Advice

How bereavement counselling can help you (even if you think it won’t)

Bereavement counselling’s pretty near the top of the list of things you don’t want to need twice in four years. My two experiences-  both after the suicide of a friend, both with Cruse Bereavement Care, both in the same town – were pretty different. But having had the second, I can comfortably recommend it to anyone…

The first time I had it, four years ago, it turned slightly awkward when, after a few sessions, I started bringing in other concerns. My counsellor was fairly insistent on sticking directly to bereavement matters, which is understandable but tricky when you have a knot of problems and it seems impossible to entangle the bereavement from the rest.

I was getting CBT for anxiety last year, and on the cusp of a decision on how and whether to be referred for the next stage of the slow snakes and ladders game that is NHS therapy, when I learned of another friend’s suicide. When I told the referral team, and that he was the second person I knew who’d done it, they said they wouldn’t see me until I’d been to bereavement counselling, so, not too hopefully but supposing it wouldn’t harm, I agreed to it.

This time I knew immediately without a doubt it was utterly the right thing to do. I’ve had short-term therapy throughout my adult life and although it was rarely actively unhelpful, if I’m honest, I’ve rarely found it as truly helpful as this before. As this great, thoughtful blog post on choosing a therapist hints at, the success rate for therapy is about the same as for dating and the reasons for it not working can be similar in both. As with relationships, some of the more promising therapists I’ve seen were non-starters or cut short for practical reasons (money; availability; logistics…). But, as with relationships, a good one feels worth the wait.

My final session is next week. I’ve never understood why people talked about “missing” a therapist. I was never particularly attached to any of mine and in the past, when therapy ended it felt little different than saying goodbye to my dentist, or builder, or any other service provider. They’d done what they could, to their best of their ability, and I felt a bit better, and there was nothing more to be said. But now I know – and I really will miss this one…

Below – without getting into things best kept within the room – I’ve put together a brief summary of how counselling has been helping me, and how it can do the same for you.

It can help you…

  • If your grief is disenfranchised. Disenfranchised grief is the academic term for grief that has less status than losing a partner or relative, especially if your relationship wasn’t widely known or recognised by others. It also covers any bereavement where the cause of death carries a social stigma, such as suicide, or addiction. This article on disenfranchised grief has changed my life.
  • To confront difficult feelings, positive or negative, around the person who died honestly without being judged.
  • To understand why bereavement might have hit you particularly hard e.g if you have been bereaved before, especially in a similar way, or if you are in a job where there is lots of instability and rejection.
  • To deal with feelings, conflicts and questions which are specific to suicide bereavement and not covered by the general received wisdom around grief and loss.
  • To work towards acceptance Giving yourself permission to look for answers but also knowing when to stop.
  • Not to take it personally if someone else affected by suicide seems reluctant to talk about it. People open up at different speeds. Even very confident, outgoing people may find complicated feelings hard to express. They may not want to upset themselves, or you, not want to open up old wounds, or just not know what to say.
  • To talk through anniversaries and decide when and how to mark them.
  • To talk about how the bereavement might be affecting your friendships and relationships.
  • To be clear on how to safely express your feelings without impinging on anyone else’s privacy or wellbeing.
  • To realise grief is a constantly evolving process, and think about how you might cope with reminders, such as news stories, anniversaries, or approaches from mutual friends/acquaintances (or, especially, from the person’s relatives if you aren’t related and they don’t know you well). All these things are likely due to the nature of the mass-media and internet.
  • Related to the above, tcontrol your worrying about things you can’t control I’m going to work on a rough plan of action for this, using some CBT strategies.

If anyone’s interested in sharing their experiences of bereavement counselling – helpful, unhelpful or anywhere in between – I’d be very interested to read them in the comments.

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Depression and Relationships: Myths and Facts

To mark the inescapable buy-some-pink-tat-to-prove-your-love-day, I wanted to share some personal thoughts on how depression, anxiety and a history of it on both sides can affect getting into and staying in relationships. Then I decided talking you through my relationship history at this juncture was actually slightly less appealing than running through Leicester Square naked wearing an Ed Miliband mask, and instead, I asked people with depression and/or anxiety on Twitter what they felt were the biggest prevailing myths about mental health and relationships. Here are some of the responses:

