Advice Column in TOI - Internet says, I’m depressed

http://timesofindia.indiatimes.com/life-style/relationships/ask-the-expert/Internet-says-Im-depressed/articleshow/49382752.cms

Question: I'm a 19-year-old girl, studying and staying with my relatives in another city. For about several months, I felt like a failure, worthless and had suicidal thoughts. I also had a problem concentrating and used to miss my classes, just to stay at home. But I couldn't make anything out of all of this.

However, I recently realized that I have lost interest in my daily activities and do things slower than before. I often find myself sleeping too much as waking up takes a lot of effort. I feel exhausted even after doing nothing much and have no energy left for studying. I don't know what my interests are anymore. I'm lacking self-care and sometimes I just do reckless things.

Sometimes, I feel guilty for many things, which I can't even express. So, I took depression screening tests on multiple websites and the result said that I may have mild to moderate depression. I don't know what I should do next?

I don't want my parents to worry for my mental issues, as they are already in stress about my two failed attempts at CA-CPT. What should I do? - By Anonymous

Answer by Aditi Kulkarni: This does sound alarmingly similar to depression. Unlike the way this term is used in daily conversation, depression is more than just momentary low mood. It is one of the most common mental health conditions and if left untreated can have incapacitating effects on your health and well-being.

I urge you to speak to a psychologist right away! The longer you wait, the more challenging it will get to cope with these symptoms. A psychologist would be able to diagnose whether this is actually depression or a related condition. She/he will also help you understand your state of mind and cope with the difficult feelings.
I understand your hesitation about speaking to your parents, but I do hope you have been talking to someone about this. A supportive network of friends and family has a very positive impact on overall wellness.The sense of worthlessness and guilt are all part of the depressive episode, and I am positive that you will overcome this with the right professional support.

Tiredness, reduced ability to concentrate, neglecting self-care, thoughts about suicide and a sense of failure are classic symptoms of depression. From what you describe, you have been struggling with these symptoms for several months, and they seem to have become more severe over the last one month.

For your safety and of those who care about you, I hope you start therapy immediately. There are numerous online and offline options for therapy now available and I will be happy to help you find a suitable therapist. Depression is completely treatable, but unfortunately most people let it aggravate either due to lack of awareness or reluctance in seeking support. I sincerely hope you find a counsellor or therapist to speak to soon.

Relationship Advice Column in TOI - My wife abuses me physically

Question: When a man hits a woman, she finds a billion supporters but nobody supports a man when he's beaten by a wife. I am in such a marriage. My wife resorts to physical violence whenever she gets angry. Initially, she used to throw stuff at me but now she has started hitting me too. She gets angry on little things and doesn't allow me to meet my friends and regularly checks my phone.

I have never hit her in return but I feel that she's ripping of my dignity. I don't know how to control her anger and stop her from doing this. Please help. - By Anonymous

Answer by Aditi Kulkarni: Violence is never an acceptable form of expression, whether it comes from a man or a woman. It is usually more difficult for men to admit that they are at the receiving end of abuse from their spouse since this does not conform to societal stereotypes. In the recent decades however, there has been a rise in the number of instances of husbands being physically abused by their wives.

I appreciate that you have never hit her back, as this would have only made matters worse. Your feeling helpless is a natural response to the way you are being treated in this relationship. Her reaction is unacceptable and you should not hold yourself responsible for not being able to 'control' it.

My suggestion is, try to speak to your wife when she has cooled down to try to understand her motivation for resorting to violence. Many times, listening to your partner patiently and making a genuine effort to understand what they want goes a long way in reducing their anger. It may also be the case that the things she wants are unreasonable or out of reach. Emphasise on the fact that though you have sympathy for what she is going through, but you cannot tolerate physical violence.

Both of you can try to identify the things that make her angry and violent, and then figure out whether these can be avoided or changed in any way. Mutually agree upon what is acceptable within your relationship and what isn't. It is always more beneficial to have this conversation in the presence of a qualified relationship counsellor. Your counsellor will be able to look at your situation objectively and enable you to communicate your concerns in a safe and confidential environment. Your wife might be more willing to see a professional if you suggest working on the relationship rather than asking her to 'get fixed' or 'change'. Professional advice about anger management and healthier ways of coping with anger outbursts will also be useful.

