In this interview, Catherine Séguin-Green and Marie-Ève Gingras demystify psychotherapy. However, it should be noted from the outset that Caregiver Support is a professional, confidential and free phone consultation, referral and information service. The advisors do not offer psychotherapy, although they have expertise in caregiving relationships.
L’Appui: What is psychotherapy?
Psychotherapy is a therapeutic process that offers, among other things, a space to unfold, ventilate, expand thoughts, ask questions and obtain assistance with the help of a psychologist. It is a dimension that the person does not necessarily have in their personal life.
The notion of change is at the very heart of psychotherapy. The website of the Ordre des psychologues du Québec (in French only) provides a more detailed definition.
L’Appui: Is it possible to choose your psychologist?
Yes, it is important to mention that a psychologist can and should be chosen. A connection must occur between the psychologist and the person seeking help. You must be attentive to what you feel when meeting a new psychologist:
- Do you feel comfortable enough to imagine yourself exploring certain spheres of your life, your experience?
- Is the psychotherapist’s approach right for you?
- Do their way of being and presenting themselves suit you?
These are essential criteria and are often unknown to the general public.
Indeed, the therapeutic process is based on a two-way construction between the psychologist and the patient. The person usually experiences difficulties, problems or even questions to be discussed with the psychologist. This process also makes it possible to shed light on specific issues which, although experienced by the person, may escape them. They are explored in a space that is meant to be safe, in a spirit of openness and kindness. Hence the need to make sure that there is a “fit” with the psychologist, as Marie-Ève explained. The following, conveyed to us by a professor of the UQAM Department of Psychology, illustrates it well: A psychologist is like a pair of shoes. If you are not comfortable, it is better to change.
Just knowing that you are in the presence of a caring professional does not mean that you will not experience negative emotions towards your psychologist, such as anger or disappointment. It would be unrealistic to believe that throughout psychotherapy, our opinion of the psychologist will remain unaltered. Again, these are two humans interacting with each other. There may be misunderstandings or different perspectives, therefore the importance of taking the time to name such perceptions and readjust so that we can continue the therapeutic work together.
L’Appui: When to seek help?
There are several signs pointing to the need to get help. Those vary from one individual to another. The following are key indicators:
- Feeling like things are not working for you anymore;
- Feeling exhausted;
- Not understanding how you got into a certain situation;
- Not recognizing yourself;
- Observing inconsistencies in your usual functioning;
- No longer feeling in touch with yourself.
Please note that these examples do not include suicidal tendencies. Those belong to another category and require immediate support. The person experiencing symptoms associated with high psychological distress might have waited too long to seek help.
Moreover, I often invite people to reflect on the changes they observe in themselves or the discomforts that have persisted for some time:
- An increase or decrease in appetite;
- Disrupted sleep patterns (insomnia, difficulty falling asleep);
- Changes in mood;
I find it useful to question people about their lifestyle to further their reflection on the need for a psychotherapy consultation. It is important to start by identifying what seems atypical or inconvenient for us. For example: not recognizing yourself, being overly sensitive, realizing that you cry more often than usual, especially in situations that are normally easier to handle. Even feeling irritable or short-tempered can be an indicator. Obviously, it requires a certain capacity for introspection.
About introspection: it is a self-analysis of our feelings and how we operate. This ability is unfortunately not encouraged in our society as it goes against the idea of always moving forward without taking time to pause.
Another way to help us decide whether to seek help is to pay attention to the image people around us have of our behaviour. For example, do they seem worried about our level of fatigue? Of our workload? Of our psychological health? This analysis is also the responsibility of health professionals. It is not always done enough, not recommended enough, and yet it is part of the role of every family doctor. When you are examined, the doctor should ask you if there have been any changes in our lifestyle.
Some people are comfortable enough with the process of psychotherapy to start it even before the first signs of great distress appear, especially in a context of separation or grief. Those people would not necessarily have gone into a pathological condition (that is, meeting the diagnostic criteria for a mental health disorder). They may wish to consult up front to make the process easier and to feel better equipped.
L’Appui: And the need for more specific psychological help for caregivers?
Through Caregiver Support, many caregivers report feeling isolated at home with the person they are caring for, even more so since the onset of COVID-19. Many tend to neglect their needs in favour of those of the person being cared for. Unfortunately, in such context, caregivers will be less inclined to listen to themselves, one of the indicators that allow us to determine whether consulting a psychologist would be helpful.
If a person’s entourage is unable to reflect their emotional load and changes in behaviour and mood to them, and if that same person does not have the necessary availability to self-analyze, they may remain in an unfavourable situation, although all the signs of distress are there. This person, like many others, will not ask for support until they are at their wit’s end, when the symptoms become more and more present, more and more difficult for the sufferer to bear. However, early intervention would have provided faster relief.
L’Appui: What can be done to better understand and defuse the psychological distress that can be experienced by caregivers?
If we have any advice to give, it would be to take the time to think about your role as a caregiver. To ask yourself:
- With whom do I intervene as a caregiver?
- What is my relationship history with my loved one?
Take the example of a caregiver who takes care of her parents. For some, the roles are reversed. In a way, the child becomes the parent of her own parent, if only for certain tasks. This person can then ask the following questions:
- How was it with my parents when I was a child?
- Did my parents take care of me and in what way?
- What motivates me in my role of caregiver to my parents?
- Am I acting out of guilt?
- Is it out of a need to be present?
- Is it because I am an altruistic person?
