challenge you and inspire you.
  • Learn to challenge negative thoughts and adopt a positive mindset.
  • Practice mindfulness and self-compassion – treat yourself like you would treat your best friend.
  • Journal if you are finding it difficult to process emotions and thoughts.
  • If your workload is overwhelming, discuss ways you can make it manageable.
  • Cultivate positive relationships with your managers and bosses.
  • If you feel that your mental health is deteriorating, or you have depression, take some time out of work to give yourself time to recover – don’t wait until your body does it for you. Remember, if you were to break down, your bosses will arrange for a replacement. Whereas you will only have yourself to restore yourself to health.
  • Speak to your GP or a mental health practitioner and find mental health support networks.
  • Re-evaluate your values, and ask yourself whether your job aligns with your values.
  • Seek therapy to work on your mental health. Therapy gives you the space to process, explore, reflect, and learn about yourself and whether you are simply living or thriving.
  • Remember taking antidepressants or going to therapy is not a sign of weakness, but rather a strength.

Could l be experiencing high-functioning depression?

People who are experiencing high-functioning depression are not always cognisant of it. In many cases, it takes one small thing to tip them over the edge, and for them to notice how poor their mental health is. When this happens, suicidal ideation emerges; due to the untreated depression. If you think you may be experiencing high-functioning depression, it’s important to seek help in a timely manner and galvanise additional support around you.

High-functioning depression is normal, but it is not a life sentence. With the right treatment, people with high-functioning depression can recover, and continue living their lives normally, feeling more wholesomely.

If you suspect that your loved one is experiencing high-functioning depression – you notice some of the symptoms identified above – it’s important to try to engage them and encourage them to seek professional help. Therapy is key in the treatment of depression – some people end up taking antidepressants, adjunct to therapy. I always remind others that taking antidepressants or going to therapy is not a sign of weakness, quite the opposite, a strength.

It’s more painful to watch a loved one struggle or die by suicide without doing anything about it than to reach out and have honest conversations. You may very well be the only person who has reached out.

It’s hugely significant that we keep re-evaluating our attitudes towards mental health and be open to our experiences being unique to ourselves and different to others. Instead of being quick to judge other people – changes in behaviour or temperament – let’s be open to it being a result of poor mental health. Compassion for each other will always take us a long way.

Counselling Directory is not responsible for the articles published by members. The views expressed are those of the member who wrote the article.

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London SE1 & Milton Keynes MK15
Written by Dr Joyline Gozho, Adult Psychotherapist (Individual & Couples) FPC, UKCP, NCPS

Dr Joyline Gozho is an Adult Psychotherapist, Relationship Therapist, and Lecturer on a Psychotherapy course. She works with both individual and couples in private practice. She also runs relationship enrichment workshops with a particular focus on communication and emotional literacy.

Main Image Credit to lasse bergqvist – Unsplash
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How to navigate toxic family relationships

COPYRIGHT CITY SANCTUARY THERAPY

No part of this website, including the blog content may be copied, duplicated or reproduced in any manner without the author’s permission.

Any information, materials, and opinions on this blog do not constitute therapy or professional advice. If you need professional help, please contact a qualified mental health practitioner.

How to navigate toxic family relationships

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Family relationships are supposed to be anchoring, a source of nurturance, care, love, and support, where there is respect and acceptance of each other as unique individuals. Healthy familial relationships are made up of individuals who can communicate openly with each other, respect each other’s opinions, and have boundaries that are mutually respected.

Sadly, some people do not have the blessing of healthy family relationships, and they go through life dealing with toxic relationships with family members. The contradiction is that the relationships which bring them the most pain are the ones that should bring them joy. This is indeed a painful place to be, one that also leads many people into therapy, to address and work through.

There is a need to manage the relationships in a tactful and consistent manner to minimise the distress that is created. Some family dysfunctions run through generations, which is a result of unresolved relational traumas from the previous generations. Therapy is a way of addressing, and healing from that generational trauma.

It is very easy for one to feel isolated and question their reality, due to the constant gaslighting when dealing with family members who are toxic and where there is dysfunction. By ‘toxic’, l mean people who violate other’s personal boundaries whether it’s by disrespectful behaviours, controlling behaviours, gossip, lies, manipulation, blaming, envy, and jealousy.

The conflict, toxicity, discord, dysfunction, and negativity, whether it’s a single event or ongoing, can lead to some family members distancing themselves, and estrangement. Often there is stigma and negative stereotypical attitudes towards the individual who is estranged, and a failure to understand their position and the underlying dynamics at play.

Distancing oneself from negative family relationships and dynamics is indeed a form of self-care and a way of creating boundaries and safety for oneself. Many people hold on to toxic family relationships that cause them pain because of poor self-esteem and an inability to self-validate – the lack of conviction that they can survive in life without these negative relationships.


Group mentality (basic assumptions) and family dynamics

A family is made up of a group of people, albeit a complex one. Familial relationships are shaped by unconscious dynamics, just like any other group where people are brought together for a common purpose.

Sibling rivalry is one of the common features in families where there is underlying dysfunction. There are often two siblings, at times more, who get into conflict and play this out within the family. While the “drama” is acted out by the siblings, the dysfunction often lies in the parents or the family as a whole.

Wilfred Bion’s study of groups during World War Two can shed some light on some of the unconscious processes at play in the family as a group. Bion (1962) defines this pairing of individuals in any group that is gripped by unconscious anxieties as a basic assumption pairing (BAP), where these two individuals are unconsciously acting out the underlying conflicts on behalf of the group. The source of rivalry is not always to do with whatever issue that is consciously fought over, but rather the underlying issues that are avoided and denied by the family and therefore acted out by the pair.

In some families, the dysfunction manifests in one individual who is the “outcast” or the “scapegoat”.  This induvial becomes the one who holds all the badness on behalf of the family. This is all a function of projections of unwanted aspects of a family member, or the family as an entity onto and into the individual.

Under the sway of these powerful projections, it’s very easy for that individual, who is a recipient of these projections, to act out these projections.

Melanie Klein (1946) would call this ‘projective identification’. It’s also easy to internalise these notions leading to limiting/negative core beliefs about oneself – “I am a terrible person”, “No one likes me, even my own family”, etc. Having these family fights leading to an individual family member, or an individual family within a wider family, being ostracised would fit what Bion (1962) considers a basic assumption fight-flight (BAFF) where there is a turning away from the issue at hand, increased hostility, rage and aggression directed at the enemy, and fighting between group members. This perpetuates the issue as alienating and vilifying the individual, leaving the underlying issues unresolved.

In other families, there is an individual, typically an elder, who is seen as a source of wisdom and cannot be challenged, no matter how wrong they are. This person is seen as omnipotent and the person who is meant to resolve all the issues for the family. This can be very harmful as this member is unchallenged, regardless of how unsound their opinion is; they are protected at all costs. This way of functioning is what Bion (1962) considers a basic assumption dependency (BAD), where there is a dependency on an individual; the phantasy is for that individual to save the family.

This powerful basic assumption often leads to despair and, as that individual is unconsciously seen as the problem solver, however, they do not have the ability to save the family. The underlying issues in the family which can be solved by open and honest communication are avoided which perpetuates conflict and toxicity.


Narcissistic parenting 

In most families, the dysfunction and sibling rivalry lies in the parents and their relationship with their children and how they raised them. “Narcissistic” parents are parents who are unable to accept responsibility for their own failures, shortfalls, feelings, or insecurities. To deflect their own feelings – a sense of shame, guilt, or failure – the individuals who are unconsciously picked in any of the BAP, BAP, or BAD, are simply acting out a family drama.

If the underlying issue is not addressed and communicated openly, thoughtfully, and responsibly, the drama only perpetuates. This hurts everyone else but the people who are responsible which is either one or both parents. Narcissistic parents typically don’t take responsibility for their own failures. Instead, they unconsciously project it onto their children, leading to a lot of conflict and rivalry in the family and between siblings or family members. The sad part is that the people who are in conflict are acting on behalf of everyone else and the root cause is often the family and their lack of dealing with acknowledging their own dysfunction.

How do you move on from an unhealthy family dysfunction?

Open, honest, mature, and respectful communication about family issues that are deemed difficult or risky is central to families moving from unhealthy dysfunction into healthy, nurturing relationships, and cohesiveness. It may mean confronting each other; however, if this is done respectfully, it is likely to lead to growth and meaningful relationships. Avoidance and denial of the issues only perpetuate the dysfunction.

If you are estranged from your family, here are some tips to manage this situation:

  1. Create healthy and meaningful relationships with friends and loved ones (not parents or siblings) who you can have mutually nurturing relationships with. This helps you replenish and foster a sense of community and security.
  2. Create firm boundaries with family members and be consistent – how far one can go with contact and how they communicate and treat you?
  3. Limit contact if it causes you distress – consider blocking on apps if necessary. Protect your peace, you owe yourself that.
  4. Remind yourself that you are not responsible for other peoples’ feelings, behaviours and what they think of you. People will always judge no matter what. They have never walked in your shoes.
  5. Self-validate – remember you are enough without the family. The toxicity will only weigh you down. You are not responsible for the dysfunction. Your family dysfunction doesn’t define you.
  6. Create a routine and find new hobbies where you can expand your social circle. This will make you feel less isolated and foster a sense of belonging and community.
  7. Find ways to self-soothe – yoga, mindfulness, sport, and other self-care routines. Do things that enable you to regulate yourself emotionally whenever you are overwhelmed, instead of lashing out at the toxic individuals or others around you. You simply perpetuate the dysfunction of if you lash out.
  8. Do things that you enjoy, and that mastery, that gives you a sense of purpose. Meaning is derived from how much we feel integrated, take part, and value in life.
  9. Be kind to yourself – therapy helps you heal from this trauma. Remember it’s a family trauma and you just happen to be the victim.
  10. If you are that elder who is there to solve everyone’s problems, step back and relinquish that role. Other people have minds of their own and their opinions matter.

