Grief: After the 10 year mark

When you experience deep loss, your world goes into a bubble where time stands still. You seem to lose future planning and the past is too unbearable to fully reflect on. People don't always realise this but it is often after time has lapsed and things resume into mundane rituals, where life goes on,

that a person in grief struggles the most. In my belief, this is because you start to realise that this is it, finality sinks in and there is a gap and emptiness which only others who have experienced loss may even begin to understand.

Somehow, with some time and care, you integrate this loss into your world view. You make peace with the pain and emptiness and almost get used to having this as a part of you. You develop rituals and strategies, you talk or you block it out, you form a new relationship with your lost loved one and start to anticipate the days that are going to be harder than others. I always say to people who have just experienced loss that the first year is the hardest. That is not to say it will be ok after a year, no, more like in that year you will experience all the 'firsts'. The first birthday, anniversary, milestone, breakdown without their support, happy occasions, longest time without speaking etc etc. You start to form coping skills and ways of dealing with this loss without losing control completely. There are times where the grief feels as fresh as it did that first day but you learn that these times are normal and a new part of your life that you adapt to.

As the years go by, things happen and 'firsts' continue. You wake up one day and struggle to fathom how you have made it through for this long. You may even feel guilty and panic because you can't remember their voice or need an answer for a question which only they can provide. The loss is relived again and again in big and small ways but you keep moving. You wonder how your life would have turned out if they were still here. You wonder what they would say about your current predicament and you listen when people tell you your loved one would be proud of you. In your heart you know they would because you have carried on despite times when you ached to join them and relieve the emptiness and pain, if only to see them one last time.

Today, for me, it has been 11 years. I know my grief well. Time has provided understanding and new grief. Loss has come in various forms and in some cases, completely unrelated to my biggest loss. I still feel stuck in a weird unknowing. I hold on to my memories as if they happened yesturday. Interestingly they are more centred around me than my mother. I reflect on this regularly and for me, I think it is because my loss has gone in two ways. I lost the person I loved most in the world, my primary attachment figure and the only person who has been there in almost every way from the beginning. But 11 years ago I lost something else, just as precious. I lost a part of myself. I lost my sense of identity in a way. I lost my safety net, my unconditional love and answers to questions I will forever need the answers to. I lost my faith and I lost a sense of belonging. People will tell you that you are loved, that you are not alone and that they will always be there for you. I personally don't know where I would be today without those people. The truth is though, those declarations can bring on an even greater sense of emptiness and loneliness because you still feel alone but people don't get it. They don't understand how you can feel alone when you are loved, how you can feel empty when you have people there to support you and believe in you.

At the end of the day, you can feel alone. It takes understanding that there are different types of being 'alone'. There is no filling this gap because the cause of the loneliness of grief is more like a severing of a part of yourself that you will never get back and will have to learn to accept and live with. We may never shake this. We may always feel like we are missing some big element of ourselves. We may try to fill this in destructive ways, we may project this onto other people in our lives and expect them to fill roles and gaps that they will never be able to fill. We may think we are ok with our loss and realise abruptly that we are not when we start blubbering like a baby when something triggers our grief (the movie 'Stepmom' is a good example for me). A dear friend said to me once, the pain doesn't lesson, is just becomes less frequent. I love that. It may not hold true for everyone but for me, it hit home.

Grief is a part of life and we will all experience this at some point. I don't want to give people the impression that there is a time limit and you will 'move on' and things will be better in time. The truth is though, in some ways you do move on and things are better but in other ways it can feel harder and more confronting. Grief works in phases like the tides. We all have different triggers, we all had different hopes and dreams and we all need things at different times and in different ways. One common thread I believe is that we learn how to make this a part of our new selves. We find ways to carry on, feel love, take risks and cherish memories. Perhaps the memories are of happier times without the loved one, that is ok too. The best thing to do however, is to find a way to keep your loved one in your life despite them not being in it. This is called a 'continuous bond' in grief theory. You will never replace them, thus they will need to be present in a different way. Whether you talk to them, talk about them, cry for them, laugh at them, learn from them or live in their honour, keeping them as a part of you will help the finality of the situation seem less daunting.

For all those people who have been dealing with loss, I am writing this with you in mind and heart. You are a survivor and it is no easy feat this carrying on business.
Be kind to yourself
XXX
Paula          

Raising Happy Children

With so many of my peers entering the world of parenthood, I have been pondering a blog around 'children and attachment' for quite some time now. To attempt to move away from fancy words and theory's I want to try and explain and discuss 'raising happy and well adjusted children'. I have been working with children in various settings for about 5 years or so now and have worked with a range of cultures and ages. My current job as a family worker unfortunately exposes me to the 'not so happy' children in the community and it is from this growing knowledge that I felt it may be helpful to a few people out there to explore this very broad topic with me. For those who are not parents, perhaps you may start to look at your own childhoods...

