Thoughts from the Couch – Let’s Talk About Death 

As we are facing the global pandemic that is the most challenging crisis we have faced since the second world war, papers are filled with the numbers of people who have died. As I write this a total of 4,313 people have died from COVID-19 in the UK, having risen five-fold in a week. We know that these figures do not provide a precise picture of the deaths and that they will be higher. It feels as if the tsunami has entered and few of us have experience of death on this scale, so sudden, so sinister, so lonely. For many there is the anticipation of death 

Most of us are doing all we can to help the NHS by self isolating and social distancing, but in a stark new document issued by the British Medical Association, doctors set out guidelines to ration care if the NHS becomes overwhelmed with new cases as the outbreak moves towards its peak. The BMA suggested that; “ Younger, healthier people could be given priority over older people and that those with an underlying illness may not get treatment that could save them, with healthier patients given priority instead.”

There has been data from China, where COVID-19 first spread, suggesting that older people and people with chronic medical conditions may be at higher risk of severe illness from it. The potential danger, along with the fear of its spread in communities across the world, has left many older people and families nervous. 

Many of my clients are concerned about what will happen to those loved ones living with a terminal illness if they get coronavirus. Whether any services they access, like help at home or nursing care, will continue. There have been horrendous stories of people being abandoned by their carers and left to die. There are very real worries about visiting someone and the risk of infection and so the more vulnerable family members are being left to manage on their own. For those providing care for a family member or friend, there is worry about what will happen to their care should they become ill. Clients whose parents live overseas and with whom they have limited contact and those living alone becoming lonely and depressed with a rapid deterioration in their mental health.

We are hearing stories of people dying one by one, their families kept at bay and being with strangers with whom they share their last breath. As challenging as it is something that we need to consider at this time is, should a member of our family become ill and ill enough to need to be taken to hospital, do we know what their wishes would be. 

Death is a hard conversation to have at the best of times and for many deeply uncomfortable, it is easier not to talk about it. To metaphorically cover our eyes and ears and not look at the possibility that this virus might end in death. Dr Kathryn Mannix, author of With The End In Mind and who was a palliative care nurse for thirty years, talks about the importance of understanding what is potentially going to happen if taken to hospital with Coronavirus on BBC Sounds; The Coronavirus Newscast. She explains the difference between the need to be given oxygen versus the next step, which is to be put on a ventilator. Demystifying the process offers a calm in these stormy seas. She offers comfort to those of us who have had images of people gasping for breath and really challenges us all to have conversations with our loved ones, whilst they are well and not to try and figure out what the best thing to do or what they might have wanted in moments of crisis and panic. We need to be clear as to what sort of life they want as sometimes it is not as simple as, ‘do whatever you can’. 

Sometimes life after being put on a ventilator is not as we would wish it and that is where we need to be guided by the medical profession. In the first instance we need to reframe our thoughts about talking to our loved ones about death as, although uncomfortable, should the worst case happen it is helpful and means that, if it happens, we know what needs to be done and can fulfil our loved ones wishes.

Perhaps that is the most loving thing we can do. 

In the space of a month, the United Kingdom has changed beyond recognition. British life has been transformed dramatically, and so fast that none of us have really had time to dwell on it and the nation are still adjusting to a systemic shock. There have been many comparisons to World War 11 where an enemy attacked, today our generation is facing its own test, fighting a very real and new disease. Time at home is better than having to fight, but in some ways the effects are similar.

With talk of 50-80% of the global population potentially contracting Covid-19, there is a loss of what Maslo considered to be one of our most basic human needs; Safety.  With personal safety, personal security, emotional security, financial security and health being about keeping us safe from harm. Paramount to these include shelter, job security, health and safe environments all of which are being threatened, for most, in one way or another. Our primitive mind knows that something bad is happening, but we can’t see it, which breaks our sense of safety and for many that core loss of is very disconcerting.

Many of my clients are thinking about the lives they have taken so for granted and are anxious as to what the future holds. For some, there is an impatience, a sort of denial of the reality of what is happening and for others a bargaining; “If I don’t go out then this will go away.” What we need to recognise is that each of us will be managing this time differently, but without a doubt every one of us will be experiencing an element of loss. With the fear of the economic toll, job losses, social isolation, loneliness, illness and the death of loved ones, there is an atmosphere of shock, fear and grief when talking to my clients. 