References

  • Bion, W. R. (1962). Learning from experience. London: Heinemann.
  • Klein, M. (1946). Notes on Some Schizoid Mechanisms. International Journal of Psychoanalysis, 27, 99-110.
Main Image Credit to Rahadi Ansyah- Unsplash

Counselling Directory is not responsible for the articles published by members. The views expressed are those of the member who wrote the article.

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London SE1 & Milton Keynes MK15
Written by Dr Joyline Gozho, Adult Psychotherapist (Individual & Couples) FPC, UKCP, NCPS

Dr Joyline Gozho is an Adult Psychotherapist, Relationship Therapist, and Lecturer on a Psychotherapy course. She works with both individual and couples in private practice. She also runs relationship enrichment workshops with a particular focus on communication and emotional literacy.

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Understanding Parentification

COPYRIGHT CITY SANCTUARY THERAPY

No part of this website, including the blog content may be copied, duplicated or reproduced in any manner without the author’s permission.

 

Any information, materials, and opinions on this blog do not constitute therapy or professional advice. If you need professional help, please contact a qualified mental health practitioner.

 

What is Parentification?

In simple terms, parentification is when a child is given duties and responsibilities that are not age appropriate. Parentification can occur in two different forms- emotional and instrumental. Some people experience one of the other, while others experience both.  Emotional parentification is when the child provides emotional support to the adult, while instrumental parentification is when the adult assigns and ascribes adult roles and duties to the child. In practice, the adult may simply off load onto the child, confide in the child, ask questions about life situations, seek counsel, & solicit advice from the child. It can also occur when a child is given adult chores, and tasks  that are not age appropriate.  When this happens, there is a role reversal where the child becomes the adult, the provider of emotional containment to an adult (care taker), and an involuntary provider of practical support. Many a time parentification happens covertly, and the adult may not recognise their emotional and practical dependence on the child.  In any situation where there is parentification, there is neither sensor in the adult, nor a recognition of boundaries of what is appropriate, and what is not. Children do not only grow and develop physically, they also develop psychologically; they have certain milestones they need to reach and accomplish. Parentification interferes with the natural psychological development of the child, and impinges on the accomplishment of their own developmental tasks, as they are pivoted into adulthood.

 

When and why  does Parentification happen?

Parentification typically occurs in parent-child relationships, and it also occurs in families where where there is an older sibling  who has to look after the younger ones practically and/or emotionally.  What is typical is that in emotional parentification, the adult emotionally confides in the child, and speaks to the child about challenges they may be having in their life-for example financial difficulties, marital difficulties, health difficulties, relationship problems, and other  life situations. These things may seem insignificant to the adult, however, they are emotionally burdening the child who has no capacity to understand, make sense, or emotionally process them. Another way emotional parentification happens is when the child grows up in an environment where they have to tune into the adult’s emotions, in order to protect themselves and feel safe. This is likely to happen when there is one or both parents who is emotionally volatile, and where there are parents who engage in regular fights, leaving the child to intervene and become the peacemaker. The child has to deal with complex emotions and  put in the adult role when this happens, which becomes parentification.

With instrumental parentification, the child takes on and assumes adult roles. They are made to do things that are beyond their capacity as children, therefore not age appropriate. This may be as simple as dealing with household chores, looking after their siblings, cooking, shopping, or budgeting,  which undermines their own experience as a child. Some parents do struggle to distinguish healthy coaching of a child to do household chores with parentifying a child. While it’s not a bad thing to teach children life skills, it is harmful when they are made to do them repeatedly, and it becomes their duty.

Emotional parentification is very common in families where there are marital problems- divorce or separation, or any other marital discord. You find that either one or both parents use the child as a confidant of their problems, and share feelings about the marital issues or the other parent.  The parent relates to that child “as if” they are an adult. This phenomenon is also common in single parents with children who become a replacement of the lost partner, and used as a surrogate partner emotionally. In actual fact, the adult is committing emotional incest with a child, as they are not their partner, but a child.  Although the adult may not recognise the burden of  emotional dumping, it is the child who is impacted by it & needs to make emotional adjustments to accommodate the adults’ feelings, while neglecting their own. Children are very compliant, they simply shut off their own feelings, and look after the adult; the adult becomes complicit in neglecting the child’s feelings. In the child’s mind paying attention to the adult’s feelings is the right thing to do. However, it also means the child’s feelings are unattended to, and unprocessed, and this does create confusion in their minds.

Parentified children are likely to develop what Winnicott (1960) would term a “False Self” organisation. According to Winnicott, this False self is a defensive organisation which the child builds, as a result of the parents’ repeated failure to meet the child’s emotional needs (omnipotence). In compliance with the mother, the child develops this False self, which protects the True Self. The False Self is inauthentic and it is not as confident, as it is a defensive organisation which shields the more robust and authentic True self, which was never allowed to develop.

Parents who parentify their children are adults who are likely to be isolated & not have much support around them, hence their reliance on a minor for emotional and practical support.  The parent who parentifies their child/children lacks boundaries, and psychologically immature  to appraise what is right or wrong.

 

Signs of Parentification in adult life?

Parentification is a  hidden trauma, that can get easily missed, yet it has such a profound impact on the individual. Most of these difficulties create real challenges in interpersonal and romantic relationships. Parentification is not gendered, both men and women experience it. However there are certain cultures where some parents have more porous boundaries with their children, which lends them to being more easily parentified. Other socio economic factors also play a part in Parentification. For example it’s common practice in immigrant families for the older siblings to look after their younger ones, while the parents are at work.

Here are some of the signs that people who have been parentified display in adult life

  • People who have been  parentified as children are likely to become adults who are insecure, and have an impoverished sense of self.  They lack confidence in themselves,  and find it difficult to advocate for themselves, and look after themselves, prioritising others-typical people pleasers. This is so because of the False self organisation as discussed above.
  • People who are parentified are likely to have difficulties with boundary setting, and unlikely to honour their boundaries. This is so because their own boundaries were violated by their parents, and had their own needs neglected. They never learnt to develop healthy boundaries. Parentified adults are also likely to breach other people’s boundaries and jump in to “fix” other people’s problems, at times unsolicited. This is simply a repetition of what they grew up doing for their parents in their childhood.
  • Parentified adults often experience difficulties defining their needs, and expressing them, as well as difficulties expressing their own feelings which are seen as secondary to others and insignificant. This is simply a manifestation of an internalised way of relating to other’s where other people’s needs takes priority- they emotionally looked after their parents or older adults around them, and they repeat the same.
  • Adults who were parentified as children are likely to experience intense feelings around rejection, and they often hold onto to unhealthy relationships to avoid feelings of rejection and loss. This is so due to the poor sense of self as a result of the False self organisation.
  • Emotionally parentified adults may be conflict avoidant. This is so because for them, serving others and not “rocking the boat” means they can maintain relationships, and this gets done relentlessly, to one’s own detriment. It’s as if they are buying love, at all costs. They do this because they have learnt to keep their environment in control and not to ‘rock the boat’. This way of functioning is harmful in interpersonal and romantic relationships. By avoiding conflict, conflict avoidant people are easily manipulated, abused and exploited in both romantic and non romantic relationships.
  • Parentified adults tend to have  insecure attachment styles -Avoidant or Anxious attachment (Bowlby, 1969). This is so because they had to detect the level of proximity with their care givers- in order not to be abandoned and at the same time, protect themselves. Anxiously attached people tend to engage in push and pull dynamics,  oscillation between intensity, and withdrawal. Avoidant people are likely to keep a distance from others, despite yearning for  connection.
  • Parentified adults tend to struggle with intimacy and maintaining long and  stable connections.  Having been put in the role of emotionally caring for an adult/s, they associate intimacy with being suffocated, curtailed and engulfed. They value their independence and autonomy; however this can be a way of keeping others at a distance and avoiding intimacy which is viewed as engulfment. While they may seek emotional connections with others parentified adults  tend to struggle with longevity in relationships, and seek new experiences which perpetuates the cycle of avoidance.
  • Parentified adults tend to become controlling of their partners or life in general. They like things to be under their control and done in a particular way. This is a way of mitigating anxiety of things going wrong. This role is familiar-they had to keep things under control for their parents and or siblings.
  • Parentified adults engage in relationships where they emotionally and physically look after other people. This can lead to co-dependent dynamics or parents- child dynamics in romantic relationships. The parentified adult is likely to be the caretaker and infantilise their partners.
  • Parentified adults are likely to experience anxiety and depression, because of the inability to fully express their feelings and emotions. Emotions make life colourful and rich, Without a heathy expression of emotions we tend to internalise our feelings. Certain feelings such as anger, frustration, and sadness, when internalised, become toxic and can lead to depression, anxiety as well as anger issues.

 

 

Should I confront my parents about parentification?

Revisiting the past and confronting one’s parent can be a double-edged sword. It depends on various things, including the quality of relationship with the person/s involved. It may evoke compassion and be a catalyst of a healing journey for both involved, or it can create friction. Parents tend to become defensive when they are made to feel like they failed, or they are being blamed.  If the emotional dumping and violation of boundaries continues in adulthood, one can mention this to the parent and have a “boundary conversation” where you as an adult are redefining your relationship boundaries with the parent. This does not have to be antagonistic, but a gentle conversation that can bring understanding, insight, and healing to both. The difference is that this time there are two adults, not a parent and a child. This may help the parent to start thinking about their own process, and their role which can make them change their behaviour and acknowledge its impact. In most occasions, these behaviours stem from a very unconscious place as these parents are people who had their own boundaries violated as children. Parents are people who were parented themselves, and once upon a time they were children. No one has  a blueprint for parenting. The parents may not be aware of this repetition, and the fact that they are simply re-enacting their own trauma with their own parents.  Having insight into this and acknowledging it is the onset of the healing and breaking these negative cycles.