No child is born 'evil' or 'bad'. Despite many people out their believing otherwise, the very tough home truth is that children are a product of learning or circumstance. This is something I believe with my whole heart and if no other message goes through, let it be this one! If you were told something awful like that as a child...it is not true. Simple. What isn't simple, however, is understanding why children develop behavioural problems, or behave in ways that are associated with our idea's of 'bad'. I thought the best way to go about this would be to explain some of those fancy phrases or terms such as 'attachment', 'emotional regulation' and 'development' in a way that is easy to comprehend and apply to your own lives.

DEVELOPMENT

I will start with development as most people know about this to some degree - if for no other reason but because we have all progressed through early development ourselves and continue to develop throughout our lives. When development is mentioned in relation to children, it is about how a child is growing, learning and reaching milestones specific to a rough age group. Theorists such as Freud and Erikson (the 2 that spring to mind the most for me) and many others have attempted to create comprehensive 'stages of development'. I wont go into what their theories are in this forum but I will discuss this concept of developmental stages a bit as it can become a great source of stress for parents, particularly if your child is said to be 'delayed' or 'immature' for their age.  

There are many theories but none of them are absolute and rigid. These milestones are meant to act as a guide. Children should start to teethe, walk, talk, make associations etc around certain ages. Some children advance in some areas and take longer to develop in others. This is normal. Your child is unique and special and should be assessed as an individual, the same as adults. Some areas require more effort and support than others on the part of parents and educators. Children are often put through assessments at school in their early years in order to assess for readiness to move up to the next grade or level. Ideally this is done in order to support the child, not to criticise and pass judgement. That said, many people do feel judged and finding out your child is behind can be quite confronting for parents. For the most part,delays in development are not an indicator of disability, slowness, lack of intelligence or underlying issues. Often it is about being flexible and understanding that your little nipper is constantly learning and their brains are still developing. Children are each exposed to different stimuli, experiences and learning opportunities and the rate at which this learning takes place is going to differ slightly for each child.

When to be concerned:

With everything, it is always good to consult with a professional if you notice areas of struggle or delay that are worrying or substantially different from other children their age. Keep talking to your Doctor and keep yourself informed about what milestones to expect from what ages so that you are able to align your expectations with your child's capability. When professionals assess a child for abuse, often these developmental stages act as a guide for abnormal behaviour. An example would be a child who is being abused may regress or halt development in certain areas like speech. Teachers should hopefully pay attention when children who are, for example, 3 years old and have not started forming words or sentences yet.

EMOTIONAL REGULATION

This is something that you may actually know about on a basic level. We need to teach children about emotions and appropriate ways of expressing them. This is something most parents do naturally. Emotions are learnt through modelling (children watching you and your emotions) as well as through validation, which is when you reinforce their emotional experiencing by acknowledging their feelings. If you try and hide emotions from children it can actually be more harmful than protective because young children are more in tune with their intuition and senses than with thoughts and reasoning. They will pick up on your emotions and react to them. Being appropriately transparent is a great way to teach your children about different emotions and take away the fear surrounding the more negative emotions such as anger and sadness, I want to stress that you do not need to be transparent about your problems and the reasons you are feeling a certain way, adult problems should not burden children. What you should do, however, is explain that you have an adult problem and it is making you feel sad or angry or frustrated. If you are crying, explain to the child that you are crying because you are feeling sad etc. It is a parents job to familiarise and support children through their emotional experiencing so that they can feel comfortable in their reactions and do not feel guilty or ashamed of 'how they feel'. I find it is easier to teach children about emotions like you would shapes, colours, the alphabet and other common lessons. Associate emotions with colour and ask children to match different emotions to the colours they think represent the emotion. There are many lovely activities to help you with this but the best way is to lead by example.

What happens when a child's emotions are not regulated?