Who would have ever imagined that at a time where family and friends are so needed, we are being asked to remain indoors with as little physical contact to the outside world as possible. We humans aren’t meant to live in isolation; loneliness has been proven to cause serious repercussions. There is a lot of uncertainty and my sense is that, as a therapist, I offer a solid ground in an otherwise unpredictable and fearful world. A place where my clients can allow their most vulnerable and powerful selves to be seen. As William James said; “We are like islands in the sea, separate on the surface but connected in the deep.”

In 1969, Elizabeth Kugler-Ross described five popular stages of grief. They include; denial, anger, bargaining, depression and acceptance. We are grieving collectively and individually and I am finding myself supporting my clients through different stages of these, depending on what they are dealing with. It is important to point out that these stages are not linear and some people might only undergo a couple of the stages rather than all five. There is no right or wrong way to work through grief and loss and important to allow ourselves to have whatever feelings emerge knowing that grief is a temporary state.

Another loss that my clients are experiencing is our face to face meetings. It takes time for many to get used to telephone and online therapy, especially if they have been used to face to face, and yet, research on the subject finds this way to be just as effective as in-person therapy. Professor Sophie Scott states that; “Video calling has been proven to be just as good for your brain and happiness as being in the same space.”  I am offering virtual therapy sessions for all my clients acknowledging that this will become part of our routines for this indefinite and uncertain period of time. What we do know is that when the world around us feels unstable therapy can offer a supportive and reliable environment where you can express and feel all your emotions in the knowledge that your therapist can meet and metaphorically hold you, shining their light through these challenging times. 

It would not be true to let anyone believe that just because I am psychotherapist I have mastered fear and anxiety in all situations. Like many, I am feeling an under current of anxiety, as the world around me feels more unstable than I have ever known it as an adult and ghosts from the past emerge reminding me of how far I have come and that I still have a way to go. It feels as if it is one of those moments in life when we are all called to look inside and dig deep. I am being challenged to take stock and look to see whether the words I speak so easily to others can land on me in the way I hope they do with my clients.

I have always believed that effective psychotherapy works because the therapist continues to grow as a person and I know that this period of time will see me grow in ways I have yet to comprehend.  As part of me struggles to come to grips with what has seemingly knocked us all sideways in one way or another, I need to remember that we can’t ever tell exactly what will happen to us and nor should we try.The reality is that a great part of our lives lies in the hands of the unknown and that is deeply uncomfortable for most. Today, things are changing moment to moment and uncertainty fills the air and although spring feels as if it is just around the corner, there is an eerie feeling of waiting and not quite sure what the waiting is for. A starting point for myself is a commitment to staying positive, reminding myself that I have control over how I plan to react, feel, think and believe in the present and that no one guides the tone of my life, except me.

The rapid spread of the virus that causes COVID-19 has sparked alarm worldwide. The World Health Organization (WHO) has declared this rapidly spreading coronavirus outbreak a pandemic, and the Centers for Disease Control and Prevention (CDC) is advising people to be prepared for disruptions to daily life that will be necessary as the coronavirus spreads within communities. We need to stop to consider how fear not only weakens our immune system, but it can also create an unhealthy disregard for those around us. Images of people stockpiling toilet paper and empty shelves in supermarkets do nothing to comfort those of us who find the unknown terrifying. Fear and anxiety are powerful immunity suppressors and so I am working on getting as healthy as possible both physically and mentally so that in the unfortunate instance I catch something, I am strongly positioned to keep symptoms at a minimum and fight it with greater speed and ease. 

Victor Frankl wrote in his book, Man’s Search For Meaning “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” I am heartened to see communities coming together to take care of those who are most challenged at this time. Now is not the time to back off our older population, who need our love and support more than ever. Along with those that live alone and who are, perhaps, already feeling isolated and lonely with no one to share their fear and anxiety with on a day to day basis. It is easy to forget when you have the noise of loved ones around just how deafening the silence can be when you live alone. 