 

Healing from Parentification

  • If you suspect that you were parentified, the first thing is to reflect on the relationship with your parents, and significant others from your childhood. It is likely that in adult life these significant others may continue to violate the emotional boundaries, in the same way as they did.
  • Where there was parentification in childhood, the adult tends to be drawn back into the caring role, and often these are adults became their parents’ own parent’s and develop co-dependent relationships. Healing could be as simple as stepping back from these relationships and creating space -this is indeed a form of self-care and breaking the unhealthy pattern. It could be simply saying no to certain things you would normally agree with or agree to do in-service of others. It could simply be doing the things that you like doing without worrying what others may think or say, or without seeking their permission.
  • A key step towards healing lies in setting boundaries as an adult who understands things differently to the child and start learning to prioritise one’s own needs. Being able to recognise how one feels, validating those feelings, and beginning to express them without the fear of hurting the other person is crucial. Without doing that, we simply repeat the same cycle of looking after other’s needs, neglecting ours, to our own detriment.
  • A crucial aspect of healing from emotional parentification is learning to tolerate intimacy and reciprocating care.   Instead of running away and/or avoiding intimacy, learn to be present and bear the feelings closeness brings up. Its also a part of learning to be cared for emotionally while caring for the other-  reciprocity.
  • Therapy is the gateway to emotional healing where the trauma of parentification can be explored, understood and processed in a healthy and meaningful way.

References

 

Bowlby, J. (1969). Attachment and Loss, Attachment and Loss. Vol. 1: Attachment.  New York: Basic Books.

 

Winnicott, D.W. (1960). Ego distortions in terms of True and False Self: The Maturational Processes and the Facilitating Environment. Karnac Books: UK

 

Main Image Credit to Kamran Chi- Unsplash

 

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STYLIST Magazine Contribution – When does ‘normal’ anxiety become an anxiety disorder?

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A Critical Assessment of NICE Guidelines for Treatment of Depression-

World Psychiatry. 2023 Feb; 22(1): 43–45.
Published online 2023 Jan 14. doi: 10.1002/wps.21039
PMCID: PMC9840485
PMID: 36640399

A critical assessment of NICE guidelines for treatment of depression

Falk Leichsenring, 1 , 2 Christiane Steinert, 3 Felicitas Rost, 4 Allan Abbass, 5 Nikolas Heim, 3 and John P.A. Ioannidis 6 , 7 , 8 , 9 , 10

The UK National Institute for Health and Care Excellence (NICE) recently updated its recommendations for the treatment of depression 1 . This effort has many strengths, including the meticulous documentation of the process; systematic reviews, meta‐analyses and cost‐effectiveness analyses; and inclusion of stakeholder comments that feed into the guidelines. Here we attempt a constructive critical appraisal of areas where future improvements for this but also for other similar initiatives are feasible, with a special focus on psychotherapies for depression.

We first notice that the methods and analyses of the NICE guidelines were not subjected to formal external peer review for any of the addressed questions. Asking stakeholders for comments is welcome, but it is unlikely to be equally rigorous, leaving it to the guideline committee how these comments are considered. External peer review is recommended as a default quality stan­dard for treatment guidelines 2 .

Furthermore, study protocols were pre‐registered only for some conditions (e.g., for new episodes of depression and treatment‐resistant depression), but not for others (including chronic depression, depression with personality disorder, and psychotic depression). Pre‐registering should be established as a default stan­dard in guidelines for all reviewed conditions.

For the primary analysis concerning new episodes of depression, network meta‐analysis (NMA) was chosen 1 . NMA has the advantage of incorporating both direct and indirect evidence, but complex assumptions need to be fulfilled, and the level of evidence provided is still debated 3 . For these reasons, NMA results and the derived inferences require extra caution.

For treatment ranking, the guideline committee primarily focused on effect sizes from NMA treatment comparisons with placebo or treatment‐as‐usual, and compared these effect sizes between treatments. From these comparisons, the committee concluded that some treatments appeared to be “more effective” than others 1 . For most treatments, however, the differences between treatment and control effect sizes were below the minimal clinically significant difference defined by the committee (standardized mean difference, SMD >0.5 or <–0.5) 1 . This applies to comparisons between individual cognitive or cognitive‐behavioral therapy (CT/CBT), individual interpersonal therapy (IPT), individual problem solving, individual short‐term psychodynamic psychotherapy (STPP), and group behavior activation. Thus, with only subtle effect size differences, treatment ranking carries large uncertainty. Furthermore, assuming differences between two treatments if one of them shows descriptively a larger effect size than the other compared to a control condition, without comparing them directly, should be avoided 4 .

The guideline committee reported head‐to‐head comparisons of active treatments only in a supplement. These comparisons show that, in more severe depression, the differences between individual behavioral therapy, individual CBT, individual IPT and individual STPP are neither statistically nor clinically significant (SMDs <0.50) 1 . In less severe depression, only a few clinically significant differences were found: for example, in a pairwise comparison, STPP was statistically and clinically significantly superior to counselling (SMD=–0.61, 95% CI: –1.05 to –0.17), but was ranked below counselling.

Thus, the committee’s conclusions about differences in efficacy between active treatments are not consistent with its own head‐to‐head comparisons. They are also not compatible with independent peer‐reviewed evidence of no substantial differences in efficacy between psychotherapies 5 . The committee, however, erroneously interpreted this independent evidence 5 as confirming its treatment ranking1,B, p.165. In summary, procedures for treatment ranking need to be pre‐defined, and subtle differences below the threshold of clinically meaningful values should not be overstated.

In principle, possible allegiance and conflicts of interests need to be controlled for 2 , for example by including methodologists, patients, and different‐field experts, and by limiting the involvement of field specialists to a consultation role 6 . Avoidance of stacking is also essential, ensuring that guideline developers do not have an over‐representation of believers in one or another treatment modality 6 .

The guideline committee based the hierarchy of treatment recommendations on both efficacy and cost‐effectiveness, which is useful in trying to optimize the use of treatments for conditions with high prevalence 1 . For cost‐effectiveness, however, peer reviews and pre‐registration are missing. Moreover, the cost‐effectiveness literature is notoriously replete with biases. This further complicates matters in a field such as depression where the primary studies are often also biased (e.g., sponsor bias in pharmacotherapy trials and allegiance bias in psychotherapy trials). Furthermore, the studies used by the committee for cost‐effectiveness analysis did not cover all relevant treatment types. For those not covered, it is not clear whether cost‐effectiveness estimates are valid. Additional cost‐effectiveness analyses commissioned by the committee were based on the NMA treatment‐control effect sizes shown above to be questionable, which further limits the derived treatment ranking.

Another challenge is whether extrapolations from new episodes of depression to other conditions are valid, when there is no solid evidence for these other categories of depression. For example, in depression with personality disorder, the committee recommends combining antidepressants and psychotherapy. For the choice between psychotherapies, readers are referred to the treatments for new episodes of depression. Then, for patients not sufficiently responding to pharmacotherapy alone, switching to psychotherapies listed for new episodes of more severe depression is recommended as one option. In reviewing new episodes of depression, however, the committee excluded depression with personality disorder and treatment‐resistant depression. Thus, the committee’s ranking of psychotherapies for new episodes of depression may not be valid for these other conditions. Finally, for the cost‐effectiveness of chronic depression and depression with personality disorder, the committee also used the economic data for new episodes of depression.

As another problem, the guideline committee found the quality of studies to be quite low. The committee tried to adjust results for bias, but a pre‐registered threshold analysis for assessing confidence in recommendations was not carried out. Quality of evidence was evaluated narratively using the GRADE system, but without assessing confidence. Assessing confidence in evidence is essential for guidelines 6 .

The committee also draws an arbitrary distinction between the more complex forms of depression, which not only reduces gener­alizability to clinical practice but appears to have led to the ex­clusion of relevant studies. Available randomized controlled tri­als have not clearly distinguished between chronic depression and treat­ment‐resistant depression. For chronic depression, the committee recommends CBT, antidepressants or their combination 1 . However, these recommendations do not take into account the evidence for STPP and long‐term psychodynamic therapy in treat­ment‐resistant depression and in depression with personality disorder78, conditions highly associated with chronic depression. Guidelines need to avoid arbitrary distinctions of disorders.

Moreover, the committee did not sufficiently consider the limitations of the available evidence 2 , especially the limited remission rates (about 30%) of short‐term psychotherapies (4‐20 sessions), with SMDs of 0.30 9 . Aggravating this problem, most effect sizes of short‐term treatments are not stable at follow‐up1. Especially for chronic depression, success rates may be improved with longer‐term treatments 9 . The committee, however, considered long‐term treatments only as an option for depression with personality disorder.

Finally, an explicit link between evidence and recommendations is missing 2 . We acknowledge that the evidence in this field is uncertain, and this may be the reason why the committee found it “difficult… to link the recommendations directly to the NMA results”1,B, pp.48,66, and based its recommendations ultimately on “clinical experience”1,B, p.66. However, it is unclear whether clinical experience can offer any solid guidance when treatment differences are modest, uncertainty is high and bias is substantial. Guidelines should fully admit this uncertainty and avoid over‐simplified, over‐confident recommendations 6 .