  • “The myth that love conquers all. But people believe that about relationships where people don’t have depression. Suspect depression just magnifies the things people deal with in relationships anyway.”
  • ‘…Now you have a boyfriend you won’t need antidepressants any more…’  Love doesn’t fix everything!”  (Can you imagine saying to someone with diabetes: “Now you have a boyfriend you won’t need insulin any more!”)
  • “The myth that support should come from your family, or significant other. Sometimes support has to come from somewhere else.”  (The person who tweeted this shared a very positive experience of finding support elsewhere after her family disagreed with her treatment. But it also got me thinking about instances where “finding support from somewhere else” can be problematic….)
  • “The myth that you can’t live without your partner. People think that if you have a partner you completely rely on them to look after yourself. If anything, you push them away! Mine helped to build me up to be reliant on myself not him. Best thing he could have done for me.” 
  • “There’s the myth (and this goes for friendships too) that we can expect our partners to fix us. We can’t. We can’t. It’s an internal issue. What they can do is support and not judge.” 
  • “An important fact is that they can massively help you deal with it by understanding it’s not your fault.”
  • “For ‘don’t judge’ I’d also read: ” ‘Tell me when my judgement is off.’ “
  • “Depression is not a free letter.”
  • “Sometimes I think the biggest myth is that it’s different from other relationships. In all relationships, you deal with the darkness in one another.” (I can see where this is coming from, but I think it’s the intensity of the darkness and the extent of the irrationality that is different. The ‘darkness’ of the occasional bad day at work is not the same as the darkness of barely having slept for a month. Or suddenly crying in the middle of the day because you’ve remembered some tiny remark you made to someone 15 years ago which might have been misinterpreted…)

There are many, many “What To Say/Not To Say to Someone with Depression” guides around. You’ll find a couple of good ones at my links page. 

For what it’s worth, the relationship myth that’s probably caused me more distress than any is the myth that “chemistry” is the be-and-end-all of them. When you’re young – especially if you’re in some sense not quite a regular Joe or Jenny and mutual attraction doesn’t happen much – someone well-meaning will probably try and soothe you with a nice, American teen movie-ish speech about “chemistry” and how, one day, out of nowhere, you’ll meet someone (maybe not who you think…), you’ll both fancy each other rotten and everything will just fall wonderfully into place from then on. “It’s all about ‘chemistry’! It’ll happen one day, just hang in there..!” Cut to fifteen years later, and you realise how many other things – the stage you’re at in life, how you live your life and what you want from it –  all matter as much as good chat. If a relationship is a house, chemistry is the front door. Every house needs a front door but you can’t build a house with just a front door (although it’s easy to think you can if you aren’t taught to think beyond someone being happy to spend an evening with you…). Rather than being told about “chemistry” when I was 16, I’d much rather someone had talked to me about the reality of meeting some wonderful people with some horrendously incompatible lives. Chemistry can be there in spades but it isn’t always helpful and can in fact be just as painfully useless as someone not giving you a second thought.

Thanks very much to everyone who replied to my tweet! Feel free to add any more in the comments…

10 ways to help someone affected by suicide (and 11 not to)

Within the last four years, two people I knew have taken their own lives. The kindness and thoughtfulness that has come my way both times has been wonderful: from close friends to people I haven’t seen in nearly 20 years, and people on the other side of the world I know through work and have never met in person. I count myself lucky to have seen such sympathetic and compassionate responses from so many. Sadly, despite the brilliant work of mental health campaigners and increased public understanding in recent years, stigmatising attitudes to mental health, suicide in particular, are still very common, and can cause great distress to those affected. I’ve read and heard of people bereaved by suicide facing huge ignorance from others, and – occasionally – been on the receiving end of it from people I thought would know better.

Based on my and others’ experiences, I’ve put together this list of the types of responses which have been most helpful, and those which – while probably well-meant – have been less. You might be reading this because someone you know has recently been affected by a suicide and you’re not sure how to respond. Or because you’ve been affected yourself and want to see if it reflects your own story. If you have relevant experiences and would like to add your own, please do comment. You’re more than welcome.

I fully recognise that no-one’s perfect, including me. I hope the take-home message is that simple compassion – both for the person who has died and anyone they meant something to – is the best thing you can offer at any time…

