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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.

This article was published on the Counselling Directory  Platform on the 11th April 2023

DEMENTIA

Dementia: Loss, grief and tips for patients and carers

By Dr Joyline Gozho, Adult Psychotherapist (Individual & Couples) FPC, UKCP, NCS

Published on 11th April, 2023

Many people have loved ones or know someone who has a loved one who developed dementia. Some people have lost (through death) their loved ones to dementia, and some are carers for parents or relatives with dementia.

The Alzheimer’s Society (2023) reports that there are nearly 900,000 people living with dementia in the UK and that this number is likely to rise to 1.6 million by 2040. The rise in numbers is due to increased awareness, which translates to more and more people being diagnosed and treated.

The reality is that dementia is not talked about as much as other forms of mental illness; it needs more attention. It is painful to witness the changes caused by the cognitive symptoms (memory loss and personality changes) as well as the behavioural changes, secondary to dementia. These changes tend to worsen as dementia progresses; the impact of the loss of faculties becomes more pervasive.

Dementia is a cruel illness, and insidious in nature. It affects anyone regardless of class, colour, gender, or creed. The famous movie, The Iron Lady, showed how one of the most powerful women in the world, Margaret Thatcher, succumbed to dementia in her later life. With dementia, it’s as if the person you once knew dies, and there is a rebirth of a whole new person, albeit in the same body. One must go through a bereavement process, and grieve for the loss of a person who is still alive. There is a real conundrum. The loss is of the old version, and encountering the new version which is altered in many ways. The initial death in dementia is not a physical one, but a psychic one.

Dementia warps the concepts of time and space, past and present, life and death, the child and the adult, childhood and old age, dependency and independence. It gives merit to what Freud (1922) postulated that “the aim of all life is death”, and that in life there is a constant battle between life instincts (Eros) and death instinct (Thanatos). Seeing someone you love succumb to dementia does indeed raise a lot of existential questions. The adult regresses from a state of independence into a childlike state of complete dependence on others.

In advanced dementia, the functional decline and regression are extraordinary; the person regresses into the past, they may speak in a childlike manner, display childlike behaviours, needing feeding, continence management, bathing, putting to sleep, and all care. Just like a baby.

At times, short-term memory loss means the person may not recognise the faces of their loved ones. This can be very distressing for all involved. If the person is bi-lingual, they may lose the ability to speak the secondary language and revert to the primary, even if they may not have used it in their adult life. Those with dementia will also go through a grieving process and experience bereavement without an actual death – the death of their healthy self.

Depression often co-exists with dementia; many people who develop dementia will need treatment for signs of depression. And actually, many carers of dementia patients will also develop physical and psychological health issues secondary to the stress of their role, and the emotional strain.

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What is dementia?

Dementia is a neurodegenerative disease, which causes progressive memory loss, personality changes, and a decline in social functioning (NICE, 2018). As dementia progresses, speech can be affected, which impacts communication, as well as functional decline. The loss of faculties leads to a decline in executive functioning abilities. The Alzheimer’s Society reports that 70% of people in nursing homes are people with dementia.

There is a myth that dementia only affects elderly people but this is not always the case. In the UK, the youngest person to receive a diagnosis was in their early 30s. Having a dementia diagnosis is not a death sentence. There are many people with a dementia diagnosis who live healthy and normal lives in society, following their prescribed treatment.

Signs and symptoms of dementia

Cognitive and behavioural changes include:

• forgetfulness, memory loss (short and long-term in advanced dementia)
• not remembering the names of people and places
• losing valuables (keys, wallets) etc.
• confusion-muddled thoughts
• communication difficulties, jumbled sentences
• disorientation – getting lost in familiar places
• falls and accidents proneness
• regression to “living in the past”
• childlike behaviours – giggly and disinhibition
• difficulties regulating emotions – emotional lability
• aggression and irritability
• paranoid and suspiciousness
• wandering
• functional decline: difficulties with basic skills such as shopping, bathing, cooking and continence

Dementia symptoms are known to worsen in the evenings, a phenomenon known as “Sundowning syndrome”.

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Types of dementia

Alzheimer’s

Alzheimer’s is caused by a build-up of protein (amyloid) in the brain. There is then a shrinkage of the brain and loss of brain volume. Medication from the group called acetylcholinesterase inhibitors (ACHEIs) is used to slow down brain degeneration. People with Alzheimer’s are likely to experience gradual memory loss in comparison to the vascular type which is a more “step-wise” decline.

Vascular dementia

Vascular dementia is a result of limited blood supply to the brain; due to the narrowing or blockage of small blood vessels in the brain. It can also be caused by vascular accidents (undetected mini-strokes) which create pockets of damage on the brain, as well as major strokes.

VD cannot be treated with ACHEIs. Sufferers have to manage the underlying vascular diseases (high blood pressure, diabetes, heart disease or high cholesterol) to minimise the risk of further accidents and deterioration. A healthy lifestyle is a recommendation.

Mixed dementia

Some people have a combination of both Alzheimer’s and Vascular dementia. This is called Mixed dementia. They will have both AD and VD pathologies and can be prescribed ACHEis to help slow down the degeneration.

Lewy Body dementia

This type of dementia is less common that the others. This is caused by deposits of the abnormal protein, Lewy Bodies, in the brain. It is named after the neurologist Fritz Jacob Lewy, who discovered these Lewy Bodies.

 

Fronto-Temporal Dementia

Fronto Temporal Dementia (FTD) is a type of dementia which is caused by damage to the frontal and temporal lobes of the brain. It is easily mistaken for other types of dementias or mental illnesses, due to the behavioural symptoms the  FTD sufferer presents. Along with memory loss, people with FTD often present with behavioural problems, and language difficulties. Younger people are likely to be diagnosed with FTD, than any other forms of dementia, and it is likely to progress rapidly.

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Dementia assessments (UK)

Dementia assessments are carried out by specialist teams in the NHS called Dementia Assessment Services/Memory Assessment Services. Some people have assessments done privately. The assessment follows a medical model; only a psychiatrist can formally diagnose dementia, although a multidisciplinary approach is taken in the assessment and treatment.

Assessments involve a combination of psychometric assessments, brain Imaging-CT scans and MRI scans, family history, and at times, neuropsychology assessments carried out by clinical psychologists. Physical causes of memory loss must be ruled out before a dementia assessment is made. For example, urinary tract infections can cause delirium which mimics dementia symptoms, albeit reversible. Dementia stages can be viewed as mild-moderate or severe, and receiving a diagnosis in the early stages lead to better treatment outcomes.

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Tips for caring for someone with dementia

Improving the well-being of families and carers

People with dementia are incredibly vulnerable. It is important that their families and carers are supported in their roles. Psychoeducation is a part of that. If you are a carer and you are feeling low, experiencing poor sleep, or anxiety, or are finding it difficult to cope, consult your GP and discuss therapy. Therapy will help you process and work through the emotional impact of having a loved one develop dementia (loss and grief).