I don't know if you have children, but if you do, it is all the more essential for you to seek counselling right away as witnessing violence between parents has a long-lasting negative impact on kids. If your wife is unwilling to seek therapy, you can start with individual counselling sessions for yourself. These will help you to regain your confidence and manage her outbursts in a more assertive manner. Once she sees how you are benefiting from counselling, she might be motivated to try it too.

http://timesofindia.indiatimes.com/life-style/relationships/ask-the-expert/My-wife-abuses-me-physically/articleshow/47160716.cms

Relationship advice - TOI Ask the Expert - I think my wife is asexual

Http://timesofindia.indiatimes.com/life-style/relationships/ask-the-expert/I-think-my-wife-is-asexual/articleshow/48051174.cms

TEXT:

Question:  I'm a 35 year old girl. If you want to know more about us, you can  write  to us at any time. We do not have sex in 2 months, but it only happens when I initiate it. And I always get a feeling. Everyone in a while she even fakes an orgasm. I like to have a good time. So she does enjoy that closeness. 

I'll be honest. This is not a huge crisis in my life but it is a constant nagging irritation. Any ideas on what I can do to get her in the mood? Is it possible that she is asexual?- By Anonymous

Answer by Aditi Kulkarni:  Being sexual or asexual are not neat stacks in which people can be placed. It is a spectrum along which individuals may identify themselves. So some people have a high  sex drive , others may not consider it a necessity; And still others may be. So, like most human traits, it is not necessarily fixed across time. So, the level or form of intimacy of your  wife can be  different from your personal needs, and this is perfectly normal.

If this has been the case, then it is openly with her. It is possible that she is faking orgasms because she thinks this is what you need. Or that she has not brought it up because she does not think it is important to you. The only way to find out what's going on. She wants to be in the mood. You can talk about how you can help each other. If you are interested in what is going on in your life,

First counselling session - What to expect

What to expect from your first counselling session

Counselling (and psychotherapy) is a process of healing; a place where one can uncover various layers of a problem in the presence of a non-judgmental and qualified professional. Contrary to stereotype, counselling is not the same as getting advice (though most often people do find solutions to their problems when in counselling). It helps people to gain clarity about their issues and to identify potential solutions for the same.

There is a lot of ambiguity and apprehension among people when going for a counselling session for the first time. The main reason for this is lack of adequate information from reliable sources about the topic. To put your mind to rest, here is a quick guide about what to expect from your first counselling session.

In the initial session, a counsellor will typically will divide her time between the following activities:

a) Explaining how counselling works and setting ground rules

b) Understanding the client’s area of concern and background information

c) Agreeing on a set of goals

Even though part (b) takes up most of the session time, (a) and (c) are equally important, and should not be overlooked. They shape the relationship between the counsellor and client, and decide the future course of action. 

A counselling session lasts for 50-60 minutes (there might be instances when the duration would be longer, e.g. during a couples counselling session). During the initial 10-15 minutes, the counsellor will work towards making you comfortable and form a good rapport with you. She will give you a brief explanation of how counselling works or her own working style. You can use this time to ask any questions you might have about their qualifications or experience. You have every right to make an informed choice about your counsellor, so don't hesitate to ask. A counsellor is ethically bound to address any doubts you might be facing about the counselling process. 

This is also the time when the ground-rules or “contract” is discussed. This includes an assurance of confidentiality. It can also include agreeing upon the duration and frequency of sessions, session fees, terms for cancellation or rescheduling and other logistics. Some counsellors ask their clients to fill out basic information forms before the first session, while others prefer to take down this information during the first meeting. This includes information such as your age, marital status, and contact details. Depending on your area of concern, the counsellor may ask you to fill out some forms or assessments. 

Once the paperwork is out of the way, you will be asked to share the reason or concern that brings you to counselling. During this phase, your counsellor will encourage you to share your problem without inhibition. Sometimes you may not have the words to express a particular feeling or experience. Your counsellor will help you articulate these difficult emotions. She might ask you some questions to gain clarity about your situation, but will always maintain a warm, non-judgmental attitude. You have the choice of refusing to answer any questions if you feel uncomfortable doing so. 

Understanding your concern may require the counsellor to gain some information about your family, past relationships and significant life events. It may also involve sharing information about areas of your life that you have never talked about with anyone. Be mindful of the feelings that come up during the conversation. If you start to feel too uncomfortable or overwhelmed, share this with your counsellor. Remember, openness and honesty is essential for counselling to succeed. So make sure that you bring up any difficulty you might be facing in talking about various things. Avoiding or ignoring these will hamper your progress in counselling. 

When one begins to talk about emotional issues, it is quite easy to lose track of time. However, a counsellor needs to maintain time boundaries and will ideally remind you 10 minutes before the session time ends. This is essential for ensuring that the session does not end abruptly. It also leaves the counsellor with some time for summarising all that you have shared with her, and ensuring that you have been understood. 