Due to the sheer enormity of child abuse and mental illness, this is an area that is strongly backed up by research although the negative effects of insufficient emotional regulation have been known to many frameworks of psychotherapy and psychology for years. Within child abuse literature and laws, neglect has been proven to be just as harmful, if not more harmful in some cases, than physical abuse. The reason is due to this regulation of emotions and attachment (which I will chat about shortly). Neglect is not simply about not playing with your children or not giving your children constant attention. It is about failure to help them develop and learn, failure to build up their strengths, failure to validate them as human beings and failure to normalise their experiences and teach them that feeling emotions is normal and not to be ashamed of. Safety is not only about a physical environment. Children need to feel like they can make mistakes and will still be loved and accepted. They need to be able to have trust in the people caring for them and they need to be able to ask questions and learn how to manage their feelings appropriately so as not to harm themselves or others in any way.
Going back to my initial statement of children not being born bad or evil, this is a prime example. Children do not have the mental capacity and ability to process their feelings and articulate their needs like adults can. That does not mean they do not feel the same emotions, it means they often are unable to understand them. Children who behave in challenging ways are often acting out their emotions due to a lack of a better outlet or guidance. They are attempting to get their needs met. Discipline and structure are important here, not in terms of punishment, but in terms of safety and boundaries. When you punish a child for expressing their emotions inappropriately, it is important to spend some time teaching the child more appropriate and healthy ways to react without shunning the emotion itself. ALL EMOTIONS ARE IMPORTANT and serve a purpose.
If a child has never been taught how to understand their emotions they will struggle in life to various degrees. The child may go on to develop low self-esteem, mental illness such as anxiety, depression and in extreme cases, more serious mental illnesses such as Borderline Personality Disorder. They will most likely struggle to have healthy relationships and may struggle to handle stress in life. As they have not been taught that certain feelings are normal in certain situations, they will have to work all of this out for themselves along the way. This will mean that they will struggle to feel confident in their reactions and may feel out of control and easily overwhelmed. A good example of a child not having their emotions regulated is when the primary caregiver has mental illness, lets say depression, and struggle to feel their own positive emotions such as joy and excitement and thus are unable to model these to their child. The child may race home with a gold star only to be met with a half hearted smile. The child may become confused and mistake this reaction for a mistake in their own feelings 'this gold star is not something to be excited about'. That lesson will be learnt and the child will be left with confusion. Later in life the child may go on to find that they are unable to recognise joy and excitement.

ATTACHMENT

This ties into both development and emotional regulation and stems from 'Bowlby's Theory of Attachment'. It is about the relationships and emotional bonds
that are formed  between people. Children will form an attachment to their primary care giver, usually the mother figure. This is different to other relationships of friendship and romantic attraction/love. It is a deep relationship requiring trust and a sense of belonging where the person creates a bond that is extremely influential to their sense of being in the world. The earliest attachments in childhood are the most important and impact behaviour, self-esteem and self reliance and have a lasting impact throughout the child's life. To have a secure attachment, your child will learn that you love them unconditionally and will be dependable and reliable. Again, many parents do this naturally by meeting the infant's needs, accepting the child's mistakes, spending quality time with the child, creating structure and safety and routine in the child's life, teaching the child continuously, being patient, showing and expressing love and guiding the child through challenges.

When the attachment is not secure: 

This can happen for a number of reasons, namely, it happens when a primary care-giver is not consistent or does not create this bond effectively with the child. Inherently, it happens when the child's needs do not get met (physical, emotional and other). If the child continuously receives mixed messages, they will become confused and will not feel secure. This happens when a parent is abusive and the child is never sure how the parent will react. It can also happen when a child is neglected or left to fend for themselves in some way. It also happens when the child's emotions are not regulated. Not having this security can lead to a range of issues down the track for example they may be unable to form healthy relationships, either becoming too dependent or too avoidant, unable to feel secure in a range of areas within their life. Thus this impacts self-esteem and confidence. Some people may go on to suffer from various forms of mental illness, similar to a lack of emotional regulation.

Some final words:

As a parent it is your job to teach your child how to believe in their own ability and experiencing. It is important to take care of yourself so that you may take care of your child. The best way to teach a child is to lead by example. I hope this has not created fear in new parents, it is not meant to frighten and scare, rather to inform. Love your children, treat children like children and don't expect children to deal with adult issues. Children learn best through play and through modelling so remember, live by example and do not use your children to meet your needs, it should be the other way around. There are no rule books and formula's, you will mess up more than once and that's ok. It is how you handle the mistakes that count in the end. Dr Phil always says 'it takes a hundred atta boy's to make up for one criticism. Never call your child names like stupid, useless, bad, hopeless etc, they will believe you and take this on board. Always punish the behaviour not the person. Your behaviour is naughty not you are naughty. Take time to explain why you are angry or upset with them, let's get rid of the 'because I said so' and replace it with a solid response 'mummy wants to keep you safe and so the answer is no'. Encourage questioning and exploration and encourage tolerance and love!

Those are my thoughts and I encourage you all to keep learning about this and find ways that work for you and your family.

XXX
Paula

Post Natal Depression and Baby Blues

Today I thought I would create a bit of awareness around Post Natal Depression (PND) or Post Partum Depression. In a simple way, this is when a new mum becomes depressed for longer than 2 weeks after giving birth. This disorder has the same severe or prolonged symptoms of Clinical Depression that lasts more than a week or two and interferes with the ability to function on a daily basis. 

PND can interfere with the relationship between mum and baby in terms of bonding and attachment. It can put relationship strains on the parents and PND can be extremely distressing for the new mum.

