Coping with grief and loss during the holidays

In the holiday season, many families eagerly anticipate getting together with loved ones and sharing these special holidays. On the opposite extreme are those for whom the thought of these weeks fill them with feelings of dread. I am referring here to individuals or families who have experienced a significant loss.

This might be the first holiday season since the death of someone that was dearly loved. This might be the first Christmas alone after a divorce or the breakup of a long-term relationship.

Losing a Loved One is Traumatic

Losing a loved one is the most traumatic experience you can go through. If someone you loved has died within the last year you are probably feeling enormous pain. There is so much you miss about them and your whole future seems bleak without them. Death is part of the life cycle but it is never easy.

Grief and loss can also refer to other circumstances like divorce, a relationship break up, job loss, disability after illness or an accident and even immigration. What we also know about loss is that when there is a loss, in the present, at an unconscious level you are also connecting with other losses at other times in your life, making the current situation even harder to deal with.

The Grieving Process Takes Time

Grieving is a process that cannot not be hurried. It takes as long as it takes to start feeling better. There is no formula. Some people may start to find their equilibrium at around six months after the loss, for others, it can take several years to come to terms with the grief and start moving on.

One of the most famous authors on Grief and Loss was Dr Elizabeth Kubler-Ross. She originally wrote about the stages that dying people tend to go through as they come to terms with the realisation that they will soon be dead. Her stages have since been borrowed by the wider grief community as a means of describing the grief process more generally.

The 5 Stages of Grieving

Dr Elizabeth Kubler-Ross’ five stages of grieving are as follows:

Denial: this is the first stage. Here a grieving person is unable or unwilling to accept that the loss has taken place. The loss feels unreal and there is the hope that they will wake up to find the loved one still with them. It can feel like being in a dream.

Anger: once there is acceptance that the loss has in fact occurred, one might start to feel anger and a huge sense of unfairness. One might even become angry at the person who is now gone and who has abandoned them.

Bargaining:  In this stage people will often beg for the loss to be undone. This is often bargaining with a higher power with promises of better behaviour or significant life changes in exchange for a reversal of the loss.

Depression: when it becomes clear that anger and bargaining are not going to reverse the loss one may sink into depression. The reality of the loss is confronted and there can be a huge sense of helplessness. During this stage grieving people may cry a lot, experience changes in their eating and sleeping patterns or withdraw from others and activities they used to enjoy. This is appropriate to give one time to process one’s feelings.

Acceptance: eventually, hopefully, one reaches the stage of acceptance. This is where the initial very strong feelings of grief start to lift and one can accept that the loss has occurred and cannot be undone. One can slowly start re-engaging with life and thinking about the future.

Not everyone will experience all of these stages and they might not occur in the same order.

At Zetland Psychotherapy, we do not hurry this process. A significant loss needs to be understood and respected and we will patiently support and assist you until you feel you are able to manage on your own.

Do I Have Social Anxiety Disorder?

If you are reading this then maybe being around people feels scary. Maybe your experience of social anxiety is relatively mild. In social situations, you might feel anxious in the beginning and then slowly start to relax, especially if you find someone nice to talk to.

On the other end of the spectrum are feelings close to terror in anticipation of attending a social event. This could be an occasion where you will know most of the people or something where there will be a lot of strangers. The actual situation is less important than your overwhelming fear of being around people, full stop!

Feeling Nervous is Normal

Many people may feel a little uncomfortable about being around others that they do not know. If they are with a partner, they will stay close to their side until they start to feel more comfortable to talk to others. This is quite common.

I think that people who are able to enter any kind of social situation and feel perfectly at ease are in the minority. If it is an occasion where they do not know anyone, the super confident person might just stand and watch others mingling until someone comes into sight that they feel they would like to talk to. Or they could just walk into the room, perhaps get a drink, and not necessarily alcohol, and just walk up to a group of strangers and join in.

I am making a point of mentioning this as there are really very few people who can do this. A certain degree of reserve or shyness is normal and appropriate. Another fear that is also very common is fear of public speaking or even just making a comment in a group meeting. So clearly many people do feel a bit socially anxious at times but it does not significantly interfere with their life.

Social Anxiety Disorder and Social Phobias are Immobilising

However social anxiety disorder, or social phobia, becomes a problem when you start to feel immobilised being around people. You might experience ongoing, intrusive thoughts about new situations that might present themselves.

Maybe even just going into work and being around others can trigger these fears. Perhaps you avoid meeting up with your colleagues for morning tea in the leisure area of your office as you find it hard to contribute to the daily office banter. So you rather stay at your desk and continue working while you can hear everyone else enjoying some social time during their busy work day.

Social Anxiety in the Festive Season

At this time of the year, as the festive season approaches, your difficulties could escalate. There will be more invitations to attend functions with the likelihood of there being many people present that you do not know. You might possibly make excuses not to attend, preferring to isolate at home where at least you feel safe and free of the terrible anxiety. Sadly the avoidance serves to reinforce the fears you have around social situations and a vicious cycle develops.