If you suspect that your loved one is developing dementia, visit the GP and request a referral to a dementia specialist service for an assessment. Many people will put this off due to fear of what the assessment may reveal, but postponing things will only make the situation worse. Early detection means robust treatment and better outcomes.

All people with dementia benefit from a healthy lifestyle. NICE guidelines (2018) make this clear – eating healthily, maintaining a fitness regime, having a routine, and doing mentally stimulating activities are all essential to part of the treatment and management of dementia.

People with dementia benefit from a routine and structure. This minimises the confusion which often leads to agitation or aggression. Arrange day centre attendance where the person can spend time doing cognitively stimulating activities. Use visual aids to orient them, such as clocks and signage.

Engage in activities that help the sufferer reminiscent of the past, e.g. playing familiar music they used to enjoy, cooking meals they used to like, compiling a family album and going through the pictures together.

Many people feel guilty about letting go and want to do everything for their loved ones themselves. This often leads to burnout, as caring for those with dementia is extremely stressful. Seek help and support from carers and arrange respite to give yourself some time out.

As a carer/family member of a person with dementia, you are concurrently experiencing grief and loss of the person you knew. This can be spelt by feelings of anger, shame, guilt, sadness, regret, and real helplessness. It’s also easy to build resentment in the caring role, as caring for someone with dementia can be incredibly challenging. Many people in this position, if not looking after themselves (a common occurrence in carers) notice a decline in their own health due to either emotional overwhelm, the physical stress of caring, or both. It is important that you maintain your well-being and have a community and support network.

As a carer, make sure you prioritise your well-being. Taking a break and using respite care to enable you to replenish is necessary. Do things that you enjoy – engage in old and new hobbies.

If the deterioration worsens and the risk to you or the sufferer is getting high, it is best to place the person in a secure environment, e.g. a residential home or care home. Many people struggle with this, as they consider it to be a sign of failure or letting their loved ones down – it is not. As difficult as it may be, this is an act of love for yourself, and your loved one.

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References

• Alzheimer’s Society (2023) https://www.alzheimers.org.uk/about-us/policy-and-influencing/local-dementia-statistics
• Freud, S., and Jones, E. (Ed.). (1922). Beyond the pleasure principle. (C. J. M. Hubback, Trans.). The International Psycho-Analytical Press. https://doi.org/10.1037/11189-000
• NICE Guidelines (2018) Dementia: Assessment, management and support for people living with dementia and their careers. NICE: UK

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.

I posed this blog topic as a question, as I think that very specific question requires huge attention;  it’s long overdue.  This question is fundamentally more topical now, as we live in a world where there is widespread misinformation, made possible by the internet, and some TV programmes, which are made for entertainment. Social media eg (Tik Tok, Instagram, Facebook) perpetuates this misinformation; we often forget that some people monetise their  content & will post anything that draws attention-clickbaits. Any one can  post anything online, and the information is not fact checked. This could be  misleading information and very harmful. I have had many clients diagnose themselves with all kinds of things- Personality Disorders, Anxiety, Autism, ADHD,  OCD, etc, after watching Tik Tok, Instagram posts, or the mighty Google. I always get them to reflect on the reliability of this information & recognise the harmfulness of it.

We live in a paradigm where people use Google, as a source of information. By simply reading someone’s advice or opinion on a particular subject, we tend to believe it, without questioning the validity, reliability, and credibility of the source of information.  There are numerous TV programmes where “individual therapy” or “couples therapy” sessions are screened. We forget that this is entertainment. I personally do not watch these programmes as the ethical issues that arise in most of them leaves me feeling very uneasy. Revolted to be frank.  Sadly, many people believe that the TV programmes of “therapy” sessions or “couple’s therapy” sessions depicts the reality of what happens in the therapy room. They don’t!  Many people are put off the idea of therapy after watching these TV programmes, while the inherent misinformation lead to some people approaching therapy with unrealistic expectations.

It’s almost impossible to know what therapy is about, unless if you have been in therapy yourself, or if you know someone who has been to therapy, who has shared their therapy experience with you.

By exploring with you why people go to therapy in this blog, l will hopefully shed some light to why people go to therapy in the first place, and highlight some of the nuances around  therapy.

The Therapist, The Human

In social settings, when asked what l do for a living, l find it easy to default into “l am a lecturer”. Why?  Because l know what kind of questions disclosing that l am a psychotherapist stimulates, which l would rather avoid & play safe.  I recognise this is something l do as a defence, as revealing that “l am a psychotherapist” or simply mentioning “therapy”, is met with a lot of questions that l don’t  feel comfortable  to answer in social settings. One question often triggers another. In short revealing that I am a psychotherapist is often met with shock, curiosity, and at times suspicion that l may have ulterior motives, and l can “read people’s minds”. That’s not what I am about; l certainly do not have the magical powers to do that. It’s not flattering at all, rather jarring.  On the contrary, another  reason why l avoid talking about therapy in social settings is that l tend to get very passionate; just like being in class with my students. So instead, I go into survival mode, which is not okay. But it makes sense in the moment.  When I have disclosed that l am a psychotherapist, two of the main questions l have been consistently asked are “what is therapy” and “why do people go to therapy”. The first question was answered in my second blog post on “Navigating the Therapy World.” It is therefore essential that we discuss why people go to therapy after all.

Why do people go to therapy?

It is difficult to answer this question without sounding simplistic, and being intentionally so. People tend to approach therapy at different stages in their lives, and with varying presenting issues.  The reasons are not universal. People are not impacted by the same things in life, and their ability to cope with certain life situations differs depending on many factors, including how we were raised in our homes, how our parents dealt with our emotions, and their emotions, which all defines the level of emotional maturity we have achieved.

Fact- people come to therapy for different reasons. Some come to therapy when they are in crisis- for example following a relationship breakdown, bereavement, job loss, or acute mental health challenges. Others come to therapy as part of their personal growth and development. Some may be aware of distressing thoughts, feelings, and repetitive patterns which are impacting on their wellbeing, and life in general.    There are some people who are more psychologically minded and will have an awareness that there were some “traumas” or pernicious experiences in their past and would like to use therapy to explore them. The notion of “working through” is used in therapy, as therapy is a process that requires confronting, and coming to terms with some parts of ourselves that may have been unconsciously split off, disavowed, denied, or felt very alien to us. In working through, we are able to create meaning out of something that may have been meaningless, and provoking distress, emotionally burdening, or stimulating disturbing feelings. Having a deeper understating of ourselves enables us to be more in control of these feelings,  make sense of them and have clarity.  Instead of being reactive or being at the mercy of them, we can embrace them with grace, compassion, understanding, and be more reflective. Many people will have had previous relationship traumas;  the new relationship experience with the therapist in the present, can effect change in many ways, for example by enabling them to learn new ways of relating,  attunement,  affect regulation, develop a secure attachment, and enhance reflective abilities.