This is different from the Baby Blues - NB.
Getting the 'Baby Blues' is very common. 50-80% of women have this experience and it usually lasts a week or two after giving birth. Symptoms include mood swings, tearfulness, anxiety and difficulty sleeping aside from the baby. Baby Blues are thought to be linked with the stresses of pregnancy and hormonal changes. The treatment for this is usually rest and support.

There are 2 types of recognised forms of PND - Melancholic and Non- Melancholic.

Melancholic is rarer and has a distinct genetic or biological basis, thus unfortunately you are predisposed to PND and will most likely require medication in your treatment plan. It is characterised by slowed cognitive processes (thinking), poor concentration and psychomotor disturbances (agitation or slowing of movements); on top of the depression symptoms.

Non - Melancholic is more common and is linked with certain risk factors in your social environment. The depression can still be severe but this form of PND responds to psychological and therapeutic treatment and approaches. This is the PND I would like to chat about today.

There is a focus on fears and the concerns are often about the well - being of the baby or feelings of inadequacy as a parent.
Symptoms of PND can include:
Loss of enjoyment in usual activities
Loss of self - esteem and confidence
Loss of appetite and weight
Broken sleep (irrespective of baby)
Sense of helplessness and of being a failure
Wish not to be alive
Suicidal ideation (thoughts of suicide)
Panic attacks
Loss of libido (sex drive)
Fears of baby or partners' well-being or safety

Risk factors for developing PND can include anxiety during pregnancy, stressful life events during pregnancy, low levels of social support, low socio-economic status or obstetric complications. Risk factors mean that there is an increased risk of developing PND; it is NB to note not everyone with these risk factors will go on to develop PND.

The negative effects of PND can be frightening for people suffering from this disorder as well as for their families. Often the mum will struggle to bond with her baby and may not feel any gratification for her role as a mother. Tasks in her life may be too hard to manage at this time, particularly to do with the baby. Thus the new mum may feel isolated, guilty, helpless and hopeless and these feelings are constantly being reinforced by her inability to tend for and love her baby.
The risk for substance abuse increases with PND as does the suicide risk. Some mums start to have intrusive thoughts of accidental or intentional harm towards the baby. NB it is very rare for a non psychotic woman to commit infanticide but these thoughts can be extremely distressing nevertheless.

Depression will effect a mothers's ability to interact appropriately with her child. She may not respond to her baby's cues or she may be negative, hostile or disengaged. The outcome will be a lower cognitive function and emotional development in the child. In lay-mans' terms a child needs to learn about feelings, behaviours and feel validated and supported in order to develop and grow with confidence and stability. If the child is not being responded to or is receiving mixed messages about how to feel, the child will not feel secure in their own reactions and will not learn to understand their own emotions easily. This is bound to create problems later in life. Perhaps some of you are thinking that your own needs may have not been met as a child....

Breast feeding can be difficult for women suffering from PND.

Medication is not a popular choice for PND, particularly because women are breastfeeding and do not want to taint their breast milk. Side effects are not yet known in this regard and the argument lies between the side effects of medication and the negative effects of PND on the child's development. Something to think about.

The common form of treatment is psychotherapy using psychological approaches. The two approaches that are proven to be effective are Interpersonal Therapy and Cognitive Behavioural Therapy. In my personal opinion, it is important to find a person, group or approach that feels right for you. If you would like to treat this asap and are time limited, money limited or a person who does not like talking about their problems, a more manualised approach like Cognitive Behavioural Therapy (CBT) or Interpersonal Therapy (IPT) may suit you. Both approaches go for a number of weeks (12 - 20 on average, CBT can be less) and the skills you learn can be incorporated into your life outside of therapy. Other forms of therapy are less structured and more open ended, often with a person - centred base. My best advice would be to take into account what you would feel comfortable, talk to your GP about options and shop around for a therapist that works for you.

It is always important to feel comfortable and trusting of your therapist. You should work with them to find the best treatment for you. Your unique problems and commitments should be taken into account and you should feel comfortable enough to say when things are not working for you. Sometimes bringing your baby with you to the sessions may be helpful and the therapist can gain an idea of your interaction styles with your baby. You should NOT feel judged, this is important. If you are suffering from PND you are doing enough judging for yourself, you do not need to add to this.

It is important to understand Post Natal Depression so that we can be understanding of ourselves and of others, should we come across this disorder. We are only human after all and no person is immune to life's hardships in one way or the other. Lets support one another!

Hope this isn't too wordy and academic, hard to casually give the facts as we know them :)

Take care
XXXX
Paula

Reference:
Treatment of postpartum depression: clinical, psychological and pharmacological options

Elizabeth Fitelson,1 Sarah Kim,4 Allison Scott Baker,3 and Kristin Leight

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/