Social Anxiety is Treatable

Your social anxiety is treatable. As with all issues at Zetland Psychotherapy, part of our early work is to get a full history of the problem, including a family history. Often socially anxious parents can, unintentionally, produce socially anxious children.

One of most effective ways of dealing with social anxiety is through graded exposure to situations that make you anxious. Under our guidance you slowly challenge yourself to take small risks and expose yourself to anxiety provoking situations. We start at a gentle pace and our goal initially may be to only stay for half an hour. At the next session we would talk about how that felt and would work on other small, manageable challenges.

It could even be as simple as joining your colleagues for morning tea a few times without any pressure to say anything. The value would be to learn to feel comfortable just being there. Making conversation would be a challenge for a few weeks later. The idea here is baby steps, while being supported throughout, until you start to feel more at ease around people. At first the tasks that we jointly agree upon to do may feel terrifying. That is ok, you will be able to debrief at the next session.

Treating Social Anxiety with Medications

If the steps described above sound too daunting, then we might need to think about some medication to assist you to engage more productively in the treatment process. Your GP would be able to prescribe something for you.

Social anxiety disorder is quite common, yet responds well to the appropriate treatment. There is a great sense of delight for both yourself, and your therapist, when progress is being made and you start realising that hanging out with people can be fun!

Signs Of Depression

Do you have signs of depression? We all feel sad at times, that is part of being human. Often our sadness can be triggered by an external event. We may be grieving a relationship breakup, we may lose our job, someone in the family may be ill or perhaps life is just stressful. This kind of sadness usually soon passes. It may take a few days or a few weeks and then we start to feel better and manage to cope quite well. It is good to let ourselves feel these feelings and a bit of self-nurturing can do a lot to help us manage.

A Feeling of Gloom and Doom

Then there is a different kind of sadness. This can be a feeling of gloom and doom and suddenly your whole world feels dark. Perhaps you are not sleeping well or maybe sleeping too much. Maybe you do not feel like eating. When you wake up in the morning all you want to do is curl up and go back to sleep. Facing the day feels too hard. Perhaps this has been going on for several weeks. If you are feeling any of these more severe feelings there is a good chance that these could be signs of depression.

Life Feels Miserable

Depression is like the common cold of mental health problems. One out of five Australians will probably have an episode of or show signs of depression in their lifetime. This condition robs you of your joy and things that you used to give you pleasure are now no longer fun. It is hard being around happy people, you no longer laugh and life feels pretty miserable.

Treatment and Medication

Depression is a debilitating illness and can affect your physical health too. You may in fact with struggling with the symptoms of depression and anxiety. The good news is that the treatments today are highly effective. Helping someone with depression often involves a combination of medication and some kind of interpersonal psychotherapy. Most depressive episodes usually pass if the appropriate treatment is received.

Not everyone who is depressed needs to go onto medication. At Zetland Psychotherapy a comprehensive assessment is conducted around your signs of depression. We look at when your mood started declining, what possible triggers there may have been for this, and your family background and then together we decide on the best way to treat you.

Medication is sometimes necessary to help to lift your mood so that you can get the maximum benefit out of your therapy. Your general practitioner will probably be able to prescribe a suitable drug for you. If you do not have a general practitioner that you know and trust we are able to offer you some names of good doctors to go to.

If you have very severe symptoms of depression, and you have been feeling this way for a long time, it may be more beneficial to be referred to a psychiatrist. These are doctors who specialise in all areas of mental health and are better equipped to treat the more treatment resistant depressions. Often they will use more than one drug to help you and it is the combination of two different medications that assist the more serious episodes. Furthermore psychiatrists are allowed to prescribe stronger drugs that general practitioners are not authorised to. If a psychiatrist is not able to assist helping someone with depression using all of these more sophisticated means, they may decide that there would be a benefit from an in-patient stay at a psychiatric facility. This is nothing to be afraid of. There are some excellent facilities in Sydney, staffed by caring professionals, who offer a full therapeutic program. Once you are an inpatient and you are still not getting better a decision may be made by your doctor to prescribe Electro-convulsive therapy (ECT). This is done under a light anaesthetic and is painless. This has been described as a miracle by many people suffering treatment resistant depression.

Psychodynamic Psychotherapy

On the other hand you may not need medication. You might just need someone to talk to and through the sharing of your feelings and concerns we may be able to make headway without involving anyone else in your treatment. The treatment style at Zetland Psychotherapy is psychodynamic psychotherapy. This focuses on establishing a warm and trusting relationship as well as getting a detailed family history. Part of this process may also involve some behavioural therapy. If you have been feeling depressed for a while you may have stopped doing many things that you used to enjoy. You may have even stopped leaving the house except for your doctor’s appointments. So part of our work is to slowly assist you to re-engage with your life. It may be as simple as going for a short walk each morning and attending to your house hold chores. As you start to feel better we can jointly decide what other activities you might feel ready to take on.

Depression is a serious condition but one that can be treated very successfully.