REFERENCES

1. National Institute for Health and Care Excellence . Depression in adults: treat­ment and management. www.nice.org.uk/Guidance/ng222.
2. Brouwers MC, Kho ME, Browman GP et al. CMAJ 2010;182:E839‐42. [PMC free article] [PubMed[Google Scholar]
3. Faltinsen EG, Storebo OJ, Jakobsen JC et al. BMJ Evid Based Med 2018;23:56‐9. [PubMed[Google Scholar]
4. Makin TR, Orban de Xivry JJ. Elife 2019;8:e48175. [PMC free article] [PubMed[Google Scholar]
5. Cuijpers P, Quero S, Noma H et al. World Psychiatry 2021;20:283‐93. [PMC free article] [PubMed[Google Scholar]
6. Lenzer J, Hoffman JR, Furberg CD et al. BMJ 2013;347:f5535. [PubMed[Google Scholar]
7. Fonagy P, Rost F, Carlyle JA et al. World Psychiatry 2015;14:312‐21. [PMC free article] [PubMed[Google Scholar]
8. Abbass A, Town J, Driessen E. Psychiatry 2011;74:58‐71. [PubMed[Google Scholar]
9. Leichsenring F, Steinert C, Rabung S et al. World Psychiatry 2022;21:133‐45. [PMC free article] [PubMed[Google Scholar]

Articles from World Psychiatry are provided here courtesy of The World Psychiatric Association
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Vacillators and Romantic Relationships

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No part of this website, including the blog content may be copied, duplicated or reproduced in any manner without the author’s permission.

Any information, materials, and opinions on this blog do not constitute therapy or professional advice. If you need professional help, please contact a qualified mental health practitioner.

 

Vacillators and Romantic Relationships

We all know that person who lives in La La land, who wants a fairy tale love story where they live “happily ever after”!  We all know that couple that is either madly in love, or fighting like cat and dog, blaming each other for anything and everything. Their relationship is either on the high or low. This way of relating and functioning describes vacillators- where either one partner or both are vacillators.  Vacillators are people who approach relationships in an idealistic, and romanticised fashion –“everything has to be perfect”. They deeply crave emotional connection & will do all they can to get it. This can be at the expense of them undermining their own needs, or emotionally manipulating their partners. Vacillators are emotionally demanding; they want to receive consistent love & undivided attention.

 

Vacillators set high standards for their partners, and the relationship. When they don’t get what they want -which is often the case due to unrealistically high expectations- it crashes them, provoking a huge sense of disappointment, and anger. These feelings are always targeted at their partner who is seen as having failed them. Vacillators sway between idealisation of their partner and the relationship, & denigration of the same – “I’m so in love with you and you are amazing” and “you are useless, l don’t need you” dynamic . There are intense highs are lows, and inherently viewing the world in black and white terms, with no in between. This leads to cycles of pushing their partners to love & connect with them, & angrily pushing them away. The lows can manifest in actual physical and/or verbal fights, while the highs are both exaggerated and superficial. This couple is typically in a trauma bond, where the early unresolved relational trauma is unconsciously played out, in a victim and abuser dynamic.

 

Underneath this behaviour is as huge sense of insecurity, and a deep seated fear of abandonment. This gets acted out in the relationship by creating the fairy tale relationship in the mind, which is difficult to sustain in real life. Consequently, being in a relationship with a vacillator can be both exhausting and confusing. The behaviour itself is indeed a trauma response, rooted in the past relationships with their care givers. Their partners are simply paying the price for their early life care givers’ failures. These behaviours are indeed transference manifestations (Freud, 1915).

 

Vacillators often find flaws in their partners, & want them to change in order to suit their phantasy of an ideal person and relationship. The more the partner gives in, the more they are likely to keep pushing for change. The changes are never enough, as they are based on an ideal and a phantasy, not on reality. If the partners  conform, they simply reinforce the power in the vacillator. If the vacillators partner changes accordingly, they are left feeling very small, fragile, insecure, and powerless.

 

Predisposition

Vacillators are people who are likely to have  disorganised attachment styles. They are likely to have grown up with parents who were inconsistent & unpredictable in emotionally connecting with them as children. Therefore, their attachment style is far from secure, but a disorganised one- as the word says “dis- organised”. Their parents would have made them feel insignificant, and that their feelings didn’t matter to them. They grew up with a constant fear of being abandoned and let down, yet they also experience intense love from then same parents.

 

We don’t talk much about vaccillators, or vaccillating in  relationship discourses, yet this phenomenon is very common. Being in a relationship with a vacillator can be damaging and being a vacillator can also lead to an inability to sustain long term, fulfilling  relationships. Partners can support each other to work through this dynamic, once the vacillator is able to acknowledge that they are indeed vacillating, and causing damage to their loved ones. Vacillators can also go into individual therapy to work on this early life trauma, secondary to adverse childhood experiences. Creating security in the relationship and boundaries is likely to help the couple, as the vacillating behaviour itself is stimulated by a fear of abandonment. Cycles of anger, and idealisation can cause huge damage to the relationship and to individuals in the relationship. The denigration erodes other positive qualities of the relationship.

 

 

Disorganised Attachment Style and Attachment Styles

The psychological health of an adult individual and relationship patterns  is directly linked re postulated to the quality of the relationship between the baby and their primary care giver, which shapes the attachment styles they built in infancy. These attachments styles are internalised ways or relating laid out in our formative years, which get reactivated in our adult relationships (Ainsworth et al, 1978; Bowlby, 1969).

Bowlby (1969) postulated that there are different types of attachment patterns which are:

1) Secure attachment is developed when they baby is able to develop a healthy attachment style with their care giver. The baby is able to play independently away from the mother, and run back to the mother, a secure base, when it needs to, and know that mother will be waiting in reverence. These parents would have had consistent boundaries and responded consistently. The parent was able to honour and respect the child’s boundaries and made them feel emotionally safe. The child was allowed to express themselves, and the parent remained emotionally connected to the child. In adulthood, these people are likely to have a secure sense of self, they can self validate and not seek validation from their partners and they can approach relationships from a mature place.  They are able to emotionally sooth themselves- conflict in the relationship,  partner’s temporary absence, or   a break down of  a relationship is not so emotionally crashing for them.

2) Anxious-Preoccupied   attachment is an attachment style developed when  the baby is unsure whether they are emotionally secure or not, mainly because they get ‘mixed messages’ from their care giver. The parents would have lacked boundaries, and struggled with emotionally regulating themselves. The parent would have not responded to the child’s needs and didn’t help the child with emotional regulation.  They may have dismissed, minimised, denied, or ignored the child’s emotional needs. In adult life, and in relationships, there is constant fear of abandonment, and hypervigilance to emotional sates. They may pick fights to stay close and the individual struggles with boundaries. The anxiously attached individual tends to be emotionally reactive, and to neglect themselves in relationships, to maintain proximity with their partner. They find it hard to deal with conflict as feelings becomes overwhelming and the threats of abandonment is costly to them.

3) Dismissive-Avoidant  attachment style is developed when the baby had parents who regularly shuts down, emotionally withdraw, or dissociates, leaving the child emotionally unattended to. These parents may also shame the child for who they are and tend to be authoritarian and perfectionistic.  As adults, the avoidant attached genuinely seeks connection but struggles with intimacy. They are likely to ghost, or abruptly end relationships. They also tend to be lone wolfs and cynical and critical of relationships. They may also lack empathy and struggle to understand other peopled viewpoints and needs that are separate to theirs. They are likely to remain single or push their partners away for self-preservation.

4) Fearful-Avoidant  attachment style is developed when in childhood, the baby was completely unable to relate, as they were unable to experience a secure base where they could run back to.  These children may have experienced abuse, neglect and violence from parents or witnessed it between parents. They are likely to have grown up in environments where there was poverty, and considerable lack of safety, shaming and the chid unable to be themselves. In these dynamics, the vital role of the parent as a reliable, trustworthy, consistent and solid care giver is lacking. In adulthood, these people are likely to cerate push-pull dynamics in relationships where they seek closeness and rejects. Romantic relationships can be highly triggering and overwhelming for them, leading to cynicism, and criticism of their partners. They may also re-enact their childhood trauma by setting their partners up into dramatic scenarios. They have unrealistic expectations of their partners and what a real relationship is.

 

The disorganised attachments are likely to be vacillators in relationships. All they are doing is re-anacting the early relationship template of having parents who are unreliable and untrustworthy. They do the same by creating idealised views of the world and relationships, and seeking others to meet their high standards.  Unconsciously, they tend to pick  partners who like being worshipped, and enjoy going through the emotional highs and the lows. The push- pull, and rejecting mimics what they felt in the care of their primary care givers.

As an individual and couples therapist, l have seen many people work through these unhealthy ways of relating, and develop healthier ways of relating.  I have helped both subjects and partners of vacillators and helped them repair these attachment styles and develop healthier and secure attachment styles. Attachment  styles are not fixed for a lifetime. They can be mended and repaired through good enough psychological work (therapy), and secure relationships with a partner who is securely attached themselves.

 

How to Heal

 Subject

-Knowing that this behaviour is a trauma response is important.

-Self-reflection is critical as it enables you to stop and think before reacting or doing things that are harmful to your partner

-Working on communication and boundaries is important. You may want to invite your partner to support you with working on this.

-Having therapy to work on the trauma is also important as it enables you to learn healthy ways of relating & work through the trauma.

 

Victim

-Learn to create boundaries and to understand that the behaviour is not to do with you specifically but your partners past trauma. This will enable the victim to separate what’s happening to them as something that’s not directly towards them.

-Communication and setting boundaries is important and being consistent in doing so.