Another concept central to why people come to therapy is “processing”. I consider this to be a form of psychological metabolism. By processing, we are able to enrich our lives with the learnings we take from the processing, and let go of what we do not need. Just like when we have a meal, the body processes  the food,  derive nutrition from it, and let go of the waste. We do the same in therapy, food symbolising our life experiences-unpack, breakdown, nourishing ourselves, & let go of what no longer serves us. A major aim of therapy is to enhance reflexive function- therapy provides one with an opportunity to explore, experience, consider and master feelings. The relationship with the therapist is central to this.

Intellectual Understanding vs Emotional Understanding

I found this very simple formulation helpful:  Some people come to therapy because they feel and need help to understand, while others understand and need help to feel.

This is so profound as it captures what therapy is about. Many people who come to therapy are very intelligent individuals and they “get it” intellectually. However, there is another level of understanding-emotional understand- which is missing. Therapy helps them develop an emotional vocabulary (naming & understanding their emotions) and integrate that to their intellectual understanding. Intellectualisation can also be a defence (Klein, 1926) which people use to keep difficult feelings at bay. Therapy is a process of slowing down and allowing an integration of cognitive understanding and emotional understanding. This requires a lot of vulnerability and trust as it means letting go of the defences that we have used throughout our lives and getting used to new ways of being.  By emotionally understanding, it means we can be more in touch with ourselves, and embrace our emotions without fear, or overwhelm. This is why and how therapy enable us to experience ourselves more wholesomely.  I fundamentally believe that having a healthy relationship with ourselves is a prerequisite to having healthy relationships with others. We cannot see, love, and accept others without firstly seeing, loving, and accepting ourselves, with all the good and the bad.

Narrative Competence

There is so much power and healing in telling our stories, in our own words. Many people find it difficult to remember or have coherence in their life experiences and the past. Their memories may be patchy, vague, jumbled, and at times completely absent-erased. This is more so when there has been past trauma, and when there has been experiences that are psychologically painful. The mind has a sophisticated way of protecting us, for its own survival. In the context of “trauma” Van Der Kolk writes a lot about how  trauma is stored and how traumatised people experience incomprehensible anxiety and numbing, and how trauma affects their capacity to concentrate, to remember, to form trusting relationships, and even to feel at home in their own bodies. Although this work is around trauma, it helps us  understand how trauma affects our ability to remember things and  how it can manifest in a somatic form. (Re-trauma, read my blog on Adverse childhood experiences). This is why at times some people  are overwhelmed by feelings, but they cannot locate the source of the feelings, which is in the past. The ability to describe one’s past, however painful clearly and coherently, without denying or censoring aspects of it, is indeed a powerful and transformative experience. This also enhances our ability to name feelings, experience them, and self sooth. This reflective and reflexive work enables one to re-evaluate the past and create personal meaning. Developing a coherent narrative enables us to integrate different aspects of our lives that may have been deemed to painful & split off or repressed. This work can only be done in a contained space- therapy. This is why the space itself has to be safe & secure enough for this work to be done. There is evidence that our minds can adapt to change, over the course of our life time, a term called neuroplasticity. This neuroplastic quality of our mind enables us to work through the past, by replacing “old experiences” with new ones that are built in the safety of the relationship with the therapist.

Do Therapists Fix People?

This question has come up very often, especially when people are approaching therapy for the very first time, with specific problems-they want to be fixed!  No, Therapists do not fix people. Therapists are human, and therapy is a process that is co-created and co-constructed by two humans. Therapists have feelings too, and clients do not often have the awareness of just how deeply they affect and change their therapists. Therapists are work in progress, like everyone else; we learn a lot from our clients. The process is not about the therapist having the answers, and telling the client what to do; rather finding the answers between us. The admirable Psychoanalyst Patrick Casement (1985) wrote an excellent book called On Learning from the Patient, dedicated to exploring how therapists creatively learn from their patients. There is a notion of therapists being all knowing, which is not true. Therapists don’t have the answers for their patients. They are there to hold the mirror for the clients to see a reflection of themselves on that mirror. They may guide or lead, or direct. However, it is fundamentally the client who is the master of their own life. Therapy gives people a voice, the ability to define themselves, and empowerment to do so. From the therapist’s perspective, it is countertherapeutic to work  from a place of omnipotence, as it simply means we are seeking to serve our own narcissistic needs by being a “great therapist”.  I myself have been a therapist for many years, and l do not consider myself some kind of guru.  In any therapy, there are two human beings, in the therapeutic space. None of them is neither superior to the other, nor better than the other. The therapist in not all knowing.

On the very notion of therapist meeting their own ego needs, Winnicott (1969) said that “ The principle is that it is the patient and only the patient who has the answers” . This is a caution against the idea of  the therapist being the fixer and giving clients, the right “tools” to “fix” things. Therapy is a journey that is taken by both client and therapist. It is not an event, or simply a meeting that takes place once weekly.  The journey itself can be precarious, and prone to having ups and downs. The ability for the therapist to “hold” the client through the journey, and through the turmoil, is what becomes successful therapy. Winnicott (1969) writes about the concept of “holding” as a mother who holds the baby in the early stages of life- providing a holding environment and psychological holding. The therapist has to have an emotional relationship with a client, but also be able to emotionally separate themselves from the client material. This is complex, and a rather contradictory place to be, where the therapist can be with the client, and bear their feelings with them, and survive it together, without contamination. The ability to survive is what the client internalises and subsequently build their own internal resources. The ability to function in this reflexive and paradoxical space, explains why therapy training is long,  and very rigorous, and why its mandatory for trainee therapists to be in analysis. Qualified and practising therapists go to therapy too. I have done, and go back to replenish when l need to.

The Relationship- Boundaries

There need to be boundaries between the therapist and client in any therapy that is therapeutic. Many clients who are new to therapy experience a degree of frustration of having to tell the therapist about themselves, and the therapist not reciprocating. It makes sense to them why this is necessary as time goes on. The relationship between therapist & client  is neither a friendship, nor is it any personal relationship where you would discuss your day-to-day shopping, fashion trends, football or other day-to-day stuff. It is unique in many ways. It is a therapeutic relationship; a deeply intimate and meaningful one. Oversharing with clients turns the process into it being about us (therapist) than the client, and takes away the attention from the client. There is an imbalance of power from the outset as the client consult the therapist who has certain accolades to qualify their position. I always remind my clients that they are hiring me, which is true, and this neutralises the power dynamic. I remind my clients to call me by my first name (Joyline), as my professional title implies a degree of authority and knowledge.  When a therapist starts disclosing and overstepping this boundary, they are creating a power dynamic, where the client becomes secondary. Social media platforms also create real issues for some therapists with regards to what they can share, and how much they can share of themselves even if it relates to wellbeing, mental health, or therapy. It is indeed very easy to breach this boundary, albeit with good intentions. Clients come to therapy because their own boundaries may have been impinged on, or they have never learnt to create boundaries. By oversharing, we are simply modelling the pathology that they need to work on and retraumatising them.  Some clients come to therapy because no one has ever given them undivided attention, or showed an interest in them, and they are neither valued nor respected and feel ignored. It’s very easy to repeat the same trauma with our clients when we step outside the boundaries of a professional relationship.