I would say be mindful of what you read. While no one source of information is perfect, some are undeniably better than others. Look for sites that rely on experts who use well accepted scientific analyses and publish their results in reputable medical journals. The CDC and the WHO, have a mission to inform and protect the public, with the WHO recently having added a myth busters page to its information to try and dispel some of the rumours that are circulating. 

I am rediscovering the art of knowing when and how to stop thinking, which helps me from fostering panic at a time when a cool mind and warm heart is needed to support my clients. With regards to my practise I am still operating and will continue to do so. For those who feel more comfortable I am happy to do remote sessions on FaceTime or Zoom. It is at times like these we need to reach other and be creative in how we do this.  Words like Self isolation and social distancing can make each of us feel very alone and it is in those lonely moments that we must remember that along the path of darkness there is always light waiting to be seen. As we face the next few months, let us be the light that shines on the paths of those around us that are struggling.  

I was privileged to be asked to work yesterday with a group who had been directly involved in the recent terrorist attack in Borough Market. With one of my specialities being that of a Trauma Therapist, I am continuously reminded of the resilience of the human spirit and how, sometimes it is out of the most horrific situations the most profound lessons are learnt. (more…)

Transference is a dynamic that most couples are unaware of and when I work with couples it is something that we explore that most find useful. www.thebookoflife.org explains perfectly how transference plays out in relationships.

‘You’re flicking through a fashion magazine and playfully suggest that your partner might want to make a few experiments with their wardrobe. How about a different pair of jeans or a new T-shirt, a duffle coat or platform heels? But at the mention of this possibility, your partner gets very agitated indeed: they scornfully declare that money is tight, they haven’t got any time, they have too many clothes already and why are you deliberately annoying them by making vapid proposals like this? This response is very off-putting. You only made a perfectly reasonable suggestion and now they are declaring war. You didn’t do anything. Their behaviour seems utterly out of proportion with what triggered it. You may conclude, as you have done on other occasions, that in some areas the person you love really does seem ‘a bit mad.’ This conclusion, though perhaps depressing, also feels strangely satisfying. At least you know what is up. Couple having serious interaction But we are all a ‘bit mad’ in ways that preclude such dismissive statements and demand closer and more generous examination.

For all of us, there are situations and behaviours which can be counted upon to elicit swift and powerful responses which don’t seem in any way in line with what is happening right now. Our behaviour seems not to fit what is unfolding in front of us. For example, someone we love is going away for a month, and tells us they will miss us very much indeed. They move to hug us. But far from feeling sad and tender, we just register numbness, pull away and can’t say anything other than that the weather is unseasonably chilly today. Or we return home to find there is a bit of a mess in the kitchen, but rather than taking this in our stride, we start to shout at our partner that the house is chaos and life with them has become impossible. Or a friend is only ten minutes late for our birthday party, but we are compelled to send them a text calling them an a**hole and asking them not even to bother coming.

These sort of behaviours don’t make any sense if we try to justify them simply according to the facts in the here and now (as we and their perpetrators are inclined to do). The clue to them lies in something known as transference – a psychological phenomenon whereby a situation in the present elicits from us a response – generally extreme, intense or rigid in nature – that we cobbled together in childhood to meet a threat that we were at that time too vulnerable, immature and inexperienced to cope with properly. We are drawing upon an old defence mechanism to respond to what feels like a very familiar threat.

In most of our pasts, when our powers of comprehension and control were not yet properly developed, we faced difficulties so great that our capacities for poise and trust suffered grievous damage. In relation to certain issues, we were warped. We grew up preternaturally nervous, suspicious, hostile, sad, closed, furious or touchy – and are at risk of becoming so once again whenever life puts us in a situation that is even distantly evocative of our earlier troubles. Perhaps a parent we loved left us for long periods to work abroad. They didn’t mean to but the pain was so intense at that time, we reacted by shutting down our capacities for affection. Our way of coping was not to feel, to grow numb – a response that we keep producing even now, 30 years later, whenever someone we love has to go away for a time. Or perhaps we had chaotic, unreliable parents whom we dealt with by rigidly organising our room, arranging books by size, and reacting with alarm at the slightest bit of dust – and even now, outer disorder ushers in a panicky feeling within that everything is out of control once again. Or we had a sister who was always late to events that mattered to us, or a mother who was both humiliating and obsessed by fashion.