-Be mindful of love bombing and suffocating affection that comes with vacillators, as it soon becomes rejection. Being aware of it makes it less painful.

-Seek therapy if you are struggling with a relationship with a vacillator.

 

References

 

Ainsworth, M.D.S., Blehar, M.C., Waters, E, and Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. Oxford, UK

 

Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. Attachment and Loss. New York: Basic Books.

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Guardian Contribution-I long to move to the seaside, but will it unsettle my children?

22/01/2022

I long to move to the seaside, but will it unsettle my children?

You’re unhappy where you are. How can you be sure you won’t be just as unhappy in a different town, asks Annalisa Barbieri

 

Four years ago, we relocated at a time we thought least harmful to our children: the youngest was starting primary school, the eldest junior school. They are now nine and 13. They are of mixed ethnicity and we wanted to live somewhere more multicultural, in a larger house in a less urban area. Our close family live outside England, so we thought moving nearer to extended family might provide some roots. The children settled well but contact with the extended family didn’t really happen.

Last year, going through the menopause, I became depressed and sought counselling. I recognised I’d been so focused on what might be best for the children that I’d disregarded what was right for me. I’ve always wanted to live by the sea and have become increasingly despondent about having missed an opportunity to move there four years ago. During lockdown my husband and I had time to reflect; he thinks our family unit will be stronger if we move again, before the children are any older. We both want our eldest settled before GCSEs. She is very empathic, knows I am unhappy and constantly asks why.

My mother died when I was a young woman and I’ve had little family support (no siblings, an emotionally unavailable father). I feel desperate to put roots down somewhere and create a supportive network of friends. My dilemma is whether to force another move on my children when they are settled here. This place has positive features for them; the place we’ve thought of moving to is less multicultural. Maybe I should just suck it up until they leave home. Mothers are supposed to put their children’s interests first, after all.

The core to resolving your dilemma lies in working out what’s within you and what are external factors. Too many people seek to change their surroundings (work, or partner, or home), while the issue within them remains unchallenged. They then wonder why the new place (or partner, or job) hasn’t made them happier.

I talked to psychotherapist Dr Joyline Gozho, who immediately noted your upbringing: “You probably had a lot of unresolved and unmet needs in childhood, and now that you’re a mother, they’re coming to the fore.” When you add in the menopause, which can be a time of great reflection (“What happened to me? What about my needs?” are questions often asked), and Covid, which is making so many people reprioritise, it’s not surprising you are in a dilemma. But you don’t need to do anything just yet.

The first thing both Gozho and I felt you needed was time to explore your own feelings, without thinking about family and future. “You need to have considered therapy that looks at your individual needs,” Gozho said. You mention seeking counselling but not whether you addressed these issues in it. “Your mother dying and your emotionally unavailable father – those are huge losses that may have left you feeling emotionally deprived.”

You rhetorically ask if a mother is supposed to put her children’s interests first. Not always, and certainly not if it makes the mother unhappy to the point of the children knowing about it, because they will then blame themselves. Gozho and I were concerned that your eldest knows how unhappy you are and wonder what internal narrative she may be establishing for herself. She shouldn’t be worrying about you when she is about to enter the turbulent waters of adolescence.

Woman's head and Great Britain map
I want to move back to the UK. How can I convince my husband to give it a try?
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You talk about being “desperate” to put down roots, while also talking about pulling them up. This contradiction makes me wonder how much of this need is within you, yet you constantly search for it externally. You need to home in on what it is you feel you are missing, and whether living by the sea will give it to you. The seaside is lovely, but when people talk about moving there in a certain utopian way, it strikes me as running away. That’s never a good basis for stability and growth.

Have you spent any time in the place you’d like to move to, winter and summer? Talked to people who live there? I would do this as soon as possible.

Making a flow chart and asking, “What if we do this, and what then?” can give great clarity. If you find the only good reason for moving to the seaside is that you want to, I wonder about putting yourself under that sort of pressure to make it a success.

 Every week Annalisa Barbieri addresses a family-related problem sent in by a reader. If you would like advice from Annalisa on a family matter, please send your problem to ask.annalisa@theguardian.com. Annalisa regrets she cannot enter into personal correspondence. Submissions are subject to our terms and conditions: see gu.com/letters-terms.

 

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Controllers and Romantic Relationships

COPYRIGHT CITY SANCTUARY THERAPY

No part of this website, including the blog content may be copied, duplicated or reproduced in any manner without the author’s permission.

Any information, materials, and opinions on this blog do not constitute therapy or professional advice. If you need professional help, please contact a qualified mental health practitioner.

 

Control is a form of abuse, so is other forms of coercive behaviours. Being in a relationship with a controller is unhealthy; it can be very damaging. Controllers dominate the relationship, leaving no space for their partners. The relationship itself is shaped by dominance & submission. Controllers do not only seek to control all aspects of the relationship, but  their partner as an individual, stripping them off their individuality. This can be depersonalising, and easily erodes one’s sense of self.

 

Control in Relationships

Many people in controlling relationships do not even recognise that their partners are controlling them. This is so because the controlling, and patronising behaviour is often coveted, and subtle.  It is often done in the name of love, which can be confusion to the victim, and difficult to pick up for anyone who has a poor sense of self.  It may take others to identify it, and highlight it for them. In some instances, controllers are aware of their behaviours, while others may not be cognisant of their behaviour as being controlling. Resultantly, they don’t realise how much harm they cause their partners.  The behaviour becomes normalised, yet incredibly harmful. This is why therapy is incredibly helpful for both the subject, and the victim. Nevertheless, it is the victim who suffers the most, where there is a controlling partner. This dynamic is typically a result of a trauma bond which is very difficult to disentangle, as the underlying trauma needs to be addressed.

As a therapist, l have worked with many people who experience control issues in their relationships-both controllers and victims. I am aware of how prevalent control  issues in relationships are, yet many people only become aware of them once they start therapy. This highlights how much damage control silently cause in relationships. Healthy relationships are created, they are not magical. It is therefore crucial that the discourse around romantic relationship dynamics  continues & the nuances of it unpacked.

 

Healthy relationships are nourishing, while controlling relationships are depleting, and damaging. Women and men are both prone to becoming controllers, or to be controlled in relationships, and it’s not exclusive to a particular coupledom. People in in same-sex relationships, polyamory, or heterosexual relationships all experience these issues. Controlling behaviour in relationships often coexist with verbal and or emotional abuse.

 

How to recognise control in a relationship?

 

Controllers are partners who:

 

  • Monitor and/or dictate how you spend your time, and make you feel guilty about leaving them out.
  • Monitor and/or dictate who you spend your time with make you feel guilty about it.
  • Monitor and/or dictate how you spend your finances and make you feel guilty about it.
  • Monitor or dictate what you wear & make you feel guilty about it.
  • Morbid jealousy and accusations of cheating or betrayal.
  • Intrude into your personal material such as going through your phone, bank statements etc.
  • Blame you when things go wrong & being repeatedly made to compromise & give up what’s important to you.
  • Make you feel your opinion is secondary & your reality is warped.
  • Control how you should behave around others-edit your self.
  • Gaslight and make you question your truth.
  • Use their emotions to set the tone and control situations.
  • Prone to use anger as a weapon to silence or frighten their partner.
  • Undermine your needs, prioritising theirs.

 

Predisposition

Controllers are people who are likely to have grown up in environments where they had to emotionally take care of themselves from a young age, and become tough because they felt emotionally neglected, and vulnerable. A parent or any care giver needs to be emotionally available to a developing child in the formative years,  offering what Bion (1962) termed containment, where the emotionally attuned and receptive adult take on (introject) the child’s distressing emotional states and feelings, metabolises it, and hands it back in a detoxified manner. If there is emotional neglect, the baby never gets to learn to develop the capacity to process and regulate their own emotions. If this form of neglect happens throughout childhood, the child develops a defensive way of coping which protects that vulnerability. Becoming tough, in order to protect oneself is indeed a part of that protective mechanism. Emotional neglect is a form of abuse and if it happens consistently throughout the child’s life, it leaves long lasting scars.  Research (Bellis, et al, 2014) suggests that people who suffered emotional abuse (Adverse Childhood Experiences) are likely to grow up to become adults who have anger issues, other difficulties regulating emotions, have difficulties with interpersonal relationships, as well as develop frank mental health challenges.  Anger is a core feeling in controller’s lives, as it makes them feel powerful, yet they do not associate it with vulnerability. Deep down, controllers feel incredibly weak and powerless; controlling the other person makes them feel powerful. People who were bullied in their childhood are likely to become controllers to their partners, so is people who grew up witnessing their parents’s dysfunctional relationships.

 

The controlling behaviour itself is a trauma reaction, as one felt exposed and vulnerable as a child. We fight, flight or freeze as survival, instinctual reactions. One would consider controlling behaviour as part of the “fight” way of functioning. From a very young age, controllers’ only way of survival has been to be tough, and this becomes integrated as part of one’s personality, albeit pathological. Controllers often finds it difficult to relinquish power, and give up their position which is all they have known. Giving up the power also means exposing their vulnerability, and there is a threat of psychic collapse. This is why most controllers present to therapy with anger related issues, either in individual or couple’s therapy. They do not often view their behaviour as problematic, until the therapist points it out to them. Anger is what you see on the tip of the iceberg, while underneath it there is fear, anxiety, shame, worry, insecurity, guilt, and a lot of fragility.