10 Ways to be Helpful… 

  • Saying you don’t know what to say Some people think this is the wrong thing to say, but it’s fine. For someone in shock, the feeling’s probably mutual. It means you understand the magnitude. And it’s better than “I know how you feel” if you don’t.
  • Getting in touch straight away Even if just to say the above. A sympathetic card or message can be incredibly touching, even  – or perhaps especially – from someone you don’t often hear from.
  • Understanding some basics about depression  An estimated 90% of people who take their lives suffer from depression. Depression is an illness, and still widely misunderstood.  It can sometimes be a reaction to something in a person’s environment, like trauma or deprivation (Reactive depression). Sometimes, it’s linked to another condition, like anxiety, chronic pain, epilepsy or a learning difference (Secondary depression). And sometimes it has no obvious “reason” at all. (Clinical depression)Depression affects those of all backgrounds, and, although some lifestyle factors can help people manage it more easily, love, faith, exercise, hobbies and money aren’t a cure. Asking “Why was he depressed?” makes as much sense as“Why did he have cancer?” “He had a great job and a loving family, how could he get conjunctivitis!?” or “Why’s she bothered about being raped – she’s loaded!” Depression can distort a person’s view of their situation in a similar way an eating disorder distorts a person’s view of their body. Someone with depression can believe their life is hopeless even though they are very fortunate, just as someone with anorexia can be emaciated and believe they’re overweight. You don’t have to be a great expert on mental health, but this simple knowledge will go a long way.
  • Simple, specific gestures Helping with daily admin, chores or responsibilities, cooking for someone, buying them something to eat, or even just a cup of tea are bound to be very much appreciated.
  • Letting them know feeling needy is allowed Even people who normally manage quite well in their own company can be quite clingy after a sudden, violent death. They need to know this is normal and OK. Be prepared for someone to want to talk/speculate/ask questions, particularly if you’re breaking the news or passing on any details. Wanting to talk isn’t also always necessarily about wanting answers, or thinking it’ll lead to some great big truth. Often it’s just comforting. I found chatting informally to a group of my friend’s mutual friends more helpful than an organised support group of strangers. Others may feel differently. Abrupt swings between wanting to be with others and be alone are also common.
  • Recognising everyone grieves differently In particular, one of the biggest distinctions in today’s world – which can lead to conflict and misunderstandings – is in how people deal with grief online. Those who’ve used the internet at home since they were young are often more relaxed about sharing personal thoughts via email/blogs/social media, while those who mainly use these professionally, and are used to tightly-controlled working environments may be warier. The only time you should – carefully – intervene in someone’s response is if their behaviour is seriously harmful to them or others, e.g they blame themselves, blurt out harmful secrets/threats/allegations, impinge on other people’s privacy, or won’t acknowledge what’s happened at all.
  • Encouraging them to take it slowly Sometimes grief or shock makes people’s mind race. They may be overwhelmed by practicalities, such as coping with paperwork or arranging the funeral. Or, they may create distractions for themselves to lessen the pain and end up being swamped. Encourage them to slow down and not take on too much at once.
  • Recognising that a suicide hits people in certain situations particularly hard As well as the very obvious (partners and first-degree relatives), this includes anyone else affected who is living in difficult circumstances, e.g far away from close friends or family, single, unhappy or insecure at work, on a low income, new to a job or area, or who’s been bereaved before, especially in a similar way. Equally, don’t think someone more fortunate or settled can’t be sad either. Being well-off doesn’t compensate for grief – or mental illness.
  • Recognising grief is a process Sadness and sensitivity aren’t confined to the aftermath of a suicide but can reappear at any time, particularly around anniversaries and after news reports of death. Bereavement might also affect someone’s responses to death in future – for example, they may be more affected by scenes of violence and mourning after a news event than want to discuss politics or “the bigger picture.” And never think it’s “too late” to talk about someone’s loss. They won’t have forgotten it. Indeed, some people find it easier and preferable to talk after a certain amount of time has passed.
  • If you can, donating to or volunteering for a mental health charity There are some suggestions on the About and Helpful Places pages of this site, or there may be an online fundraising page in memory of the person who died. Fundraising pages are a great way to donate to charity, as the money goes straight to the charity, saving them time and money. Most let you donate anonymously.