The unconscious mind is slow to realise that things have changed in the outer world but sadly quick to mistake one person for another, seeming to judge only by crude correspondences; ‘someone we love’ or ‘a person coming to our party’ appears to be enough to confuse us. Because transference happens without us knowing it, we generally can’t explain why we are behaving as we are. We carry years behind us that have no discernible shape, which we have forgotten about and which we aren’t in a position to talk others through in a manner that would win us sympathy and understanding. We just come across as mean or mad. What we would ideally need is a guardian angel who can pause the present and carry our partners back to another time and place, to the moment when the neurotic defence that we are projecting originated. They’d be able to see the unreliable parents, the chaotic house, the loving but neglectful father, the fashion-obsessed mother etc. – and might be appropriately moved by what we had to cope with before we knew how to.

The concept of transference – and the accompanying idea of projection – provide a vantage point on some of the most frustrating behaviours that we ever meet with in relationships. And they allow us to feel sympathy and understanding where we might have only felt irritation. If we cannot always be entirely sane in our relationships, the kindest thing we can do for those who care about us is to hand over some maps that try to chart and guide one through the more disturbed regions of our internal world. In good relationships, people are ready to accept that they might be involved in transference. Ideally, we should all rationally disentangle and un-distort our transferences and explain them to others in good time. But it rarely happens and collectively we pay a big price for our ignorance. We keep making things tough for everyone by over- and under-reacting – and so our relationships are far harder than they need to be.’

Please feel free to contact me should you want to explore this or any other topic further.

In our society fewer and fewer people grow up seeing a strong relationship modelled between their own parents and so it comes as no surprise that it is not because of incompatibility that many marriages break down, but because the couple have no idea what it takes to make their relationship work.

As a relationship therapist I am often astonished when working with couples just how little they know about each other’s views on things that are of fundamental importance to a relationship. I see couples shocked in the realisation that they have never really talked about what their partners reveal to me, a complete stranger. Feelings, thoughts, hopes, dreams, disappointments and expectations that they had not known even existed which can be both painful and enlightening.

At the heart of a strong marriage is a strong friendship and like all friendships they need time and attention to be maintained. Communication is at the very core of any relationship and yet topics such as money and sex seem to be cloaked in mystery between two people who have chosen to spend the rest of their lives together.

Relationships that break down are usually as a result of a process of growing apart over many years as this poem describes: –

The Wall
Their wedding picture mocked them from the table.
These two whose lives no longer touched each other.
They loved with such a heavy barricade between them that neither battering ram of words nor artilleries of touch could break it down. Somewhere between the oldest child’s first tooth and youngest daughter’s graduation they lost each other.

Throughout the years each slowly unraveled that tangle ball of string called self and as they tugged at stubborn knots each hid their searching from the other.

Sometimes she cried at night and begged the whispering darkness to tell her who she was while he lay beside her snoring like a hibernating bear unaware of her winter. Once after they had made love he wanted to tell her how afraid he was of dying, but fearing to show his naked soul he spoke instead about the beauty of her breasts. She took the course in modern art trying to find herself in colors splashed upon a canvas and complaining to other women about men who were insensitive. He climbed into a tomb called the office, wrapped his mind in a shroud of paper figures and buried himself in customers. Slowly the wall between them rose cemented by the mortar of indifference.

One day reaching out to touch each other they found a barrier they could not penetrate and recoiling from the coldness of the stone each retreated from the stranger on the other side. For when love dies it is not in a moment of angry battle. Nor when fiery bodies lose their heat. It lies panting exhausted expiring at the bottom of a wall it could not scale.

Anonymous

I work with couples at all stages of relationship. I offer five weekly marriage preparation sessions, which allow couples to have the often forgotten conversations before walking down the aisle together. I offer sessions for couples having a challenging time. These can be anything from a fifty minute session, to sessions of up to four hours in one go. These allow enough time for issues to emerge and time to devote to creating a better understanding of what is happening to the space between the couple, which is ‘the relationship’.