Many caregivers feel very guilty about not being able to meet all of their parents’ needs since their parents were very present for them during their childhood. Different caregiving scenarios give rise to emotions such as repressed anger or guilt over role reversals, emotions that can affect the caregiving relationship. Human psychology is very complex. In many cases, there is some involvement, a gift of self that is disproportionate to the person’s abilities, and which can lead to exhaustion or emotional distress. This is why it is important to think about how the past relationship with the parents tints the way caregivers intervene, both positively and negatively.
Caregivers often call us when an event has occurred that causes an episode of distress (a fall, hospitalization, etc.), which allows them to be very present in the “here and now” and then very active in finding solutions to resolve the situation.
All of this can drag them into a downward spiral and cause them to feel out of breath. So, as Marie-Ève says, it is important to stop and take the time to question yourself, especially about your role as a caregiver in the present:
- What is positive for me in this role?
- Do I feel valued in this role? If so, how?
- Am I happy to be there for my parent, my loved one?
- Does it allow us to spend beautiful moments together?
We must also allow ourselves to explore what is difficult in all of this:
- Is it demanding? How?
- Am I annoyed because the loved one I take care of is rambling? How?
- Do I find it difficult for the disease to take its course and always have to repeat myself?
- Am I tired, because I am working in addition to my caregiver role?
It is essential to take a break and question ourselves. Where are we? In which direction do we want to go? What are our limits? Our limits will not always be the same, they will evolve throughout our life. It is not always easy to set them, but it allows us to better orient and respect ourselves.
L’Appui: What are the difficulties that can arise in seeking psychological help?
Seeking psychological help is a very personal process. It is therefore normal that some people feel a certain reluctance to do this. It is hard to ask for help. You have to be solid to seek support and explore our emotions. Giving proper space to our emotions should not be seen as a weakness. It is part of being human.
We have heard, especially from seniors, that they want the psychologist to have a life experience similar to theirs in order to feel understood. While this may be interesting, keep in mind that no experience is entirely similar to another. The psychologist who is in front of the person could have, on paper, a life course particularly close to their own without having lived their experiences in the same way.
It is important to give the psychologist a chance. The professional consulted may not completely correspond to the expected image, for example in terms of age, gender, professional experience, etc., but that does not mean that they will not be able to provide adequate support that is in line with our needs.
It remains crucial to see if we feel good enough with a psychologist to express ourselves and open doors, while feeling welcomed, without judgment. That said, the therapeutic alliance is more likely to form when prejudices about the desired psychologist are put aside. For example, a 30-year-old psychologist may well have been a caregiver to one of his parents when he was 15. This is information to which the person consulting does not have access and may even never know. Therefore, you need an open mind.
I would add that it is part of the psychologist’s job to help the person consulting them to recognize their needs and to offer an adequate response to them: a need for the caregiver to feel recognized in their experience and to know that someone is there to welcome and understand them. This can be done without the psychologist having experienced what the patient has experienced.
L’Appui: Is psychotherapy “confrontational”?
What happens in psychotherapy can be compared to a dance. It is the role of the psychologist to adapt to the pace of the patient. It is thus not immediately about big “confrontations”, which could be distressing or not indicated for the person, such as questioning great existential issues or suggestions major life changes.
Psychotherapy requires a commitment on the part of the person seeking help. To bring about change, “confrontation” will become inevitable. However, it is the role of the psychologist to adjust the level of “confrontation” according to the person’s capacity to receive it.
“Confronting” can be limited to pointing out repetitive behaviours or going so far as to point out a deeper emotion. “Confrontation” takes place on different levels, according to different issues and different people.
L’Appui: Why does psychotherapy have the potential to be as beneficial for the person being cared for as it is for the caregiver?
The example I have in mind is one that comes up frequently during phone calls: the loved one has a neurodegenerative disease, such as Alzheimer’s disease. It is difficult and demanding for the caregiver because often, as mentioned earlier, a role reversal occurs. In some respects, the caregiver becomes the parent of their parents, spouse or partner.
Thus, physically, the loved one whose health seems to be deteriorating is there but has completely changed. At least in some ways it is no longer the person we knew. Our bond with someone significant to us is changing, while they are still physically present. This is what makes this situation difficult to approach as a caregiver.
I often observe, as advisor for Caregiver Support, that people allow themselves very little space to express themselves about the difficulties associated with the changes and multiple overhauls in the relationship with their loved one. Yet, talking about it can do a lot of good. But not everyone has the space in their personal lives to express all this range of emotions. Psychotherapy can provide this space, while allowing for a better understanding of their emotional experience and recognition of their role as a caregiver.
Indeed, psychotherapy becomes a moment when the person agrees to think and work on themselves, because often in the caregiving relationship the caregiver forgets themselves. Taking that time is going to subsequently benefit the caregiving relationship. The caregiver may return to their loved one, relieved of a certain emotional tension that could have affected the quality of the relationship.
As in any relationship, there can be tensions that persist. Having this space allows you to ventilate and come back in the best possible way to stay abreast of both your needs and those of your loved one.
L’Appui: Final word?
It is important to give yourself a chance to express your pent-up emotions. It allows you to move on to another emotional register and avoid being overwhelmed on a daily basis by negative emotions. It feels good and it allows you to work on something else afterwards.
Need to talk?
More than ever, we remind you that Caregiver Support remains at your disposal to help you, guide you and listen to you. Please do not hesitate to contact us by phone at 1 855 852-7784 or by email.