Case Studies by Psychological Counsellor about Marriage, Depression, Stress, Anxiety Counselling in Mumbai

 

THE PSYCHOTHERAPIES OF MARITAL DISHARMONY

Chander and Ruby was a couple in their early 40’s. Both are employed. The couple have two sons and one daughter. The family lived alone on an acre land in a semi urban section of North East India. Both Chander and Ruby are from decent origin.

The couple came to therapy with initial complaints of developments of fear, separation anxiety, sleep disturbance, nightmares, sadness, loss of interest in normal activities, reduced concentration, decline in overall shared activities, increased irritability, beating, screaming, abusing, violence, etc…

Taking an account of the anxiety on Chander’s part, Ruby stated that her husband would come home from workplace every day and be preoccupied to the television for hours. He had been having difficulty in sleeping and therefore experienced an edging during the day. This caused his distress leading to anxiety. She further stated that he was not being himself in recent months. She was extremely concerned about his behaviour.

To this, Chander explained that he and his office colleagues had gone to a farm yard on one occasion and he was accosted by a wild cat that lived in the farm for many years. Chander had been to this farm very often and was aware of the cat’s irritable demeanour. And it was then that he realised after the day of the encounter that his wife is actually much the same way. She can be nasty and mean as the wild cat. He further explained that Ruby had growled at him for something he had forgot to do around the house. He said that her response caused him some ‘angst’ which he described as a nervous and edgy feeling that made him very uncomfortable.

Chander was tall, dark, soft spoken. Ruby was tall, healthy and out-spoken, saying what ever came to her mind. She had lost both her parents and siblings in a car accident.

In the session, Ruby began talking about how she and her husband had difficulty in their marriage for years. Now, recently their problems had worsened. Chander expresses that they were not happy with self and together and they got on to each other’s nerves too easily. He claimed that Ruby was extremely negative and could be very nasty to him. He stated that at times she was ‘street angel’ and ‘house devil’. Ruby felt that Chander was too passive, not speaking enough, and that he ignored her. She could not remember the last time he was affectionate with her. To this Chander explained that ‘I just don’t feel motivated to be affectionate with her’.

I suspected that this had to do with underlying anger that he harboured against his wife and his lack of open affection was possibly his way of controlling or even punishing her.

Over the course of several sessions, I learned that Chander had always struggled with his wife’s dominance and her negative attitude. She was always sour about everything. He would just keep his mouth shut taking into consideration the tragic events of her life. But now he was not able to take it anymore. He believed his reactions could help his wife to overcome her tragic losses.

I arranged to meet the couple individually. However, Ruby preferred to be with her husband in every session. Chander was open to the idea of allowing his wife to talk freely and individually.

Therefore in the following combined session, Chander when asked what the primary issue was, explained that he was not sure. He believed his wife had derived a lot of negative attitude from the tragedy. Chander had assumed the role of a caretaker in the home. In many ways his mother idolised him for taking care of the family. He married Ruby willingly and made her a part of his family. He had also started to begun compulsive care taking for his wife. However, he explained further that he had been going through anxiety for many years. He would go to work early and also opt for overtime. The anxiety however, continued to accumulate. He continued saying that his wife was a good woman in many ways. She is always there for me. She is damn possessive about me. We also have a lot in common. We enjoy shopping but she is so negative and so nasty at times that it goes right through me.

These were some of his feelings towards his wife. On one hand, his feelings about the many fine wonders of the woman he loved but at the same time not being able to deal with her nasty approaches.

I tried to get Chander to think a little bit about whether the nasty behaviours exhibited by his wife might be the defence mechanism against certain aspects of her vulnerability.

I was already planting a seed for him to alter his perception. In the meantime, my plan was to explore what lay beneath Ruby’s attitude.

In the following session, Ruby informed me that she was raised in a hostel by her uncle who was very rigid. Therefore, she had developed a rough exterior in order to survive. When asked about the tragic event, she wailed and spoke aloud saying that she was the only individual who survived the car accident. She witnessed both her parents and her elder and younger sibling die. She also explained that she wished she received timely help and saved her family.

Yes, I felt within me, this lady is stronger than me in this particular situation. Why? Yes, I believed she toughened and learned to survive. Her brash attitude had over a time become a knee-jerk reaction in the face of what she perceived to be situations that warranted her defensiveness. When asked specifically about Chand she stated that he was a good man, very loving and honest individual. But in many ways his mother put him on a pedestal and in a way, sheltered him too much. And she refused to do the same. In addition, she conceded that she struggled with depression, a condition that came up intermittently, particularly since the death of her family members.