In the words of Robert Louis Stevenson ‘marriage is one long conversation chequered by disputes.’ Sometimes couples are under the impression that it is because they argue that things are wrong in the marriage. From my experience it is not the topic that is usually the main issue, but how disagreements are or are not discussed and resolved. In relationships, disagreements are not nearly as dangerous as secrets and for as long as there are strong emotions there is hope. As written in the poem it is when barriers of self-protection are created that resemble impenetrable walls that a relationship is most at risk.

I offer a safe space for couples to come and speak to each other and support them in doing so in a way that has perhaps not been done before, so that each party feels heard, which is often the starting point to resolving issues that have seemed insurmountable.

There is no magic to couples therapy and yet for many couples who have had the courage to seek help at times when it would have been easier to walk away, turn a blind eye or ‘wait for another time to have a conversation’ magical moments of connection can be created by talking to each other in new ways.

What I have come to learn from my work with couples is that what often disconnects us is our reactive survival dance. Each of us has learnt a way of protecting ourselves that is rather like putting on a survival suit.  Some of us resemble a turtle by our behaviour of withdrawing from difficult conversations or conflict. Others like an Octopus, loud and flailing, trying to get heard and understood. From either of these places we know how to defend, attack and protect the most vulnerable aspects of ourselves. Often the way we protect ourselves has been learnt from childhood, either continuing the patterns of our caregivers or, as a result of having made a silent vow to ourselves to act differently. What we don’t stop to consider is if that well-worn suit supports us in having the quality of relationships we so long for in the here and now.

Often from behind this defensive façade we feel lonely, unseen and even more detached from the very people we are desperate to be in connection with. I work more and more with partners, siblings, parents, work colleagues and friends who have reached a place of desperation and who are at a loss of how to communicate effectively with each other.

What prevents most people from moving forward when there has been conflict is the desire to be ‘right’, which in turn makes the other person by default ‘wrong’. When we are in conflict with another we often assume we know what they are thinking or what they are going to say. We have made up stories about their behaviour and are reluctant to consider their point of view. This makes communication impossible and is often the first stumbling block when trying to resolve differences.

I see my role as a teacher, teaching people the ‘three invisible connectors’: the Space, the Bridge and the Encounter.  We don’t often stop to consider the space that sits between us, which is our relationship. Truly connecting with one’s partner is being willing to metaphorically ‘cross the bridge’ to their world, being curious and open to learning about their inner landscape. Listening with compassion is being a ‘visitor’ and learning the culture of the ‘other’. Speaking intentionally, in a clear and concise way is being a ‘host’ and sharing one’s truth and vulnerabilities enables the encounter.

When we invite someone into our world as a Host it reminds me of Otto Scharmer’s U theory. The U theory of Otto Scharmer says that if we allow ourselves to go to the deepest truth of ourselves, it’s like coming down the left side of a U. At the bottom of that U are our core truths, some of them riddled with pain, some of them riddled with confusion, some of them riddled with frustration. It is the truths we’ve not been able to speak. And when we can speak them, we start moving to the other side of the U, the right side of that U. And that, Otto Scharmer says is ‘the future calling us’.

To be willing to Host a visit from someone is being willing to enter the U, and to go to the very bottom of the U, to sense what is at our deepest core and to share that with our visitor, so that we can come out of the other side, being better understood, feeling heard and moving from all the negativity that can be so destructive in our relationships.

By visiting your host you need to do more than just be an empathetic listener. Being a visitor is about ‘generative listening’. Generative listening is the kind of listening that allows us to land deeply into the world of the other, to surf the waves of their emotion, to see the landscape of their face as if for the very first time, essentially learning the geography of their soul.  In order to do this we need to be willing to leave behind all our own thoughts, assumptions and judgements, thus making ourselves truly available and curious to hear what the other is saying.