Towards the end of the first session, your counsellor will summarise the key issues you are facing at the moment and arrive at a mutually agreed set of goals which you will work towards during the counselling process. These goals will be based on your narrative, and are not rigid or fixed. You and your counsellor can revise them at any point during counselling. 

Before the session ends, both of you would have ideally agreed on an appointment for the next session. Depending on your concern and their style of practice, the counsellor may suggest some tasks for you to undertake in the interim period till you meet again. 

Most people expect to leave the counsellor’s office with a sense of relief or accomplishment, however this is less common than believed. Don’t beat yourself up if you feel uneasy or stirred up. Counselling, like any change, needs time. Feeling unsettled and disturbed are natural responses to bringing up uncomfortable aspects of your life. This is also a sign that you are moving towards change and betterment. It is in your best interest to not get too overwhelmed by the negative feelings and discuss the discomfort with your counsellor in your next session with her. 

Impact of client & counsellor culture on the therapeutic process

I have had the privilege of getting my counselling training in a country whose culture is very different from the one I grew up with. It was only when I interacted with people from diverse cultures and backgrounds that I realised the impact culture has on everything we do and think. As long as you are confined to people and places belonging to your ‘home culture’, you tend to assume cultural norms as facts. For example, putting the family or community before oneself is an integral part of a collectivist culture like India. However, assuming that this is the right thing to do for all people is an error. Similarly, a commonly held belief in predominantly white western cultures is that talking about one’s feelings makes one feel better. This again, is a cultural norm and not a universal truth, some cultures place greater value on being able to keep one’s feelings to oneself.

A counsellor needs to be sensitive to minute cultural details such as these. Recent research has focused on the need for cultural competencies as one of the core skills required in counsellors. This does not imply that a counsellor should know everything about every culture, but means that she should not base her interventions and practice on assumptions. As a practitioner of person-centred approach to counselling, I believe that the client is the expert on her life and I try not to make any assumptions about her on the basis of culture, gender or any other group that they belong to. This encourages me to be inquisitive about their life situation and ask clarifying questions whenever needed.

Social psychology research indicates that people generally prefer to associate with persons who they perceive to be similar. This similarity could be on the basis of appearance, worldview or affiliation to a group or culture. The obvious implication of these findings to the field of counselling is that clients would tend to prefer therapists who are from the same ethnicity as them. However, a meta-analysis by Cabral & Smith (2011) reports that despite client preference for counsellors from same background, ethnic matching does not improve therapeutic outcomes.

Reflecting on my prior experience with clients from diverse backgrounds, I think that positive change in a person depends a lot on the therapeutic relationship that develops between the client and the counsellor, and not on how similar they are. Considering the social psychology findings I mentioned earlier, it is natural for clients to want to work with counsellors from similar ethnicity. However, the presumption of similarity on the basis of cultural affiliations can lead to disappointment. For example, despite sharing the same nationality or ethnicity, the counsellor may be very different from the client, and vice versa.

A benefit of working therapeutically with a counsellor from a different country or community is that the counsellor can maintain an open stance of ‘not knowing’, thereby giving the client complete authority to narrate their situation with minimum risk for bias. Differences can promote insight – your counsellor may be able to suggest to you things you overlooked because of your conditioned beliefs. The most important thing is that a counsellor treats you with respect, and does not make stereotypical assumptions about you.

Seeking help..a sign of weakness or a mark of strength?

Many of my counselling clients, apart from the issues they are struggling with, have an additional difficulty: they beat themselves up for 'needing' counselling. A lot of people grapple with the guilt of not being able to 'snap out of it'. Maybe you are familiar with the feeling that you are the only one who can't deal with this problem; maybe at some point you have had the nagging thought, that you are making it worse by overthinking it. This could be worsened by the fact that there is no evident cause for how you are feeling, or that someone else in a similar situation reacted differently, or the people around you don't quite understand what's going on or how to help you.

I want to clarify this to all the people contemplating seeing a counsellor, and those who are thinking of dropping out of counselling - the fact that you decided to seek help is a mark of great strength. I am not just saying this to encourage you, I really and truly believe it. For any sort of positive change to occur, the basic pre-requisite is accepting that something needs to change or is not going as well as it could.