We talked about whether she had really recovered from the death of her family members and she admitted that she had not. Tears rolled down her cheeks and she looked hazed and worried.

Later, Ruby admitted that she enabled Chand’s passive behaviour mostly unknowingly, but felt that she was being cheated particularly with respect to lack of affection.

The death of her family members was devastating to her. Unfortunately, she never talked about the tragic event after the funeral, instead hiding lot of her feelings and grief.

I felt this might be something that was percolating beneath the surface of their relationship perhaps contributing to the tension and probably needed to be explored in the course of the therapy.

The following conjoint sessions were arranged with special focus on family-of-origin in exploration.

For recovery treatment restructuring in reframing of schemas that contribute so much to the dysfunction and conflict.

The therapist helps the couple to explore their perception by introducing ways to slow down their thinking and to generate new evidence to support changes in their thinking.

The therapist became more aware of attending to the couples needs, placing more focus on altering interactional patterns within the relationship.

The therapist is in the process of helping the couple who is struggling an ingrained belief system………..To continue with a series of casework and articles.

CASE OPINION OF AN ABUSED CHILD

Soham, a 29 year old adult, was referred to me by a social worker who kept in mind that Soham's life was at stake, the reason being her marriage being called off two days prior to the scheduled date and the reasons being as stated below.

The reluctant Soham was brought to me by her parents who are both high school Maths and Science teachers and her brother an IT software professional who studied in a boarding school during his early developmental stages. Soham herself was a graduate in Botony, Masters in Social Work and an MBA in human resources. The agitated parents were shocked to understand from the grooms parents and the groom that their daughter's character was questionable. They further explained that Soham was already involved with a boy who was twice her age but she had no desire to marry him. They also produced letters and email documents to substantiate their stand. They further stated that she maintained an email friend who was a divorcee and communicated sex and other topics which was unexpected from a girl of good background. They were surprised that the parents were so unaware about their own child's background.

I interviewed the parents separately before meeting Soham. The reluctant Soham confided to me that every statement made by the groom's party was correct. She also agreed that her parents were not aware of the same and about many other facts that have occurred in her life. Soham reported that she was meeting a Christain Tamilian boy who worked for the hospitality industry. She also maintained that they were physically involved and her disagreement to marry him in spite of him being there with her when ever she needed him. She also confessed about the email friend and the contents of the email. She also mentioned about a boy who was a school mate who was aware of her involvements and who made an untiring effort to correct her. Soham was a physically normal adult and the product of a normal pregnancy. However she wore clothes that covered her body and full hand even on a sunny and hot day. The father was a recurrent alcohol abuser with a history of child and wife beating. However, when the couple patched up they would pack their bags and move out for short vacations in and out of India leaving young Soham at the hands of family care providers.

The case work included interviews with Soham's teachers, principles, friends and acquaintances to get as much information on her as possible. It was found that her grades had been excellent. They had never fallen from A's to C's and poorer. During one of the sessions an uncle tried to visit her at my clinic. He seemed very much agitated at her consent to come in for counselling. I ran interference because no one is allowed to talk to the patient in the counselling clinic except under controlled conditions with the clinic. Looking at my initiative, Soham was much more at ease with me but reserved in her demeanour. She declined to talk, so I asked her to draw a picture. She drew a picture of a tree. It was void of surroundings. The trunk was large with no curves. The leaves were black instead of green. From my reversed position it remarkably resembled a penis with pubic hair. Her unconscious seemed to reveal the story that she couldn't. After completing the drawing, Soham was more relaxed, and we spoke to each other through a stuffed animal which was kept beside my table. When I touched the animals private part she became so disturbed and wanted to leave the clinic. She exhibited fear, exhaustion, anger, resentment, difficulty in trusting adults and helplessness. Finally Soham broke down and reported that her uncle had been molesting her since she was six years old.