Safety and Security in the Relationship

 Safety and security are innate needs, that humans are biologically wired to seek. We are programmed to seek safety and security and without it, we defer into survival modes of fight, flight or freeze.  Just as an animal would;  that’s the essence of who we are as humans, who belong to the animal kingdom. This becomes paramount in any therapeutic encounter. There is an encounter of two strangers. Clients need to feel safe, secure, and held, not just in a physical sense but held in the mind. This is the foundation of clients working through their difficulties, knowing that the therapist is holding them in the mind, and they are safely held. The therapist act as what Winnicott terms the “auxiliary ego” for them, by being able to hold the client in the mind. Winnicott (1960) wrote about this concept hypothesising that the therapy dyad mirrors the mother and baby relationship, where the client identifies with the baby, and the therapist the mother. The mother has to be capable of holding the baby safely, by having the function of being the auxiliary ego.

Despite there being different modalities to therapy, most therapy approaches will have the following qualities:

•  Discussing presenting issues & their onset
• Discussing past experiences
• Exploring distressing thoughts and feelings
• Affect and expression of emotions
• Identifying recurrent themes and patterns
• Learning to identify and name feelings
• Developing an understanding of our emotional life
• Making some links between past and present
• Creating a definition of self
• Meaning making-creating meaning around one’s experiences

Some therapy approaches (more specifically CBT) focus on the present, and will entail a lot of behavioural experiments and homework. This is unlike most approaches to therapy which are explorative, and themes emerge naturally.

As a therapist, I have struggled with the notion that there are certain modalities that are based on the principle that  by ticking boxes, clients’ experiences can be reduced to specific diagnoses, and there are certain “proven scientific tools” applied as a form of treatment. This is what some of the contemporary and so-called evidence-based therapies purport. The basis of this approach is a medical model; applying it to something hermeneutic (therapy) is problematic.  The human experience is very complex, and multifaceted- from its bio, psychosocial, spiritual, sexual, and phenomenological contexts. While I appreciate that this approach is helpful for some acute problems- OCD, Agoraphobia, panic disorder, etc, the approach itself is reductive, and simplistic.  With these type of therapies, clients  have a prescribed set of treatment, and  they come with a set of tools and a manual. I fundamentally believe that this approach disregards the contesting and multivariate nature of what it means to be human. It also undermines the significance of the fundamental aspect of therapy which is the therapist and client’s deep and meaningful relationship, which is key to any successful therapy. The tools become the focal point, and we forget the person who is suffering and why they are suffering in the first place. This does not sit well with me. That said, I have found using this approach (tools) useful as a form of grounding for clients who are experiencing present day distress and functional  impairment, before going into therapy proper. When clients build a deep and intimate relationship with their therapist, they are also learning to build an intimate relationship with themselves and others, and to trust themselves and others. If we have an understanding of ourselves, we are likely to understand why we feel the way we do and why we do things the way we do them. When we have this awareness, we respond and not react. We experience the world in a conscious fashion; knowing something makes it less scary, less painful, and more bearable.

Therapy Metaphors

The House-Rearranging Psychic Furniture

 When thinking about therapy, I like to use the metaphor of a house to describe our psyche. If your house is  unattended, dirty, with furniture disintegrating, rubbish everywhere, paint/wallpaper falling off, lighting going off, and you keep stumbling and falling in that house, it won’t feel good, living in it. It will feel quite scary, and unsafe. Using that analogy, therapy is akin to you simply cleaning the house (psyche), rearranging the psychic furniture, and bringing everything back to life again-light switches etc. Rearranging the furniture, will entail moving things around, opening some packages & looking at what’s inside them & getting rid of what we no longer need. That’s why therapy can be a painful process, as it means confronting some of these packages that may be “foul and rotting” and getting rid of them. These may be packages that we have relied on, and deemed important. Therapy is a process of continuous loss and grieving over the loss, of the old and coming to terms with the new; what we become.  When you have a clean home, you will feel safe & in control. You will know where to find things, value your property and likely to continue taking great care of it.  This is why people who come to therapy become acutely conscious of their boundaries- it’s the psychic boundary they create after the process of  cleaning & rearranging their psychic home.

The Gym- Psychological Stretching

Therapy enables emotional stretching and expanding one’s emotional bandwidth. We go to the gym to exercise in order to strengthen our muscles & core- physique. Our emotions also need the same kind of stretching in order to maintain a certain level of robustness & stamina. Therapy enables us to do the emotional stretching & helps us to access a repertoire of emotions available to us in our emotional landscape, and understand them. Being in touch with our emotions and experiencing them fully, is what makes life meaningful, pleasurable, and rich.

Some people apologise for crying in sessions. Crying in front of the therapist is seen as a sign of weakness, and shameful. These are unhealthy internalised  notions. When you go to the gym, you sweat. By crying in session, you are simply sweating. And that’s ok. Believe me, therapists do tear up as well, when they are deeply impacted by your story. They just don’t break down and disintegrate.  We are right there with you. And l must confess, l have on many occasions been deeply affected by my clients’ stories (countertransference) and shed a tear with them.  For them. And that is indeed a special and deeply intimate moment, that no words can describe. In that moment, we encounter each other as fallible humans,  and heal together. l remain human, and will always be one.

References:

Casement, P. (1985.) On learning from the patient: Tavistock Publications. London

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

Winnicott, D. (1960). The theory of the parent-child relationship, International Journal of Psychoanalysis, 41:585-595

Winnicott, D.W. (1969). The use of an object, International Journal of Psychoanalysis, 50:711-716

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.

This article was Published on the Counselling Directory Platform on the 04th April 2023

RELATIONSHIP PROBLEMS

Ghosting and online dating: Psychoanalytic and Attachment Perspectives and self-care tips

By Dr Joyline Gozho, Adult Psychotherapist (Individual & Couples) FPC, UKCP, NCS

Published on 4th April, 2023

The Oxford Dictionary defines ghosting as “the practice of ending a personal relationship with someone, by suddenly and without explanation, withdrawing all communication”. Being ghosted is probably one of the most painful experiences to ever happen to anyone.

The abrupt and unanticipated nature of ghosting is often experienced as a form of emotional violence; it hurts. The ghosted person is left with a lot of unanswered questions, and the whole experience can be wounding, leaving one completely terrified of ever dating again.

There is typically a lot of emotional investment from the person who is ghosted, or at times both, and things seem to be going well. It all suddenly ends, with no warning. The person one was emotionally getting closer and closer to, evaporates into thin air. Most people who have been ghosted, report being blocked on all social media platforms, phones, WhatsApp, and any other apps that would give them access to the person who ghosted them. This can all be incredibly confusing, disorientating, and truly maddening.