 

Victims of controlling partners are likely to be people who have a very impoverished sense of self and lack a definition of themselves. They are therefore unable to fully articulate their needs since they do not know what they value, or not and the limits of how they should be treated. They often lack the ability to advocate for themselves, and depend on their partner, deferring to them to make decisions. People who are in this type of relationship are likely to be co-dependent on each other, one playing the role of the controller and the other the victim. Victims of controlling behaviours are likely to be people who grew up being made to feel like their neds were insignificant and secondary. They had to rely on others-parents, or older siblings, to make decisions for them. Being in the dynamic with a controller is a familiar place for them. Freud (1912) described this as a transference, where one relates to figures in their current life as if they are figures from their past. While this phenomenon is unconscious, there is repetition of the dynamics in these early relationships “there and then”, projected in the present “now” and there are similar feelings evoked. This is why people who are victims do not often realise it, as it is a repetition of something repressed, however familiar at an emotional level.  Freud (1912) argued that in repeating, remembering, and working through these early experiences, we are able to use the transference to unravel the past, and work through the early trauma that was repressed in the present. This is why therapy is significant in helping both victims and perpetrators of controlling behaviours in relationships. It is true that a big part of how we relate to our partners in romantic relationships is transferential. Some partners will unconsciously create  parent – child dynamics, while others will have sibling dynamics etc. These transferences are not always fixed &  get illuminated at different times- for example a partner can  easily become the critical mother, annoying sibling etc, or a simple argument can provoke a powerful response, as a transference response. The reaction is due to the familiarity of the experience & the feelings it evokes.

At unconscious level, what attracts us to our partners is the very thing that either we may have sought in our own parents, or see in our partners & want to regain & preserve it.

 

Couples can work through and heal from this form of abuse, if they put in the work through therapy. Individual therapy is also helpful in addressing control issues in relationships, for both victim and the controller. A big part of this behaviour is related to past trauma. Recognising that there is an issue is the first step into the healing journey, and developing empathy towards each other. It is true that some cultures normalise controlling behaviours in relationships, and women are often viewed as subservient to men. This is very harmful, as it often leads to other forms of abuse such as physical, verbal, and emotional abuse.

 

How to heal from controlling behaviour in relationships

 

Victim

  • Recognising and accepting that you are being controlled is the beginning of the healing journey. When we acknowledge something in our lives, there is a huge transformation that already takes place.
  • Learn to advocate for yourself and be firm & consistent.
  • Make your partner aware of how their behaviour makes you feel and remind them that you are an adult, and you have the right to make decisions for yourself.
  • Have meaningful relationships with your family and friends. Controllers like any abusers often alienate their victims.
  • Seek professional help as some of these behaviours are deep rooted.

 

The Controller

  • Learn to let go of the need to control your partner and the relationship.
  • Understanding the source of the need to control and being able to reflect on it is helpful in managing this behaviour. Think about your past and when you were made to feel weak and vulnerable. Have compassion over your younger self and understand that is the past.
  • Find ways of managing your anger, which is often at the root of controlling behaviours.
  • Seek professional help individually and work through some of this childhood trauma that gets acted out in the relationship.
  • Seek couples therapy & learn healthier ways of relating with your partner with their assistance.

References

 

Bellis, M.A., Hughes, K., Leckenby, N. et al. National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England. BMC Med 12, 72 (2014). https://doi.org/10.1186/1741-7015-12-72

 

Bion, W. R. (1962). Learning from experience. London: Karnac

 

Freud, S. (1912). The Dynamics of Transference. – Strachey, J. (1958). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913): The Case of Schreber, Papers on Technique and Other Works. [Electronic version]. Retrieved from PEP Archive database. http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib,cookie,url&db=pph&AN=SE.012.0097A&site=ehost-live

 

Freud, S. (1914). Remembering, Repeating and Working-Through (Further Recommendations on the Technique of Psycho-Analysis II). – Strachey, J. (1958). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913)

 

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Victim Mentality and Romantic Relationships

COPYRIGHT CITY SANCTUARY THERAPY

No part of this website, including the blog content may be copied, duplicated, or reproduced in any manner without the author’s permission.

Any information, materials, and opinions on this blog do not constitute therapy or professional advice. If you need professional help, please contact a qualified mental health practitioner.

 

Do you know someone who “wallows in self-pity”, or complains about their life/situation without doing anything about it?   They blame everyone else around them, but themselves. They lack any sense of responsibility or accountability over their own actions and overlook how they contribute to situations that they repeatedly complain about. People around them are quick to label them “energy vampires”, and you can only take them in small doses, because being around them is emotionally depleting. They bring you down, no matter how much you love them. The description l gave matches people who have victim mentality.

 

Victim Mentality

Victim mentality is one of the phrases/concepts that has emerged in this current psychobabble era;  its also a period where people are more open to talking about abuse in relationships. Victim mentality is harmful in any type of relationship-friendship, sibling, collegial, and other interpersonal relationships. It is even more harmful in romantic relationships where the power disparities are likely to get bigger, as a result of this way of functioning. If there is one partner who views themselves as a “victim” in every situation, it subconsciously puts the other partner in the perpetrator role. It then becomes very easy for the victim & their partner to inhabit these roles, and unconsciously enact them. Ironically, people who have victim mentality tend to pair up with “controllers”-people who like to control and dominate others. This means each partner adopt a fixed role & play it well.

 

Victims in Relationships

Victims are people who tend to be passive in relationships & simply let things happen around them. They allow their partners to get away with abusive behaviours, and let their boundaries pushed, without enforcing them. Victims feel that they can neither  speak up, nor advocate for themselves. So they simply complain, and complain, and complain , about the same situation. Since they view themselves as the victim, it’s safer for them to complain without doing anything about the issue they complain about.  At an unconscious level, this behaviour is a result of fear of abandonment, and lack of trust in themselves as lovable and deserving. Safety is an innate need. Our ancestors lived in batches for safety reasons. Abandonment meant being mauled by wild animals. We all have that inbuilt  and hard wired need for safety, and security, which is part of our evolutionary make up. Victims also lack a definition of themselves; any threat of loosing partners (by speaking up) will trigger extreme anxiety of loss of self and/or psychic disintergration. Therefore, the   dynamic where there is victimhood leaves the victim in this fixed position without making any effort to change things, due to the fear of abandonment. Things going well for long periods of time can also make the victim fearful and insecure. They may unconsciously trigger bad behaviours from their partners, in order to reinforce that victim role, as it gives them a sense of validation. These destructive cycles reinforce that victim role and perpetuates the destructive cycle.

 

Internal Experience

It’s easy to ignore the distress behind people who have the victim mentality, and simply view them as annoying, weak, irritating, or spineless people.

 

People who adopt the victim role often have:

 

  • Low self esteem
  • Depression
  • Low confidence
  • Impoverished sense of self
  • Anxiety
  • Insecurity
  • Worriers
  • Emotionally fragile

 

Predisposition

People who adopt the victim mentality are likely to have grown up in environments where they felt vulnerable and unprotected by their care givers. They were made to feel bad for  being themselves, or speaking up for themselves, & often had to tune into their parents’ feelings and emotions. They  were neither nurtured emotionally, nor allowed to develop what Winnicott (1960; 1965) called the True Self.  According to Winnicott (1960; 1965) the mother must be receptive to the baby’s emotions, and respond to them in a way that the baby can be more trusting of their own abilities and develop their True Self. In order for the True Self to develop, the mother has to be able to receive what Winnicott termed the baby’s “gesture”, which gives gives expression to a “spontaneous impulse”. The source of this gesture is the True Self.  When the mother is unable to meet these spontaneous gestures, by receiving the baby’s omnipotence, the baby complies with the mother’s defensiveness, which forms the origins of the False Self.  In order for the True Self to develop, the mother has to be able to  makes sense of the baby’s needs by being attune to the baby’s emotional needs, and respond with empathy. There has to be repeated experience of this nature, which the baby has to internalise.  Failure to do that, the baby creates a defensive- False Self – out of compliance, which hides the True Self. When the False Self becomes organised, it acts as a protector of the True Self,  albeit inauthentic, weak and fragile. In contrast, the True Self is playful, creative, and robust.  If the  True Self, was never cultivated, the False Self becomes dominant over the True Self.  In adult life, the False Self means an impoverished  internal world and weak ego.  Since the  False self is inauthentic, one will seek validation in others- victim mentality. The lack of development of the True Self is what is behind feeling “fake”, “wearing a mask”, “an imposter” or feeling detached from oneself, and the world. People who adopt the victim mentality role are likely to have never developed their True self and therefore have an organised False Self, which lacks confidence & agency.

 

From an attachment perspective, victims are people who are insecurely attached, therefore fearful of abandonment. Most people who have victim mentality have anxious avoidant styles. Following Bowlby (1969) formulation of anxious avoidant attachment style, anxiously attached adults are people who are likely to have had mixed messages from their care givers. They could not depend on them, they had to care for themselves by keeping a distance, in order to feel safe. Anxious avoidant people tend to repeat the same pattern in romantic relationships-they tend to be very clingy and submissive to their partners, which is what lends them into victimhood. Although they may play the victim role, they are sensitive  to rejection. They crave to feel wanted, and needed by their partners, hence the submissiveness & placating themselves- the “martyr”.

 

People who had a secure attachment with their care givers/ parents, in childhood, are likely to approach adult romantic relationship from a place of confidence, autonomy, and maturity and see themselves as an adult who has agency, not a victim. If one has an insecure avoidant attachment style, they are likely to play out the internalised way of relating by drawing their partners close by being needy, and seeing themselves as victims who need protection. They do so instead of them doing something about the situation.  The clinginess itself & passivity is what perpetuates the cycle. From an attachment perspective, care givers of the anxious avoidant child would have not provided them enough safety and security and they could not rely on the parent to meet their basic needs. The partner of the victim is dealing with unmet needs from the parents.