And 11 Ways Not to Be…

  • Assuming too much Respond according to how someone actually feels, not how you think they should feel.
  • Blanking someone A work acquaintance once told me that when her husband died, some people literally crossed the street to get away from her. It’s understandable to hang back a bit if you find it difficult to express yourself or aren’t in a situation where it’s easy to talk. But grief is an irrational, sensitive time and rumblings of: “Is X being off with me?” can creep in. Do let them know they’re in your thoughts and that you’ll be around in the future.
  • Being judgemental/unkind about the person who’s died, especially someone you never knew Keep your negative opinions and/or assumptions to yourself. Comments like “That’s so selfish!”  “What did s/he have to be depressed about?” “I’ve got no sympathy for people who do that! can be very hurtful – even to those who are angry and incredulous about it themselves. People who kill themselves will almost certainly have hidden complexities and your impression of them and their lives is almost certainly based on limited information. They were a real person, who mattered to someone who is real to you; not a TV character or a distant celebrity whose life is yours to pick apart and comment on.  You don’t have to butter someone up, or pretend that because they died they were heroic (which few people are, and suicide isn’t) or flawless (which no-one is), but running them down in front of people they mattered to is not on. Sometimes people do this out of frustration, or well-meaningly to try to ease someone’s grief. Whatever your intent, it’ll only make them feel worse. Quite simply, if you have nothing nice to say about someone, don’t say anything. On a similar note, try and resist publicly moaning that a railway suicide has inconvenienced your day. Being depressed, or bereaved by suicide, is loads more inconvenient than a delayed train. Trust me; I’ve experienced all three.
  • Saying anything that could make a grieving person feel ashamed, guilty or to blame To avoid implying blame inadvertently, it’s best not to delve too deeply into people’s arguments or disagreements with the person who died, or try and talk someone out of something with: “Imagine what X would say…”  (People’s capacity for misplaced anger can be quite astonishing: I’ve even heard of someone being blamed for her boyfriend’s suicide by his ex-wife who left him…)
  • Nit-picking People in grief or shock probably aren’t at their most articulate and may say things that are raw and disjointed. Splitting hairs over their word-choices, trying to give perspective: “Well at least you’re not in a war zone…” or being dismissive: “She had good points? Yeah, I bet Myra Hindley did too!” are not helpful. Perspective doesn’t take the pain away, and respect for the dead and grieving isn’t intellectually beneath you. You’re not in a student debating chamber; you don’t need to score points.
  • Wild, spontaneous gestures, or emotional blackmail In a Richard Curtis film, travelling hundreds of miles across the country and turning up at someone’s door uninvited is charming, cute and makes someone want to marry you. In real life, it tends to have the opposite effect. Don’t see this as an opportunity to get into/back into somebody’s pants, or convert them to your religion or politics. Similarly, don’t pressure someone into big life decisions too soon. They’re probably barely up to deciding on a pizza topping, let alone a round-the-world trip, house move or career change.
  • Making too many promises you can’t keep The slightest change of plan can be quite a stress at a time like this. Obviously some problems are unforeseeable and any reasonable person will understand, but before you suggest any kind of outing or gesture, try and make sure it’s viable and can be easily rearranged if you have to. This is also why very simple gestures are often better than big whacky ones (see above).
  • “You meet so many damaged people. You should find some happier friends!” There can be a fair comment in this. Some people do seem to surround themselves with vulnerable people to distract them from their own pain, or out of guilt for their own advantages, which is not always healthy or helpful. But it’s not a useful discussion to have at this point. Although I’ve written about mental health, the great majority of the depression sufferers I know are people I didn’t meet through mental health writing, but through other work, at university, through “regular” blogging, and the same way anyone meets anyone. People with depression don’t walk around with neon flashing badges, and you couldn’t prevent yourself from meeting them if you tried. Would you tell someone not to make friends with people in the military, frequent flyers or fans of extreme sport in case they die?
  • Making grief into a contest or confrontation “Some of us don’t have time to be upset.” “I knew X longer than anyone/I’ve been through worse than anyone else…” “I didn’t get like this when X died and he was Y” and so on. Offloading onto a grieving person everything you don’t like about them, and everything they’ve ever said or done to annoy you, is also a bad idea.
  • Immediately asking someone whose opposite-sex friend has died whether they were together, ever fancied each other, etc etc When someone tells you a friend has died, accept their description “friend”. Don’t make them feel obliged to tell you whether they were romantically involved, explain why they weren’t, or relive any past involvement. Unless they tell you, it’s not your business. And they’re more likely to open up about this sort of thing if you give them time than steam in with questions. Oh, and drop the careful euphemisms. “Were you two…close?” “Did you have an intimate relationship?” Oh, please. We know what you mean. You may as well just say: “Did you used to shag?” and be done with it…
  • Telling someone not to speculate Look; someone has died very suddenly and violently. Let those who are left behind speculate if they damn well want to, thank you very much. Now, of course, there is healthy speculation and there is unhealthy speculation. Unhealthy speculation is blaming yourself, saying that if only you hadn’t worked late that day and been home an hour earlier none of this would have happened, etc etc. Or bandying around harmful allegations and accusations in public. Like suggesting that someone took his own life because his parents were mean to him, his brothers were richer than him, his wife didn’t understand him, or he was secretly infatuated with an old classmate. And doing nothing else but speculate is obviously unsustainable, emotionally and financially. Those are the sorts of things you should – compassionately – intervene in. But a certain amount of going over and wondering about things (especially if you weren’t their next of kin and had even fewer of whatever few details there are to know), is normal and natural. Telling someone who’s lost a loved one or friend to suicide: “It’s no good speculating” is like telling someone to ignore having a nail file pushed into their eye socket. It’s just not realistic. It will make the person want to sneak into your room at night and stick an upturned plug right by your bed so you step on it. A much more constructive approach (based on Cognitive Behavioural Therapy techniques) is to help them reign in the speculation so that it doesn’t get in the way of too much else. A good way to do this is by encouraging them to timetable it, giving themselves permission to mull over stuff at set times of the day/week/month/whatever interval works for them. But DO NOT just ban or discourage speculation altogether.

A final point, specifically for the bereaved (and believe me, I know it’s easier said, but I’ll say it anyway…): Feeling that someone isn’t being as available or sympathetic as you’d like is horrible – but there’s no point in putting your life on hold hoping for them to be, or trying to badger or wish them into being. If you’re in this situation, step back and find support from a trained professional. Good luck.