Ghosting has become such a common phenomenon, and the hashtag “ghosting” trends on many social media platforms (Instagram, Facebook, Twitter, TikTok), where people share their stories of being ghosted. It seems there is a collective healing for victims of ghosting in sharing these stories and validating each other. Curiously, it appears, that it’s only the victims of ghosting who discuss their experiences, and never the ghosting perpetrators. This stimulates a lot of questions about why, and the inner workings of the person who ghosts others.

The new paradigm of internet/online dating has translated into a plethora of dating platforms and apps. This has certainly changed the dating approach from its conventional, and traditional ways. Dating platforms and Apps such as Tinder, EHarmoney, OKCupid, Hinge, Bumble, Match, Zoosk, etc. have millions of subscribers worldwide. GQ Magazine stated that in 2022, there were 5 million UK subscribers on E-Harmony, 3 million on Match.com, 4 million on OKCupid; the numbers of people on all the other platforms are staggering.

Before the rise and popularity of online dating, people would meet in pubs, bars, at parties, at work, at times randomly, or get introduced by family or friends. It was natural for people to know each other first, before dating, and relationships would develop organically. The pandemic with all the subsequent lockdowns disrupted people’s lives in such a profound way. People were locked up in their homes, and there were no longer opportunities to meet in more natural ways, as they used to. This also transformed into an increase in online dating, which is now the most common way of meeting potential partners.

Exploring the embodiment of the self in techno culture, Lemma (2015) views the nature of online dating as one that creates a short-circuiting of the work of desire, where there is instant gratification, and things happen in the moment. By simply logging onto the platform, one has access to thousands of profiles and potential dates. This affects how we relate to others intimately and challenges how intimacy is experienced on and offline. These virtual relationships can be very intense and surreal, as there is an illusory and seductive sense of safety.

The impersonal nature of it, and the screen acting as a barrier, can make someone who is ordinarily shy, lose their inhibitions, and feel empowered and confident to approach or interact with others on the online platforms. Lemma (2015) suggests that “The technological environment of cyberspace can thus confuse the boundaries between internal and external worlds, creating the illusion that internal and external reality are isomorphic” (p.7). We therefore need to revisit intimacy, and how it is experienced in the context of online dating.

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Psychoanalytic perspectives of ghosting

The paradox is that while the person who has been ghosted is left with a whole range of emotions – inadequacy, insecurity, shame, guilt, sadness, anger, vulnerable and confusion – these feelings seem to mirror what the person who ghosts may be feeling subjectively. There is a projective identification (Klein, 1946), a phenomenon where intolerable feelings in the person who ghosts are projected into the other person, and the recipient reacts to it as if it’s their own.

Klein (1946) considered projective identification as one of the most primitive forms of communication, during the earliest stages of life (paranoid schizoid position), where the baby mitigates the death instinct by mobilising these projective defence mechanisms. With projective identification the projections are “into” the mother’s breast, at times the good is projected for safekeeping (Klein, 1946). The person who ghosts simply projects their feelings “into” the victim, leaving the recipient to grapple with these feelings- shame, guilt, inadequacy, sadness, anger, confusion and vulnerability. The reason why the person ghosts is because they are unable to take back these projections, own them, and make sense of them.

People who ghost, yearn to have connections with others; that’s why they attempt to engage. However, they are fearful of emotional intimacy and will do everything they can to keep a distance, even if it means pushing people away and hurting them. They do this as a way of protecting themselves, as intimacy is seen as threatening. The sad part about it is that there is a part of them that genuinely wants to connect with others, but the act of connecting becomes unbearably threatening.

Glasser (1979) hypothesises with way of relating as a “core complex” where a double bind is created due to the fear of engulfment, leading to one keeping a distance. This distance then stimulates feelings of abandonment, which creates a double bind where one oscillates. The ‘ghoster’ will pivot between these two positions – wanting to connect and shutting down any form of emotional intimacy. Glasser (1979) views this as an infant’s form of self-preservation, which is very much led by anger and sadistic feelings. Self-preservation is indeed the underlying reason for ghosting.

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An attachment perspective of ghosting – avoidant attachment

People who ghost are likely to have avoidant attachment styles. Avoidant attachment is one of the three insecure attachment styles coined by John Bowlby (1969). Bowlby worked with Mary Ainsworth et al, (1970; 1978) to carry out infant observations, investigating how infants’ responded to separation from their caregivers, their level of distress, their response to strangers, and their response to being reunited with the parent.

Through this empirical work, they formulated that from as young as one year old, an infant has already begun to create these internal working models (attachment styles), and this can be discerned by observing how the infant interacts with the environment and behave around strangers.

Bowlby (1969) suggests that securely attached children who had received sensitive care in the first year of life would typically seek proximity with their caregiver, and show contact maintaining behaviours when reunited with their carer on their return. The children who did not have sensitive care in their first year of life were highly defended and showed avoidance ‘flight’ or resistance (fight) in reunion with their parents.

These observations would allow the classification of whether children are securely or insecurely attached and helped in deducing the child’s emotional development (Ainsworth; 1978). The psychological health of an individual and relationship patterns are postulated to be directly affected by the quality of the relationship between the baby and the primary caregiver, and the attachment pattern built during these formative years. These attachment styles are internalised, and they get reactivated in adult relationships and cause psychological ill-health if there is a disruption (Bowlby, 1969).

Bowlby (1969) identified four different types of attachment patterns which are:

1. Secure attachment, which is the healthy attachment style where the baby is able to play independently away from the mother and run back to a secure base when it needs to and know that mother will be waiting in reverence.
2. Avoidant (insecure) attachment where the baby is unsure whether they are secure or not, mainly because they get ‘mixed messages’ from their caregiver.
3. Preoccupied/ambivalent (insecure).
4. Disorganised is when the baby is completely unable to relate as they have not been able to experience a secure base where they can run back to.

In these dynamics, the role of the parent as a reliable, trustworthy, consistent, and solid caregiver is vital. Fundamentally, Bowlby viewed human connections (attachments) as key to our being and as an evolutionary component.

Although established in childhood, attachment styles shape how we interact with others, respond to loss, distress, seek help in life and behave. In romantic relationships our attachment styles which are these internal workings models are illuminated in such a profound way. Following Bowlby’s (1969) formulation of the anxious-avoidant attachment style, anxiously attached adults are people who are likely to have had mixed messages from their caregivers. They could not depend on them, they had to care for themselves by keeping a distance, in order to feel safe.

Avoidant people tend to repeat the same pattern in romantic relationships-making bids for closeness and pulling away. If one had a secure attachment with their caregiver/parent, in childhood, they are likely to approach adult romantic relationships from a place of confidence, autonomy and maturity.

If one had an insecure-avoidant attachment, they are likely to play out the internalised way of relating, where they are in a double bind of seeking closeness and distancing-ghosting. From an attachment perspective, caregivers of the avoidant child would have not provided them with enough safety and security and they could not rely on the parent to meet their basic needs. In adulthood the romantic context provoked feelings of dependency which are abated by ghosting.

