Using the questions below, we will try to create an overview of your past relationship experiences; what you have learned from them, and what you are looking for in and expecting from a relationship currently. Writing about these experiences can create clarity.

• How have I dealt with relationships in the past?(e.g. what was my role; was I a giver, a taker, a talker, a listening ear? Was I there in times of need or not? Was there personal contact often or was there just contact by phone/internet?)
• What did I miss in a relationship in the past?
• What has been a nice relationship in the past and what have I learned from this relationship?
• What am I looking for in a relationship?
• What do I expect from the other person in a relationship?
• What does the ideal relationship look like to me?
• Who would I want to have this relationship with and where could I find this person? (e.g. someone my own age, someone with the same hobbies and interests, someone of the same or the opposite sex)

Almost everyone needs other people to feel happy. Humans are social animals and it’s very important to have relationships. For some people, depression is related to a reduced ability to enter into or maintain relationships.

When treating depression caused by a lack of interpersonal relationships, the coach or practitioner will carefully explore the relationships from your past to see what kind of relationships these were and how you have experienced them. By doing this, you will find out what your strengths and weaknesses are in regard to looking for and finding other people together.

Then you will find out what your expectations are regarding relationships. Are these expectations realistic or not? Unrealistic expectations can then be adjusted where necessary.

Finally, we will look at which skills need to be practised in order to improve your contact with another person. How to have a chat with someone or how to address someone, for example. We can practise these skills together through a role play.

Source: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, ​​P., (2017). Protocol treatment for adults with psychological complaints, part 3.

During this writing assignment, you will investigate what has changed in your life, such as leaving home, the birth of a first child, retirement, divorce, moving houses or a changed work situation. We will discuss what your life was like before the change and what it looks like now. We will look at what has been lost and what feelings these losses evoke. You will write about everything you did before the change and which people played a role in this.

Explanation of the writing assignment

Writing about a situation sometimes makes it easier to list all your thoughts and to get a good overview. Find a quiet place, pick up a sheet, notebook, or a computer…

Try to answer the following questions as extensively as possible:

1. Which change has taken place?
2. What did your life look like before the change? Which activities did you do? Which people were important and why?
3. What does your life look like now? What has changed? Which activities do you do now? Which people are important and why?
4. What has changed? What has been lost?
5. Which feelings played a role in this?

The transition into another phase of life is generally accompanied by many changes. Examples of situations in which a role change can occur are: leaving home, birth of your first child, retirement, divorce, moving houses or a change in work situation. Thus, it can be either a chosen or a forced change, which can be either positive or negative. Changes that generate negative feelings are similar to a grieving process and, if these negative feelings are not addressed, can lead to depression. Because feelings of sadness, anger and other negative emotions are not recognized by the client and his/her environment, people will focus on the new situation instead. But it is important to properly say goodbye to the old before anything new is started.

During IPT

During interpersonal therapy (IPT), your therapist will assist you in recognizing, processing and accepting the losses and the associated negative feelings. Attention is also paid to any necessary adjustments. It is often not clear to someone that there is a loss: “I was so happy when I retired”.

With the help of your practitioner, you will consider the relationships that are pressurized due to the role change and, together, you will look for ways to rebuild valuable bonds. This can be done in various ways, such as by reviving old relationships or by building new ones.

Source: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocol-based treatments for adults with psychological complaints.

In our daily lives, we are continuously communicating, both verbally (with words) and non-verbally (gestures). This communication can go well, but can also end in a conflict, often because people do not fully understand each other.

There are a number of dysfunctional ways of communicating, which are explained below. Occasionally, it is normal to communicate this way, but doing this too often can cause problems. Do you recognize yourself responding in these ways? Each method of communication also contains some tips on how to improve your way of communicating.

Reading minds

When we interact with people for a long time, it sometimes seems as if we know what someone else is thinking and vice versa. But this is not always true. We tend to make assumptions. You don’t know what the other person is thinking for sure, unless you ask. If people don’t talk to each other this can result in conflict, simply because you don’t understand each other. For example: you come home from work and you see that the dishes are not done, while your partner knows that you hate coming home to a dirty house after a long day of work. You automatically get angry and assume he doesn’t think you are worthy of being considered, and, without saying anything, you run upstairs and lie down in your bed. Does your partner know what you are thinking? Do you know what your partner is thinking?

Exercise: Are there other ways to respond to situations similar like this one? If so, describe the consequences of this alternative response.

Collecting stamps

Do you say what you are thinking, or do you rather ‘collect stamps’?

Your partner says or does something that you are not happy with or that annoys you, but you don’t say anything because you don’t want to argue or whine. Subconsciously, you put a ‘stamp’ in your savings book. At some point, the booklet is full; you have the feeling that you have endured enough, which results in you exploding. The next time something happens, even if it is something very small, you will get very angry! All the complaints you have been holding back come flying out. Chances are that the other person sees this as very unexpected and reacts angrily as well; exactly what you don’t want.

Three tips to collect fewer stamps:

1. Be aware of the moments that you feel you are adapting to keep the peace. This is exactly the time when you should choose to assess the situation for facts.
2. Use Marshall B. Rosenberg’s model of nonviolent communication, which consists of four steps: 1. State what happens, 2. State your feelings, 3. State your need, 4. Say what you do want. You communicate your entire experience and indicate what happens to you, and what you would like; there are no ‘stamps’ involved!
3. Explore how you see yourself and the world around you. When you are convinced that you are OK, and the other person is also OK, the main motivation to always adapt your behaviour to others will disappear.