In An Ethological Approach to Personality Development, John Bowlby and Mary Ainsworth (1991) argue that attachment theory is “personality development based on the interaction of the child and the caregiver during infancy and early childhood” (Bowlby’s attachment theory integrates evolution, ethnology, emotion regulation, and social cognition. The attachment theory system is posited as one of a variety of behavioral system that promote survival and reproductive success. According to Broberg (2000), “The purpose of the system is to enhance the likelihood of protection, by maintaining proximity to the caregiver in response to real or perceived stress or danger”. In other words, attachment is a biological and evolutionary system that forms close bonds between the child and caregiver (typically the mother), particularly during times of stress or threat, that helps increase the odds of survival by ensuring parental care giving and protection.

All infants form enduring emotional bonds or attachments with their caregivers. These emotional bonds go beyond the need for basic survival needs like physical nourishment. The biological purpose of attachment protects infants from predators and maintains physical safety. So, too, attachment enables the infant to feel secure when exploring his or her environment.

An understanding of Soham’s needs of was basic to the provision of treatment and intervention. Psychiatric disorders are prevalent among such children and adults. A study in London of adolescents in residential units found the rate of psychiatric disorders among this group (65 percent) much higher than the rate of psychiatric disorders among the general adolescent population (15 percent). The range of psychiatric problems among the adolescents in the care system included conduct disorder, over anxiety, depression, and unspecified functional psychosis. The authors of the study concluded that these adolescents could be helped with the right type of treatment and intervention: "One of the most worrying findings was that a significant number of adolescents were suffering from severe, potentially treatable psychiatric disorders which had gone undetected" (McCann et al., 1996, p. 1529).

I feel ongoing parental problems related to substance abuse and fights which lead to rejection of the child, temporary separation from the primary caregiver, and exposure to chaotic physical surroundings.

We worked with the abused in therapy

The counselee was ready for all measures to protect her integrity. She began to understand that she was the same Soham not ‘unclean’ or ‘dirty’ in any way. She was convinced that she was not to blame for what happened, no matter what has been told by the perpetrator of the abuse. By encouraging her to talk about the abuse or violence we together witnessed and worked through the feelings of anger, depression, guilt, and any acting out behaviors that were being exhibited by Soham. Once the feelings were out in the open, the healing process began. Feelings were discussed with Soham and I conveyed to Soham that “I believed what she was saying.” Letting her know that she was a “good person” and that she was not alone in her feelings helped. There is probably nothing worse than feeling that you are the only one dealing with a problem. Talking about prevention of abuse in the future worked through that “victim for life” mentality. Also, an insight into dealing with symptoms like nightmares, bedwetting, social withdrawal, avoidance, and constant thoughts of the abuse helped the young Soham to regain lost confidence and trust.

BEAR CHASING YOU IN THE WOODS?

I am Serin Stanford born in 1968 in Mumbai, India. I have studied languages, philosophy, history, journalism and counseling. In 1991, I became a writer. I worked several years as a writer and then became an editorial chief with a leading newspaper. During this time I was also the publisher of a leading industrial newspaper and published over 200 magazines and books, articles on various topics such as financial, industrial, medical, etc. Unfortunately, I lost my brother in 2007. Though he was five years older to me, I believe he died young. He was probably murdered. However, the real cause of his death established medically was a heart attack. We were only two children to our parents. My parents were in a state of shock. They have still to recover. Ever since I have seen many dreams. Some of them I vividly remember. Some of them were real nightmares. But I awake thinking it is foolish to be frightened because the dream was not real but imaginary. Over a period of 3 years now I study my own dreams. I have recorded a few and the accompanying circumstances extensively and also examine the validity of the dream report.

Dream pattern
While I was sleeping once, in my sleep I was strangely walking in a forest surrounded by thick trees and thorny shrubs. I was seeing a bear suddenly in the woods which was beginning to follow me. Suddenly, I was dreaming that the bear was beginning to chase me. I began to flee as fast as I could. Since I am a little heavy and cannot run very fast, I got very anxious and desperate and began to panic. My muscles were getting cramped accompanied by pain in the stomach and urge to urinate. The chest was absolutely tight making the breathing very difficult and loud. I was breathing heavily and panting. I was beginning to see my end. I remembered my family and friends. I f they were around I was sure they could save me. The bear was watching me as though he could understand my emotions. Being very frightened, I took to a mountain to escape the bear. The trip up the mountain became more and more arduous. My legs were beginning to feel very weak and eventually, I saw myself in a pool of water. I was surrounded by a lot of known and unknown people. The breathing pattern had changed. Slow heart beats accompanied by exhaustion. I looked horrified and startled as to how I got there. I was still in my sleep. I then began to look for the bear. The big black bear who came out of his cave to search for his food. I was unable to communicate or express myself. It seemed a tiresome journey. The mouth still very dry. I reached out to a big bottle of water lying near by and drank almost five glasses of water. Then suddenly there was a big sound and again the bear reappeared and everyone around just disappeared into their homes and I began to flee not knowing where but suddenly I was being chased back into the forest. I grabbed myself and woke up from my mysterious dream. I was now awake after a real nightmare. The early morning sun had shown through the window. My 8 year old son was smiling at me and my husband greeted me aloud.