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Self-care tips after being ghosted

As a therapist, I have worked with people on both camps, and l am taken aback by how vulnerable the person who ghosts equally feels. People who ghost others may present as confident, mature, and secure, yet underneath they feel very insecure, and fearful of intimacy. Ghosting is their way of regaining control in a situation where they are feeling less and less in control. Understanding this is likely to help you distance yourself from viewing the ghosting as something that you caused or that is about your own inadequacy.

If you have been ghosted it is important that you reflect on your experience with that person and your role. Do not always see yourself as the victim; someone who is unlovable or inadequate. It may not be your fault, as you were simply dealing with someone who has an avoidant attachment style.

If you are someone who tends to ghost when dating partners, you may need to reflect on yourself and seek therapy. The good thing is that insecure attachment styles can be repaired, and one can develop a more secure attachment by having partners who are consistent, reliable, and dependable and make us feel safe and secure.

If you have been ghosted, self-care is a significant part of your recovery from it. Be kind and gentle with yourself. Journal about it if you can, engage with hobbies, sleep well and eat well. Try to do things that distract you and divert your attention from thinking about the ghosting experience. Eat well, exercise, and spend time in nature. This will help you heal more swiftly.

Avoid getting into a habit of snooping online and trying to find what the other person is doing. Some people may feel so hurt that they want to seek revenge. They may create ghost profiles to check on the other person’s social media, etc. This will not help you in the short term and long term. It is likely as it is likely to cause you more anguish and it’s easy to start ruminating about the whole experience.

Ghosting can be very traumatic. Seek therapy if you are finding it hard to overcome the trauma of being ghosted as it may have provoked other childhood wounds around loss, abandonment, and rejection.

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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.

Glasser, M. (1979) Some aspects of the role of aggression in perversions. In Rosen, I. (ed) Sexual Deviations, (2nd Editions) Oxford: Oxford University Press

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

Lemma, (2013) Psychoanalysis in times of technoculture: Some reflections on the fate of the body in virtual space. International Journal of Psychoanalysis, Vol 96 (3): 569-82.

GQ Magazine
Accessed, 03/04/2023

Oxford Dictionary
Accessed, 03/04/2023

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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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.

Navigating the therapy world and not sure where to begin?

Many people are deterred from approaching therapy, and this is for various reasons. Some lack an understanding of what therapy is, and how it works, while others have no clarity on what the various approaches mean, and how the therapist would work with them.

Therapy is a very personal journey. Knowing the basics of each approach, reflecting on how you are living your life, & reflecting on which approach resonates with you is helpful, in identifying the right fit (therapist), and getting the right help (modality). I believe clients  should feel empowered and autonomous  in their journey, and they should make an effort to explore before engaging.

Is there such a thing as the best modality?

There have been numerous debates around which therapy approach is most effective, abetted by the IAPT placing some modalities above others. This has the effect of positioning  therapy modalities in a hierarchy, viewing some as gold standard, panaceas and evidence based. Instead of it being helpful, it often creates more confusion to people who are unfamiliar of the therapy world, and places some therapy modalities at a disadvantage, not because they are ineffective.

The Layard report (2006) informed the reforming of the NICE Guidelines, which led to the adoption of short-term, manualised therapies in the NHS. While this was a cost cutting exercise, it also meant longer term therapies were marginalised, as they are costly, and seen as non-evidence based. Secondary  questions on what is considered credible evidence arise,  as most of this research came from Randomised Control Trials (RCTs), whose reliability, and credibility in researching talking therapies remains questionable (Hinshelwood, 2010) . Furthermore, some research has concluded that while short term therapy is beneficial, its benefits wear off in the medium-long term (Norcross, 2005)

Numerous research studies have concluded that in any therapy process, it is not the modality that lead to positive outcomes, but the relationship. Some of the research which supports the notion that the relationship between the therapist and client is the main ingredient in any successful talking therapy has been carried out  by Blagys and Hilsenorth (2000); Leichsenring and Leibling (2007); Shedler, (2010); Norcross, (2011); Norcross and Wampold, (2011); Norcross and Lambert, (2019). This means that regardless of whichever modality one takes, the capacity to have a deep, and meaningful relationship, and an emotional (human) connection between therapist and client  is key to that process. Norcross, (2011) considers having a real relationship, empathy, positive regard, congruence and genuineness as some of the core elements of a therapeutic relationship   As humans, we have an innate need for safety & connection. This is central to any therapeutic, and meaningful therapy and is contrary to what is considered evidence based, therefore more superior.

Do we make the right fit?

There are many factors involved in considering who could make the right fit in therapy. I have encountered many people who have had negative experiences in therapy, and left feeling  completely discouraged & put off therapy. Sadly the reason behind this disheartening experience was mainly due to simply the client and therapist not being the right fit. Many people approach therapy already aware of whether they want to work with a male/female therapist, LGBTQ therapist, White/Black/Asian/Mixed therapist, etc. Issues around class, culture, geographical location, and lived experiences are also central in choosing the right therapist. For example clients who have experienced discrimination in their lives will find it easier to have a therapist who can identify with their experiences, LGBTQ clients may want to work with a therapist who is from the LGBTQ community, while a White Middle class client may want to work with a therapist who can understand their world better. These are certainly not written rules, nor are they indicators of successful therapy. There are more nuances  around this, which are beyond the scope of this short blog. Some clients have a preference for face to face sessions or online- vice versa & this will again impact on their choice of therapist.

To reiterate, it is the relationship,  the connection, and feeling of safety that matters. Some clients are also unaware of the significance of working with a therapists who is accredited and registered with any of the psychotherapy accrediting bodies- UKCP, BPC, BACP, HPC, HPCP, NCS and other accrediting bodies which have ethical codes of practice for therapist, and regulate the profession. There are many people (unaccredited) claiming to  be therapists and life gurus offering therapy, yet they are untrained to deliver therapy. This can be harmful.

Which approach do I choose?

What makes the best approach to therapy for anyone is determined by what one wants to get out of therapy, the nature of their difficulties, how one is living their day to-day life, & psychological mindedness. The commitment therapy is also key -whether the one wants short-term or long-term therapy- time, finances etc factored in.

Schools of Thought and Therapeutic Approaches

While therapy is a concept which binds the non-medical models of treatment of mental/emotional distress, and understanding the human mind, there are different schools of thought, orientation, and therapeutic approaches to therapy. These schools of thought have different philosophical underpinnings, and does have unique and specific language, concepts, and ideas to distinguish themselves epistemologically, and describing what they do. While these postulations are different, from a philosophical perspective, they are essentially describing the same thing-the human mind and understanding human suffering. There are a lot of parallels. Fundamentally, there  are more similarities than differences within these schools of thought, and a lot of borrowing from each other.

Here are the main schools of thought and the breakdown and their approach to therapy.