 

 

How to Heal from Victim Mentality

  • Remind yourself that you are special & you deserve to speak up for yourself.
  • Learn to put your needs first or at least consider your needs in any situation.
  • Take risks and change the familiar patterns that you are stuck in for example apologising for things you haven’t done, taking the blame.
  • Remember you are not to blame for who you are, however you have the responsibility to change the dynamic
  • Seek individual therapy of you think you have victim mentality. Many a time we do not recognise how much of our behaviour is simply a manifestation of our way of relating, from the internal working models laid out in childhood. Not all these patterns are healthy & we have a duty to change them.

 

References

Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. Attachment and Loss. New York: Basic Books.

Winnicott; D.W. (1960). Ego Distortions in Terms of True Self and False Self. The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development. NY

Winnicott, D. W. (1965). “Ego Distortion in Terms of True and False-Self” in The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development 140. New York: International Universities Press

Image Credit- Anthony Tran- Unsplash

Categories
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Adverse Childhood Experiences/Childhood Traumas

COPYRIGHT CITY SANCTUARY THERAPY

No part of this website, including the blog content may be copied, duplicated, or reproduced in any manner without the author’s permission. Any information, materials, and opinions on this blog do not constitute therapy or professional advice. If you need professional help, please contact a qualified mental health practitioner.

 

Adverse Childhood Experiences/Childhood Traumas

What are ACEs/Childhood Traumas

Adverse childhood experiences (ACEs), also known as childhood traumas encompass the big stressors ” big T traumas”, and any other events which undermines the child’s sense of safety & emotional well being -“small t traumas”.  We often overlook the significance of these events unless if we examine  their impact on the child (0-17), who has no emotional capacity to process them. These traumas are not only actual events, but non-events, and deficits, that have a negative impact on the emotional wellbeing of the child. Our experiences in early life shapes our physiology, and brain structure which is primary to the developing personality. Contemporary studies in Adverse Childhood Experiences (ACEs) suggest that individuals  suffer “disrupted neurodevelopment” and “social emotional and cognitive impairment” following exposure to adverse and traumatizing environments during their development, which is associated with later costs to both mental health and physical health (Peckham, 2023).

 

The medical model has historically neglected the impact of the environment in “psychopathology”, until recent years where there is an acknowledgment of the intersection between early life traumas, and the development of emotional and psychological problems in adulthood.  In contrast, psychotherapy, particularly the analytic approaches, have always  put greater emphasis on the early life  experiences in the formation of one’s personality, and the development of “psychopathology” in adult life.  I am quoting psychopathology as it implies scientific knowledge, and conceptualisation, which goes against the non scientific  model of trauma which l am subjectively in favour of. It is true that most people who seek mental health treatment, or psychological interventions have a history of complex trauma, or some form of early trauma/s.  This means, without acknowledging the significance of ACEs,  these individuals would have their suffering pathologized, and diagnosed as having some mental disorders, and subsequently medicated- they simply become commodities in a system that seeks to label and medicate.  The psychotherapy world is experiencing a paradigm shift,  to a trauma informed  approach– which is ecological rather than pathological framing. This approach privileges the impact of life experiences, over underlying “pathology“. The trauma informed approach gives weight to the early life experiences, in shaping ones adult way of functioning; it also seeks to de-stigmatize, and de-pathologize one’s suffering.

 

My work as a therapist, and mental health practitioner, as well as my own lived experiences has given me the full appreciation of the impact of our life experiences in the formative years, in shaping ones subjectivity, personality, ways of viewing the world, and relating to others. I fully endorse and subscribe to the trauma informed model- philosophically and as an approach to therapy. I strongly advocate for an ecological approach, rather than medical approach, which often gives people fixed labels, without a consideration of the contextual factors behind ones emotional and psychological suffering.  Emotional and psychological suffering should not be viewed as some form of pathology, that should require a fixed diagnosis.  I fundamentally believe that as therapists, by focusing on psychiatric diagnoses and labels, we are unintentionally shaming our clients, and objectifying them as simply a “psychiatric diagnosis”. This has the effect of invalidating their unique lived experiences and the traumas that is behind one’s psychological distress.  That said, l am not anti-psychiatry; l fundamentally believe that the medical model and the trauma informed approach can inform each other, and work collaboratively, resulting in a more holistic way of working. Having alternatives also mean clients are empowered; they have options to choose between the medical or trauma informed approaches to address their difficulties.

 

Many research studies have  demonstrated the negative impact of adverse childhood experiences on an individual. Neuroscience Research (Amann, 2022) has proven that having a combination of ACEs increases the likelihood of developing mental health and emotional difficulties in adult life; three times higher  than the average person. This study examined 93000 cases, and concluded that those who experienced childhood traumas are 15 times likely to be diagnosed with borderline personality disorder. BPD is a personality disorder where the sufferer experiences difficulties with regulating emotions and experiences the world in extreme (black and white) terms. This leads to intense highs and lows, as well as other self-destructive behaviours. People with BPD often have great difficulties building and maintaining healthy relationships, as well as emotional regulation.  The formative years are crucial to personality development and some people’s emotional challenges in adulthood are directly related to a combination of environmental and psychological factors in their upbringing. Other studies on ACEs have been carried out by Kaiser Permanente and the Center for Disease Control in the USA involving 17,337 adults and correlated the number of categories of adverse childhood experiences (ACEs) with physical and mental health outcomes.

 

Allan Schore’s (2000) research and  pioneering work highlights the likelihood of people who have experienced childhood trauma- which corresponds with brain development- experiencing mental health challenges in adult life. Like Fonagy, he puts emphasis on the developing child’s capacity to emotionally mature, enabled by their environment-the attachment  with mother and relationship with mother who is able to help the child to regulate affect.  Schore coins the term ‘relational trauma’ bound in the traumatogenic experiences happening within the ordinary transactions between parent and baby in the course of looking after the baby. Through the research work there is evidence that early trauma impacts the child’s brain development, attachment styles, capacity to mentalise, which are the hallmarks of emotional and mental health difficulties in later life. Martin Teicher  researches on child abuse and maltreatment argues that “Brain development is directed by genes but sculpted by experiences” (p652). These approaches are viewed by many as medical, as they conceptualise that trauma leads to physiological changes in the brain development and functioning, leading to psychopathology. The focus is on the link between physiology and pathology.

 

Among other vital research, Young Minds (2018) and Bellis et al, (2014) concluded that having a situational or cumulative ACEs led to poor mental health in adult life. ACEs affect the child’s emotional development, which translates to problems with relationship with themselves, others and the world as adults. Apart from experiencing mental health difficulties in later life, people who had a combination of ACE are likely to have drug and alcohol problems, have early or unplanned pregnancies, are likely to be involved in crime, and likely to end up in the criminal justice system. Aman (2022) concluded that ACEs were related to mood disorders, depression, PTSD, anxiety disorders, eating disorders, schizophrenia, and substance abuse. For every reported type of abuse experienced in childhood, a participant’s risk for PTSD increased 47%. Each cumulative trauma also increased one’s risk for making a suicide attempt by 33%.

 

Examples of ACEs are:

  • Physical Abuse
  • Verbal abuse
  • Sexual abuse
  • Emotional neglect
  • Parental divorce/separation
  • Parental sickness or ill health
  • Having a parent who experienced mental illness
  • Having a parent  who went to prison
  • Living with a parent who abused drugs or alcohol
  • Living with a sibling who has a disability or mental health challenges
  • Exposure to parental conflict-family dysfunction
  • Loss through death-parent/sibling or family member
  • Loss of home-boarding school, foster care
  • Loss of home- foster care/adoption, house moves
  • Loss of home through emigrating and or house moves
  • Childhood sickness & illness eg asthma, cancer, eczema etc
  • Development issues eg stutter, dyslexia, bedwetting
  • Bullying
  • Relational Trauma in how the child is cared for by the parent
  • Accidents-car/fires/etc
  • Wars/conflict
  • Parental Responsibilities

The Child and the Adult

It’s easy to overlook the significance of childhood ACEs unless if we unpack and understand their long-lasting impact on one’s way of relating to the self, others, and the world, as well as one’s overall personality. Many people come to therapy unaware of the fact that some of their experiences in childhood were adverse. At times it’s a defence (Klein, 1946) against the pain of acknowledging it, while others simply genuinely lack the understanding, or the language to express it. Having an awareness of how an experience that was adverse or traumatic is impacting on one’s current life is significant. Not only is it validating, but helps that person integrate the trauma, and work through it. Knowing something about ourselves, helps us develop a more intimate relationship with ourselves, and relate to ourselves in a more sophisticated way. It makes that problematic issue less scary and we can also approach it with compassion.

 

Trauma and Privilege

Having a privileged life does not mean one is immune to ACEs. Parents who can provide economically but  emotionally cold, cause significant psychological harm to the child. A child who has been send to boarding school (rupture from their care givers & emotional support) is no different to a child who is placed into foster care. The emotional impact is the same.  The only difference is one has an economically privileged life, while the other comes from poverty. In her book on Boarding School Syndrome Joy Schaverien writes, evocatively, about the trauma of the privileged child who is removed from home, and send away to an artificial environment (boarding school) away from the primary care givers (Schaverien, 2015). Bullying is rife in boarding schools, and the children are deprived of love, physical affection, and emotional warmth, something that they fundamentally need in these formative years. Drawing on real life stories from ex-boarders, she is able to demonstrate how people who went to boarding school earlier on in their lives tend to experience significant difficulties with intimacy, sustaining emotional connections, have an impoverished sense of self, and lack confidence in adult life. This creates secondary issues in relationships -both romantic and interpersonal. Many ex-boarders have been negatively impacted by the separation from their care givers at a young age, tend to feel a lot of guilt and shame, and that they have no right to complain about their parents for creating such a solid foundation for them. These contradictory feelings invalidates their trauma and leaves them feeling even more isolated in their pain.   It is always important to reflect on the experience from a child’s perspective, not an adult; the adult is able to make sense of a lot of things that the child was incapable of.