My role is to bring awareness to the couple present, whether they be intimately involved or not, the guiding principle being that what disconnects us is our reactive survival dance. What connects us is the mutual embrace of three invisible connectors: the Space, the Bridge and the Encounter.  I support the visitor in bringing their presence in the ‘now,’ and the host in speaking their truth no matter how dark, shameful or painful that might be. I see my role as being in the service of unravelling the ‘survival knot’ between two people, because in that unravelling there is the often unspoken becoming spoken, and the possibility then of healing past hurts and misunderstandings that have prevented us from being the very thing most of us yearn to be ……. in connection.

Katrina Taee broaches the topic that so many counsellors/therapists find hard to do – Sex & Grief.

She writes :-
‘I think most people would agree that sex appears to be everywhere these days. It’s on book shelves in newsagents, on television, in popular books (think 50 Shades of Grey), at the movies, in magazines and all over the internet at the touch of a button. On the other hand, grief, death and dying remain taboo subjects for the vast majority of people, though I think the tide is turning slowly.

So why don’t more people talk about sex and grief? Lucie Brownlee braved the subject in her book Me After You with honesty, humour and insight and Amy Malloy wrote about her experiences as a very young widow in
Wife Interrupted but in general, there seems to be a wall of silence around it.

If a couple have had a close, loving and happy sexual relationship, they will inevitably miss sex (not that many, if any, friends will ask them about that, which makes that admission that it is on their mind rather tricky). This poses lots of problems because their body may tell them one thing, but their head another. They might start having lots of sexual fantasies and longings but what are they to do? They may feel very married still and not see themselves as free to date, or engage in sexual activity with another person. On the other hand they can consciously try to repress those feelings or engage in masturbation if they want to but for some, that misses the very thing they are yearning for, the intimacy and the closeness that they had before.

This brings to mind a moving scene in the movie The Things We Lost In The Fire, with Halle Berry where after her husband’s death, she asks her husband’s friend to get into bed with her, to hold her a certain way, to put his arm around her just as her husband did and then to rub her ear, just as he used to.  It is excruciating to watch her longing and her need for that kind of comfort.

Sex can mean many things to different people, to name a few: a wonderful distraction from grief and misery, a comfort, a relief, a way to feel alive again, a way to feel attractive and wanted again,  a way to fill the void and sometimes an outlet for grief (maybe letting go). It probably depends on one’s attitude to and experiences of sex before the death. When people have been in a loving relationship, they are ‘programmed’ for relationships and they can long for that warm connection to fill that space and sex would naturally be a part of that.

There seems to be a conflict between the ‘unwanted’ freedom to have sex again and being bound to the one they already love.  We might say it is a conflict between spirit and flesh. Then throw into the mix, the difficulty in later life to find opportunities for developing sexual relationships. If someone finds a relationship with leads to sex, they may find themselves feeling very vulnerable because it is a very intimate act and it requires trust to let another see their true sexual self.  Understandably too, the bereaved person embarking on a new sexual experience carries with them their history, their partner, their family, their emotions and their loss and it complicates things. It really isn’t as easy as it sounds.

As if that isn’t hard enough, the bereaved person’s family and friend circle will often all have views on what is appropriate and most certainly what isn’t (according to their own ‘Book Of Rules for Widows, Widowers and Partners’).  This sort of judgement can impact the surviving partner badly, adding to their grief, distress and their own feelings about their predicament.

Having said all this, there are of course, people who move from grief to new relationships and a renewed sex life successfully, so those of you who are bereaved, please don’t despair when you read this, there is so much hope, and in time a new and different life will emerge around you, in spite of your grief, and you don’t know as yet, what that will look like.

I spoke earlier about the  repression sexual longings after a death; I believe this leads to difficulties later on.  We should have nothing but empathy for those who struggle with sexual issues after the loss of someone they have loved.  Bereavement  is a very hard and rocky road, and we should not judge anyone who struggles with it, until we have walked in their shoes.  We human beings are sociable animals, we are drawn to companionship and love, it is what makes our lives meaningful and leads to contentment, and disruption of that is a big struggle oftentimes.

If you have a good friend or counsellor to talk this through with, it can be good to air it and talk it through.’

Katrina can be found at www.katrinataeecounselling.com