1-Psychodynamic/Psychoanalytic

Based on the works of Austrian Neurologist Sigmund Freud (1856-1939), this approach places the relationship between therapist and client at the centre of the process. Psychodynamic psychotherapy seeks to enable the client to develop the capacity to reflect on their experiences & create an understanding of the unconscious drives behind certain behaviours, feelings, thoughts that may be causing their distress, making connections between the past and the present.  Psychodynamic/ psychoanalytic clinicians’ work is inductive and explorative. The therapist’s role of helping the client make connections between the past and present, understand the different levels of our psyche- conscious, subconscious and unconscious and  interpreting the past in the present is key. This approach is essentially about meaning is key. The therapy addresses the person as a whole, not simply their symptoms, but try to create an understanding of the root cause of the symptoms. Distress is alleviated by processing & developing self-awareness- insight oriented. Therapists pay attention to the real relationship and the transference (internalised relational patterns) which is a tool and informs the therapy. It is unstructured & a deeper way of working and one of the oldest forms of therapy. This is typically long term; however, one can also have short term psychodynamic counselling focusing on a specific issue.

2- Cognitive Behavioural Therapy

CBT is type of therapy which originates from the works of American Psychiatrist Aaron Beck (1921-2021). It is a type of therapy which combines Behaviourism and Cognitive Therapy. CBT as an approach seeks to help one create an understanding of how thoughts (cognitions), feelings/emotions, behaviours and the body’s physiological reactions are connected. By understanding these connections, one is able to disrupt whatever maintains a negative cycle, therefore undoing certain unhealthy patterns. CBT focuses on present day distress. Behavioural experiments & using the body to emotionally regulate, are key tenets of this approach. It is typically short term, structured, & very specific to a particular presenting problem. CBT therapy can be applied through a formulation approach, or protocol treatment which is manualised and follows specific guidelines. This is true for the treatment of some complex presentations such as eating disorders, OCD, certain phobias, and severe depression.

3- Humanistic/Person Centred

 This type of therapy originated from the works of American Psychologist Carl Rogers (1902-1987). It places the client at the centre of the process, with the therapist guiding the client to discover their innate abilities, wisdom & creativity in order to reach their full potential. It is typically long term and unstructured. Transactional Analysis and Gestalt Therapy falls in the Humanistic approaches as well. They all place the human at the centre of their existence, and view them as capable of autonomously making changes to their lives.

4- Existential

 This approach stems from the works of Philosophers Friedrich Nietzsche (1844-1900) and Danish Theologian Soren Kiekegaard (1813-1855). Other Phenomenologists such as Martin Heidegger (1889-1976) and much later Otto Ranks (1884- 1939) contributed to the theoretical principles of Existential therapy. It focuses on developing self-awareness, creating an understanding of one’s place in the world in relation to others & meaning making of one’s unique experiences in the context of life. Responsibly and freedom is key to this type of therapy. The therapist guides the client in their journey of self-discovery.

5- Integrative

 Some therapists are trained to work pluralistically, which means they can integrate various models in their therapy. This is typically a combination of any 3 of the modalities between CBT, Existential, Psychodynamic, Gestalt, Transactional Analysis and Person centred. Cooper and McLeod (2007) view this pluralistic approach as beneficial as clients will benefit from a different therapeutic approach at different points in time. Since these therapists are trained in 3 different modalities, there are pros and cons, with regards to depth and breadth of their work.

Difference between Counselling and Psychotherapy

 Although counselling and psychotherapy are terms used to define  talking therapies, the main differences between counselling and psychotherapy is in the depth, breadth, and duration of the work. These concepts tend to be used interchangeably, which create more confusion on their meaning.  Counselling is often short term, and focused on a specific issue, while psychotherapy is a deeper way of working, which attends to the person as a whole, helping them identify the root cause of their difficulties. Counsellors are typically trained at Diploma level, while psychotherapists tend to be Masters level going up. Psychotherapists can practice as counsellors, while counsellors can not deliver psychotherapy. There are current debates around professional titles (protected) and who can have certain privileges.

Couples Therapy

 Couples Therapy is a form of therapy where the therapist works with a couple, or a pair in a relationship. The aim is not to address the individual pathology of each partner in isolation, but help the couple understand how it is impacting on the relationship. A lot of people present to individual therapy with relational issues with their partners. However, if they go into couples therapy, it helps the couple work through their issues together, and grow in parallel. What often happens is that when one partners goes into therapy, they begin to grow and mature emotionally, leaving the other partner behind. At times this is positive as the growing, and emotionally mature partner assist the less mature partner in their growth together. In other situations, the gap in emotional maturity becomes wider, which can aggravate the relationship further. This highlights the significance of partners considering couples therapy if they are having mainly relational issues. Many people have couples therapy adjunct to individual therapy. They would however not have the couples therapist giving them individual therapy concurrently.

Other Contemporary Therapy Modalities

• Dynamic Interpersonal Therapy (DIT) Time limited/Short term
• Cognitive Analytic Therapy (CAT) Time limited/Short term
• Interpersonal Therapy (IPT) Time limited/Short term
• Dialectic Behavioural Therapy (DBT) Time limited/Short term
• Emotional Freedom Therapy (EFT) Time limited/Short term
• Eye Movement Desensitisation and Reprocessing (EMDR) Time limited/Short term
• Attachment Based Therapy (ABT) Medium-Long term/Short term

  Other Health Professionals

Clinical Psychologists

 Clinical Psychologists are trained to deliver psychotherapy along with other specialist assessment, diagnosis, formulations, and treatment of psychological and behavioural problems. Psychology and psychotherapy training is different; psychotherapists are not trained to carry out specialist psychological assessments and diagnosis. Psychologists are typically trained at Doctoral level and this reflects their skill, and specialist roles in clinical practice. Although they are Doctors, Psychologists do not prescribe medication. Psychologists have a different Accrediting body (UK Context) and this is typically HCPC or BABCP.

Psychiatrists

 Psychiatrists are medical trained doctors who specialises in psychiatry. Psychiatrists apply the medial model in their work, and they are prescribers of medication. They can assess, diagnose, and medically treat mental disorders. Not all psychiatrists are trained to deliver psychotherapy; it is an additional training they need to undertake. In order to practice as psychotherapists, they need to be registered with one of the psychotherapy bodies for them to practice as both psychiatrists and psychotherapists. Psychiatrists  also provide other specialist psychiatric assessments and diagnosis of ADHD, ADD, Autism, Aspergers, Dyspraxia and other neurodivergences, which therapists are not trained to do. Psychiatrists are registered with the GMC, and other bodes for any specialisms they may have acquired.

Most therapists offer a free 10-15 minute call. Do request for one if you are unsure, and use it as a time to explore, assess, and evaluate things. Browse therapists websites, and familiarise yourself with how they work before arranging a consultation.

Remember therapists are human!

Blagys, M. D. and Hilsenroth, M. J. (2000) Distinctive features of short-term psychodynamic

interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology, Volume 7 (2): 167-188.

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Implications for research. Counselling and Psychotherapy Research, 7 (3). pp. 135-143. ISSN

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preferences of laypersons and mental health professionals: Whose therapy is it? Psychotherapy, 56, 205-216

Leichsenring, F. and Leibling, E. (2007) Psychodynamic psychotherapy: A systematic review of techniques, indications, and empirical evidence. Psychology and Psychotherapy, Research, and Practice. 80: 217-228.