A lot of people live in denial that there is an issue to be addressed because it is too painful to admit otherwise. Probably you have denied this in the past too (or are still doing it). And you know that the discomfort that you feel while revealing your innermost fears sometimes feels much worse than pretending that everything is ok. Where is this feeling stemming from? Seeking help is a sign that you are accepting that something beyond your capacity is bothering you. It requires you to feel vulnerable. And that definitely is not easy.

When I say that seeking counselling or any sort of professional help is a strong positive in your favour, I mean that it is a first major hurdle crossed. It may not be an easy progress, and it may be something that takes up more time than you first imagined, but I assure you that if you persevere, you will come through it stronger and more fulfilled.

All the best! 

What to expect out of counselling

Your reason for going to a counsellor or contemplating going to a counsellor may vary from mild emotional disturbance to unbearable distress. Though the degree or nature of your problem may not be comparable to someone else’s, one thing that is common across people who seek counselling is that their situation is interfering with their life in one way or another. For most people, especially in the Indian context, the decision to see a professional for emotional troubles is a big one; often made after a lot of contemplation, and in a lot of cases, covered in a shroud of secrecy. The stigma attached to seeking therapy is a topic for another day. Today, let’s focus on what to expect out of counselling.

• First and foremost, counselling provides you with a warm, safe and confidential setting, where you can explore your concerns in the presence of a non-judgmental, qualified professional. Since this person (your counsellor) is an objective outsider, he/she does not have any personal agenda while understanding what you share. Your perspective is the only one they know.

• Counselling usually happens over a period of weekly sessions. The number of sessions or the period of time required will vary from person to person. It is difficult to give an exact number at the beginning of counselling. I find it a useful practice to schedule a ‘review’ session after 4 or 5 counselling sessions. This gives both the client and the counsellor an opportunity to look at the way things are progressing, and take into account what is working and what isn’t. Depending on the severity of the problem, a more realistic estimate of further sessions required can be made.

• Being open and honest during counselling will lead to clearer understanding of yourself and your context. Counsellors are trained to listen with empathy, but that’s not all they do. They will help you to read between the lines of your own words, giving you a better insight into yourself and the situation you are in.

• The counselling relationship is the cornerstone of any change you wish to see. You can make the most of your counselling experience if you actively engage in the process, rather than passively expecting advice. If there is anything about your counsellor that is bothering you, communicate it openly. A qualified counsellor will be able to consider your feedback in a positive manner and help you understand your misgivings better. Someone who seems rigid or judgmental towards you may not be best suited to address your needs. 

• Most counsellors will work collaboratively with you towards identifying therapy goals. Your counsellor should be able to help you to formulate realistic achievable targets. These goals are open to revision and modification, depending on your progress.

• Many a times, we unknowingly indulge in practices that are detrimental to our own betterment. For instance, a person who has had a string of bad relationships may be unconsciously choosing partners who are abusive, thereby maintaining the pattern. Counselling gives you an opportunity to identify any patterns or recurrent behaviours that may be maintaining the crisis situation. With the help of your counsellor, you can become more aware of your behaviours and learn ways to modify them.

• Counselling also involves some risk. Sometimes, clients experience an emotional upheaval – things that you didn’t think as relevant to your current problem or were not prepared to talk about, might come up. Some painful memories, which you had put away, may resurface. In addition, the changes you are beginning to experience may not be well received by the people in your life. However, these risks can be dealt with if you honestly discuss with your counsellor about how you are feeling. Working through these difficult feelings often leads to considerable personal growth and progress for the client.

• Sometimes, the ‘problems’ we take to counselling may be beyond its scope, or may require the assistance of another professional. For example, through the course of a few sessions a counsellor may suspect that your mood swings may be related to a clinical condition, or that your lack of appetite may need a doctor’s attention. In such a scenario, a counsellor refers the client to psychiatrist or a general physician, as required. There are many instances where a person benefits from continuing psychotherapy in addition to medical aid.

• A structured ending is perhaps the least talked about aspect of counselling. Considering the amount of time and money you invest in counselling, it is natural to want to ‘stop’ once things seem a little better. Many a times people may stop therapy quite suddenly, fearing that if they told the counsellor they wanted to stop, he/she may not ‘allow’ it. This couldn’t be further from the truth. A professional counsellor will never extend therapy beyond the required period of time. Also, as a client, you have complete authority to bring counselling to an end whenever you want to. However, it is in your best interest if you do this in a structured manner rather than quitting abruptly. A planned ending session will give you an opportunity to process your learning and progress and to give you a sense of closure.

If you have any queries or doubts about what to expect from counselling please feel free to contact me on aditikdcounsellor@gmail.com