Dream analysis and validity
This dream associated with a wide range of human experiences as well as different levels of consciousness. The dream was unique because all the characters speak in different ways. Their styles and speech tell us things about them and their association with the dream. The feelings involved my sensory impressions and all kinds of stimuli like blood circulation, breathless pauses, temperature shifts i.e. from the deep forest into a pool of water and then on land and back again into the forest, uncomfortable postures i.e. running, falling, etc. Emotions relating the threat, fear, desperation, etc. are also observed. At the pool, on meeting even unknown people help as an agent of transformation is seen. On the reappearing of the bear you see people and their changing minds and hearts who all flee away to save themselves. Finally, a night changes into day and back again with your loved ones, the God presents a world transformed by magic, where nothing is what it seems, and everything may evolve into something else. Considering the dream has an accompanying role of threat and death, the deeper, threatening emotions of the situation are felt. The structure of the human brain is enormously complex. The involvement of the reptilian brain, mammalian brain and the cerebral cortex is seen in the above dream.

DYSFUNCTIONAL MARRIAGES

I am a Mumbai-based psychological counsellor and family therapist. I have seen fair share of dysfunctional marriages. Here, I recount the case of Subeesh and Suprabha.

Subeesh and Suprabha were married for 6 years. Subeesh was a recovering alcoholic and drug addict years before he met Suprabha. She was a successful professional and Subeesh was in the top management in a multinational. After several years, the couple started a business of their own which they hoped would help grow their savings and allow them to travel and enjoy life more. Things did not go as smoothly as expected, but they kept working on it and trying to deal with the stresses of a new business together.

After about a year, Suprabha found Subeesh weeping. She asked him what was wrong and he said he had to move out and "see what he wanted in life". Devastated, but left with no choice she let him go. After a week, he came back to pack up his belongings. In the meantime, Suprabha worked the business on her own. About a month later she received a call from the bank that her business account was overdrawn. She discovered that Subeesh had been funnelling money out of their business account for some months before he left. When Suprabha finally reached him, he minimized the theft, but said that he would reimburse the account. A couple of weeks later, she found out from friends that Subeesh was dating another woman. Later, he stopped reimbursing the account.

What we have to analyse is whether there is much hope for this relationship. With a history of addictive behaviour in the past, he could have been secretive about his feelings for some time. By the time he decided to talk, he was ready to leave. Now who was the co-dependent in this relationship? Who takes the lead in trying to help? Why did Subeesh betray his loyal wife? Did he make an attempt to be honest, apologise or take responsibility for his actions?

Probably there is a very strong chance he had started drinking, drugging, or gambling. This was the point where he was in a complete relapse, and it was only a matter of time before he would be found out. Subeesh bailed out with more lies before he had to face that consequence.

A postscript: She can take some steps to stay out of the co-dependency role by being completely honest about Subeesh’s behaviour to family and friends. To do otherwise would be a continuation of caretaking, "protecting" him from having to face the consequences of his actions. By the same token, Suprabha will be extremely vulnerable to Subeesh’s "charming" side should he try to reconcile with her. Chances are also strong that he will attempt a reconciliation because addicts are very dependent on their co-dependent partners.

Another postscript: I don't want to give the impression that recovering addicts are bad partners. Recovering addicts who are actively working a programme can be very good partners because they have been forced to look at themselves closely, are used to talking about and listening to feelings.

Here is another case study of a woman I started working with three years ago. She's a 46-year old woman. Her father's first wife died when his older two children were tiny, so he remarried. She remained the only child of the second wife. She was totally over protected from the first wife’s relations and her children. The bottom line is that the woman never developed any coping methods. Whenever she was in a stressful situation - with school, friends, relationships - she was bailed out. Few years ago, she married her childhood sweetheart even though they had split up many times. There were huge conflicts between her and him about their relatives, whose family is better and whose mother is better. A year ago, they had a baby girl. It exacerbated all of the problems in the relationship and between the two families. And it always comes back to the mothers, the families, the differences, and which is better.