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conclusions and clinical practices. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (pp. 423–430). Oxford University Press

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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.

This article was published on the Counselling Directory Platform  on the 29th March 2023.

SEPARATION AND DIVORCE

Co-parenting after divorce or separation

By Dr Joyline Gozho, Adult Psychotherapist (Individual & Couples) FPC, UKCP, NCS

Published on 29th March, 2023

Divorce or separation where there are children involved is not always easy for the adults, let alone the children. Emotions are high in most situations, as what was “until death do us part” turns into “death wishes” due to the level of acrimony. Often there is rancour – bitterness, anger, resentment and a desire to punish, blame, and shame each other.

In the UK alone, between January and March 2022, the Family Courts recorded 30,152 divorce petitions (Gov.UK, 2022). The Office of National Statistics recorded 113, 505 divorces in 2021 (ONS, 2021). In 2023, many leading family law firms in the UK reported a spike in divorces, with a prediction of 50% of marriages ending up in divorce. Many of these divorces are between parents who have children, some of them very young. In addition to that, there are many other children from non-married parents who separate and have to go through the same painful process of witnessing their parents’ relationship breaking down.

Sadly, what should be a process that involves two adults disentangling their lives from each other, turns into a battle where children become collateral damage. This is so because parents often forget their children’s own emotional needs and the impact of the divorce or separation on them. Their focus is on themselves individually, or the other parent. Some parents will even use their children as pawns, and weaponise their relationships with them, against the other parent.

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Loss and trauma in divorce and separation

Trauma can be defined as an exposure to an event, or a series of events that are emotionally disturbing or life-threatening, with lasting effects on the individual’s functioning – mental, physical, social, emotional and general well-being (De Kolk, McFarlane and Weisaeth, 1996).

Trauma is pervasive, and it has an enduring impact on the subject, no matter how long the original trauma took place. De Kolk (2014) argues that trauma is not what happened to you, but how you responded to the traumatic situation. This highlights the significance of how the parents deal with the divorce or separation themselves as individuals, and how they support their children through it.

A psychoanalytic definition of trauma was given by Chertoff (1996) who postulates that trauma is an event or a series of events which specifically overwhelms ego defences, causing the traumatised person to regress into earlier modes of functioning. The breakdown of a marriage or relationship is indeed a multi-layered loss, a form of trauma. There is a loss (death) of a relationship, loss of identity, loss of a shared home, loss of mutual relationships, and loss of life as a couple. Things will never be the same again, and this can be disillusioning; coming from a place of interdependence to being self-sustaining can be very frightening.

Whenever there is a loss, there has to be a grieving process; with it comes a range of feelings – shock, shame, sadness, guilt, anger, and acceptance (in no particular order). This loss disrupts one’s life, threatens one’s identity, disrupts the future, gets one to reevaluate the meaning of life altogether and reconsider their place in society. Some parents experience a huge amount of anger, guilt and shame either for not saving the relationship or for staying longer than they should have done. The adults are able to process these emotions, unlike the children who are in the shadows of the parents’ experiences.

The child and the adult

The breakdown of the parental relationships can be viewed as an attachment injury from an attachment perspective (Bowlby, 1962). Children create emotional bonds with both caregivers (parents) as they grow up, as well as an attachment to their environment. These bonds are strengthened by consistency, and constancy, and help them create an internal sense of security.

Any breakdown of these attachments is very threatening to the child’s ego, which is still very fragile and weak. The breakdown of a parental relationship can create a long-lasting attachment injury on the child, which can impact their adult life in many ways. Poor self-esteem, poor self-image, identity insecurities, and difficulties in interpersonal, and romantic relationships is often a result.

It is true that many people who access therapy in adulthood are products of divorced parents or unmarried parents who had a relationship breakdown in their early life. Their issues often stem from that early “trauma” due to the breakdown of their parental relationship. Divorce and separation is a loss and a form of trauma for the children who lose the potential for growing up with loving parents who are together, living in the same home. This process becomes even more difficult when new partners emerge on either side.

Where are the children in the equation?

The intensity of feelings provoked by the relationship breakdown can override the capacity for parents to think rationally and put their children’s interests first. Sadly, some parents use their children to leverage their process, practically, emotionally and financially. This is unfair on the child and burdens them with adult life situations and complex emotions, that they should not be involved with. It is indeed very damaging as children have no emotional capacity to process these complex emotions. Instead of protecting the children, some parents put the children at the centre of their battles.

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How to co-parent in a healthy way

Tips on healthy co-parenting

1. Don’t talk badly about the other parent with your child/children. They are innocent and deserve to be kept out of your battles.
2. Do not discourage your child/ren from having a relationship with the other parent. You are simply creating a situation where once they are adults, and more aware, they will learn the truth and hate you for it.
3. Don’t overshare with your child/ren or turn them into your confidants. It’s perfectly fine for children to be told that their parents will no longer be together, but it’s not OK to download the details of the relationship onto the child/ren. It will only confuse them than help you or them. Children are very emotionally vulnerable; emotionally burdening them can lead to behavioural problems, emotional difficulties and other developmental disruptions.
4. Learn to communicate well with your ex-partner putting your child’s interest at heart. Avoid situations where you openly argue in front of the child/ren. Being difficult is not helpful to everyone involved, and it will only complicate things. By being difficult, you are punishing your children, not the other adult parent.
5. Honour and value each other as parents who have a dual responsibility in your child/ren’s life. No parent is better than the other and you are not in competition. Put your differences aside and focus on parenting and being adults nurturing your child/ren.
6. Stop emotionally manipulating your child and buying their love. Some parents do this by showering their child/ren with money, expensive toys, and gifts as if to demonstrate that they are better than the other parent. Not only does this confuse the child/ren, it works short term and in the long term, children grow to understand the love currency.
7. Many divorced or separated parents will start dating soon after their divorce as they are keen to start a new life and find love again. It’s important not to introduce your child/ren to every person you date unless you are sure that you are in a stable and exclusive relationship.
8. Show your children love and let them experience the same love they had before the divorce or separation. Create a happy home and have rituals to help you settle into your new life. You would rather have your children in two happy homes than one unhappy home. Create it for them.

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References

Bowlby (1969) Attachment and Loss, Volume 1. Attachment. New York, Basic Books

Chertoff, J. (1996), Psychodynamic Assessment and Treatment for Traumatised Patients. Journal for Psychotherapy Practice and Research. APA

Der Kolk, B.A. (2014), The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. Viking

Der Kolk, B.A., McFarlane, A.C., and Weisaeth, L. (1996) Traumatic Stress; The Effects of Overwhelming Experience on Mind, Body and Society. New York

Gov.UK. [Online] https://www.gov.uk/government/statistics/divorces-in-england-and-wales-2021 (Accessed 29/03/2023)

Office of National Statistics [Online] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/divorce

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