 

Immigration and Loss of Home

 Many people do not recognise the significance of rupture from one’s home, and the impact of not having consistency in childhood. Whenever there is a move, we experience loss of home- the environment- as well as the relationship we create with that home (environment) and other people in our lives. When children are moving from one place to the other, whether it’s a one off or repeated moves, there is an internal sense of loss they experience. There is a breakdown of attachments (emotional bonds) (Bowlby, 1969) they create with the home itself, their friendship groups, teachers etc. This leaves emotional scars where in adulthood, attaching to others is avoided as there was never a sense of permanence in their world; attaching also means experiencing loss, so their relationships remain very superficial albeit unfulfilling. In adult life it’s not unusual for these people to have difficulties building and sustaining long term relationships, and having deep emotional connections with others. Some may also have identity issues, and feel rootless at an emotional level, and untethered in life.

 

 

Parental Divorce/ Separation

Most of the ACEs listed above happen in the children’s home environments, where there is either one or both parents present. It’s obvious that any form of abuse negatively impacts on the child; parental divorce and separation also does. While it may be the best outcome for parents and the children,  children inevitably experience loss of a parental unit, a family unit, and a disruption of their lives. The parental situation is not something that they can inform, nor make a decision on- as a result children of divorcing parents tend to blame themselves for the divorce, or feel that they are a liability. The adults involved often overlook the meaning of parental divorce and separation on the children  as the focus is on themselves. Ongoing parental discord does compound this trauma, while healthy co-parenting mitigates some of the trauma.

 

Parentification

Another ACE to keep in mind is when the child is being given parental responsibilities, also referred to as parentification. It is not unusual for parents to give their children adult or parental responsibilities and to be put in that role. This is typically the oldest child who is made to look after their younger siblings, or becomes an emotional confidant for one or both parents. It can also be a child who is made to manage other household chores, budgeting, etc. this takes away the child’s innocence and right to be a child who does not have adult responsibilities. Often, we hear people say “she/he is very mature for his age” implying that its a good thing. What we do not recognise is that we are burdening a child with adult responsibilities, and the perceived maturity is the only way that child had to cope with the situation. People who were parentified often turn out to be adults who are not very good at prioritizing their needs and advocating for themselves. They also easily become people pleasers, and may struggle with recognising when they are being exploited.  This is because as children, they never learnt to fully take care of themselves, as the attention was on others. They also lack the sense of justice  and injustice- boundaries-as their own boundaries were infringed at a very young age.

 

Abuse

It is no surprise that children who experience any form of abuse-physical, emotional, sexual and neglect will develop some psychological and/or  mental health challenges in adult life. Healthy development of a child is highly dependent on an environment where there is emotional safety,  where the mother  or care giver is able to make both environmental and emotional provisions for the child. The care giver has to be emotionally available and attuned to the child (Winnicott, 1960). Any adverse experiences will interrupt the normal and natural psychological development of the child. Children do not simply mature physically, but emotionally-they have certain milestones that they need to successfully reach and succeed. Without his holding environment and the presence of ACEs mean that the development can be arrested at any time. This means a lack of psychological maturity which translates to mental health problems in adult life. Neuroscience confirms that the child’s brain develops differently where there is abuse.

 

Discord in Parental Relationships

Children who grow up exposed to parents’ fights are indeed being harmed by those experiences. It is adverse and damaging for the child to witness directly to have an indirect awareness of parental discord. Children need to grow up in an environment where there is emotional warmth and safety. Even if the fights are concealed from them, children are very sensitive and emotionally perceptive. Children do very easily blame themselves and adapt according to what they think is best for the parents, not for them. This means that the children end up looking out for the parents, and putting their own needs down. They mould their world around their parents’ not according to their own growth trajectory.  Many parents stay in dysfunctional homes “for the sake of the children”. What they do not realise is that, raising children in an emotionally volatile environment is more harmful, and damaging to them than having two happy and warm homes, they can spend time in. Some cultures promote the idea of staying in toxic relationships for the sake of the kids which is damaging for them. For any parents, recognising the different ACES, minimising the exposure to them, and cultivating a healthy environment where the child is nurtured emotionally, supported, and their wellbeing prioritised is key.

 

Therapy and Healing Trauma

Neuroplasticity

Neuroplasticity refers to the capacity of neural systems to adapt and change. Neuroscience suggests that neurons in many parts of the brain continue to undergo structural change not just through childhood and adolescence, but throughout life. This means that any new experiences, at whatever age, can cause the brain to physically alter its synapses and change. In other words, we are stable enough in our environment because our genetic inheritance has been sculpted by natural selection over many lifetimes, but we are “plastic” enough to adapt to our environment within our lifetime. Peckham (2023) argues that “For so many mechanisms of neuroplasticity to have evolved indicates that the capacity to learn from and adapt to past experiences and to better anticipate the threats and opportunities we may have in the future enhances inclusive fitness, survival, and reproduction in our environment. p.5.

 

Trauma informed approach therapy validates one’s lived experiences and acknowledges the link between presenting symptoms and early trauma-ACE/s.  Since our brains are capable of changing, we can recalibrate them, and re-adapt to new experiences. The new “new experiences” can be used to heal or mitigate the impact of previous experiences; psychotherapy being an obvious candidate for “new experience”. The intersubjective relational work done in therapy enable people to work through the ACE trauma. The trauma informed approach is anti-shaming- it is very easy to shame our clients in therapy and retraumatise them, which also re-confirms their trauma. If the “new experiences” contradict the old experiences, clients are able to develop new ways of relating and being. This is what defines healing. Repeated shaming experiences generate an anticipation of shame and the experiences that trigger it. This anticipation may be referred to as toxic or chronic shame where the shame experience organizes a person’s identity and life around avoiding the anticipated and feared shame experience. Shame-driven distress and suffering is common across experiences of trauma and adversity.  “Recovery can take place only within the context of relationships; It cannot occur in isolation. In her renewed connections with other people, the survivor recreates the psychological faculties that were damaged or deformed by the traumatic experience. These faculties include the basic capacities for trust, autonomy, initiative, competence, identity, and intimacy. Just as these capabilities are originally formed in relationships with other people they must be reformed in such relationships” (Herman, 2001, p101).  Herman’s words highlights  why therapy is a fundamental aspect of healing childhood trauma. Van Der Kolk one of the pioneers in the trauma gives emphasis to the neuroplastic nature of the brain and the ability for trauma to be worked through in therapy. He postulates that traumatized people experience incomprehensible anxiety and numbing and intolerable rage, and how trauma affects their capacity to concentrate, to remember, to form trusting relationships, and even to feel at home in their own bodies. This work can only be done in a therapy where there can be repair to the damage caused by trauma. For more on the trauma- The Body Keeps the Score by Bessell Van Der Kolk and The Myth of Normal by Gabor Mate are excellent copies on trauma and healing.

 

Attachment Styles- Secure Attachment

Bowlby’s work on attachments-internal working models – relationship templates we create in childhood suggests that they can be repaired throughout the course of life. ACEs  lead to people having unhealthy attachment styles-avoidant, anxious, disorganised.  This create difficulties in interpersonal relationships as the attachment style informed behaviours and distress responses get reactivated in adult relationships. However through therapy, we can heal  and redefine these ways of relating to more secure relational patterns. The relationship with the therapist is a strong conduit for these attachment working models to change, as we can learn to trust others as reliable consistent, nurturing, and trustworthy beings.  The therapist can be experienced as a reliable care giver, and the therapy space becomes  a secure base. Donald Winnicott would have viewed this as  providing “corrective emotional experience”.

Understanding the significance of ACEs helps us make sense of why some people experience emotional challenges and psychological distress in adult life. No one is damaged, we have the capacity to heal and heal others through our own healing.

 

References

Amann, B.,  (2022) Trauma During Childhood Triples the Risk of Suffering a Serious Mental Disorder in Adulthood, European Archives of Psychiatry and Clinical Neuroscience.

 

Bellis, M.A., Hughes, K., Leckenby, N. et al. National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England. BMC Med 12, 72 (2014). https://doi.org/10.1186/1741-7015-12-72

 

Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. Attachment and Loss. New York: Basic Books.

 

Fonagy, P. and Target, M. (2000) Mentalisation and personality disorder in children: a current
perspective from Anna Freud Centre. In Lubbe, T. (ed.), The Borderline Psychotic Child, 69–89. London: Routledge.

Herman J.L. (2001). Trauma and Recovery: From Domestic Abuse to Political Terror. Pandora ed. New York, NY: Basic Books

Klein, M. (1946). Notes on Some Schizoid Mechanisms. International Journal of Psychoanalysis, 27, 99-110.

 

Peckham, H. (2023). Introducing the Neuroplastic Narrative: a non-pathologizing biological foundation for trauma-informed and adverse childhood experience aware approaches.  Journal of Frontiers Psychiatry,  Psychopathology Volume.

 

Schaverien, J. (2015). Boarding School Syndrome: The Psychological Trauma of the privileged child: Routledge, London.

 

Schore, A.N. (2000) Early relational trauma and the development of right brain. Unpublished invited presentation. London: Anna Freud Centre

 

Winnicott, D. W. (1960). The theory of the parent–infant relationship. In: The Maturational Processes and the Facilitating Environment (pp. 37–55). New York: International University Press, 1965.

Image Credit- Chen Mizrach Unsplash