She can't get her mother-in-law out of her mind, and has an inability to concentrate on work because she's so obsessed with the problems she has with her family. Her coping strategy is to talk, talk, talk, while her husband's is to withdraw. That creates a problem. She seems to be fully aware of the issues involved, but she also believes that she has no power to control it. Because she didn't learn any coping skills when you need to learn them and integrate them, she can't maintain any self-discipline. There's no firm foundation for her, so you're trying to build on sand instead of rocks. She's quite addicted to the sand, to the feeling of not being comfortable. She likes the anxiety, and it kind of initiates her tractor.

I didn't make a formal diagnosis. I would rather focus on what's going on than look at the DSM5 and say "she has this." While in the sessions for counselling and after a period of three weeks she manages better day to day, and she's calmer. She didn't do well with the (CBT), because she was not committed to the therapeutic process. If you looked at her file and her comings and goings, you would think she was very committed. She makes notes and keeps a journal. She works hard but she doesn't integrate it. There's still no platform for this, there's nothing for it to grow on. I feel more like a coach who's helping her to maintain. And that might be the best we can do so things are a little better for her. I think she will stay in the extremely dysfunctional marriage and that the child will grow up with the same issues she has: a sense of entitlement and a lot of anxiety. When I try to point this out to her, she's full of grief about doing this to her child. But it's not enough to make her change her ways or resolve the marital issues or leave the marriage. So, for her it is necessary to stay connected with a professional help to work out or maintain the marriage.

One wonders: what has happened to the venerable institution of marriage? In some cases, the marriage was doomed from the outset, because it was based on nothing more than animal magnetism. In others cases, it was ruined by external forces, such as financial hardships or infidelity. The real tragedy is that in most cases, marital problems are due to the accumulation of many small things, such as bad habits or mindless criticisms. These annoyances were tolerated during courtship but became increasingly unbearable when the magic of romance died.

Is marriage good for you? Before you answer, consider this: Marriage, like everything else in the world, gets stale, worn out or even broken with the passage of time, unless special care is taken to protect it and rejuvenate it. Marital love can be a magic source of strength and comfort. “It’s not marriage that makes you happy; it’s a happy marriage that makes you happy”

Perish the thought that marriage is about romance and happiness! Banish the idea that marriage guarantees you a safe heaven! Even pre-marital counselling seldom prepares couples for the realities of marriage – the hard work, conflicts and trials and tribulations ahead.

All the pledges of never ending love, all the happy memories of passionate love cannot withstand the unrelenting onslaught of change.

Timely, it is important to keep away the common enemies of a marriage. Checklist on the mutuality of purpose in the marriage.

However, there are happy marriages. Couples remain best friends and partners in managing their charitable organizations. You can say that such marriages are made in heaven, but they also entail hard work based on sound psychological principles. The most important factor for a successful marriage is that the couple shares the same life goals and values. It is difficult for couples to plan a future together if they have different priorities and ambitions. Irregular marriages or inter-faith marriages demand greater effort for adjustment because different value systems make it more difficult for two people to share life at its deepest level.

Understanding is the frame and pillars that keep the marital house together. Responsible action represents all the works necessary to repair and rejuvenate the marital house. Acceptance, belief and commitment will help us to discover the true self in the marital house. This will help us to enjoy the benefits of a marriage. However, this doesn’t mean that we’ll be happy all the time – nobody can be happy all the time. There will always be rough patches to go through and problems to be resolved.

If the problems persist, then you might need to revisit the basic rules or checklist or seek marital counselling.

For a troubled marriage it is best to meet an experienced marriage therapist. The counsellor will help couples discover, actualize and make use of the meaning potentials in intimate life. The activities during the therapy include reflection, evaluation, and termination. Marriage therapy is not easy. It takes time and effort to learn how to communicate in a rational and healthy way to resolve issues and build relationships. The important take home message is that true love is sacrificial and self-transcending. There is the need to change one’s mindset from self-serving to that of caring for another whatever the costs. I would like to leave with you a gem of wisdom “self-actualization is possible only as a side-effect of self-transcendence.”