Exercise: When you notice that someone’s actions are annoying you, but you don’t say anything to keep the peace, try simply mentioning it – “I find it annoying when you leave the door open” – instead of letting it happen a few times and then reacting angrily; “you ALWAYS leave that door open”.

Keeping silent

Keeping silent is seen as a facade technique used to prevent other people from seeing their true feelings. Silence is used to reveal as little of themselves as possible and often arises due to fear or uncertainty. It can be an effective technique, but the drawbacks are significant. The silent party puts himself at a disadvantage by missing opportunities to express himself, which can negatively affect a group decision or relationship.

It is important to learn to deal with your fear. The best way to achieve this is to ‘just’ do it.

Exercise: Try to say or ask something in a situation in which you notice that you are consciously silent. For example, practise with someone who you feel comfortable practising with first, e.g. someone who is close to you. You can review your sociogram for this.

Stay vague

Vague or ‘woolly’ language is used by many people. Those who are vague in terms of language often obscure the message, are unclear, indirect in communication, fail at conveying a message or do not get to the heart of the matter.

Someone can have different reasons for choosing vague language. It is sometimes done consciously (e.g. a politician who does not want to give a clear answer). It can also be a habit that they are not aware of. Also, it can be a form of indirect resistance or a way to avoid conflict.

In the case of conflict avoidance, people often don’t get to the point because they find it difficult to tell the real message, or because they are afraid of hurting someone or not being liked.

Some tips to be less vague:

1. Determine the message you want to convey in advance
2. Think of a sentence you want to use and use it in the conversation
3. Be aware of how long it takes for you to convey your message
4. Try to lead the conversation and focus less on how the other reacts

Exercise: If you need to convey a difficult message, try using the tips above. Write down exactly what the message is, and how you could say this as directly as possible.

Blaming

Blaming is a way of communication that leads nowhere, except for damaging your relationships. When you blame, you blame the other person for something that you think they should or shouldn’t have done or said. For example: “I have always been there for you, but now that I am moving you are nowhere to be seen” or “You can exercise three times a week, but you don’t have time to see me“.

Behind every reproach is actually a desire that is not expressed. In the examples above, this would be “I would like your help with moving houses” or “I would like your attention and time”.

Therefore, blaming is ineffective because you don’t actually say what you mean, and the other person often responds negatively because it can feel like a personal attack.

Exercise: When you notice or feel that you are blaming someone, try to find out what your need is in that situation and how you could explain that without blaming the other person.

General exercise

In which of the 5 ways of communication listed above do you recognize yourself? Think about the situations in which you use them most often. Write those down below:

Communication patterns         In which situation?

_____________________ _____________________________

_____________________ _____________________________

_____________________ _____________________________

_____________________ _____________________________

____________________ _____________________________

What are your experiences with these ways of communicating? What works and what doesn’t work?

_____________________________________________________________________

______________________________________________________________________

Sources:

Wiertzema & P. ​​Jansen (2005). Basic principles of communication. Pearson Education.

www.desteven.nl/leerdoelen/personlijke-leerdoelen

It is important to establish what an ideal situation would look like if the conflict no longer existed.

Imagine what this situation would look like, and write it down as extensively as possible.

Think about, for example:
How would you feel, what would the other person feel?
What would you think, what would the other person think?
What do you say to each other?
What is the mood like between you?
What is different now compared to during the conflict?

The purpose of this assignment is to outline the conflict as accurately as possible. It will include who you had a conflict with, what the conflict was about, what feelings the conflict evoked in you, and what your wishes are regarding the person with whom you have the conflict.
Finally, you will pay attention to what you have already done to make your wishes clear to the other person.

Instructions

Write down the answers the questions below as extensively as possible.

1. Who am I in conflict with?
2. What is the conflict about (try to mention one clear topic and talk about it extensively)?
3. What feelings does the conflict evoke in me (e.g. angry, scared, sad, shame, irritation, insecurity, vulnerability, etc.)
4. What are my wishes regarding this person (what do I expect, what do I want to see differently? Try to make at least 3 points.)?
5. What have I already tried to do to make my wishes known?

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Conflicts can occur regularly and they are not all necessarily bad. A good conflict can provide clarity and ultimately positively influence the atmosphere. However, conflict does not always end with a positive outcome. Sometimes, a conflict can even turn into an argument, which can have unpleasant consequences; recurring arguments, no longer wanting to talk to each other, and sometimes even breaking off contact or ending a relationship. As you can imagine, such a conflict can have a major impact on a person’s life.

Although conflict is often not seen as the most important contributing factor to symptoms of depression, it can be a primary cause. The feeling of loss or a ‘conflict of interest’ is common and has a major impact on a person’s life. It often concerns a conflict with a partner, but it can also be with a family member, colleague or another important person.

Finding the cause

With the help of your practitioner, you will try to find the cause of the problem. This involves looking at who is involved and the topic of the argument. In general, this will be a conflict where there seems to be no solution. After mapping out your wishes and desires, you will work together to see if you can bring the conflict into the negotiation phase.

In addition, you will examine the various occasions on which a conflict occurred to get an idea of your communication patterns and whether they are working or not. You will review what you have already tried in regard to this conflict.

Expressing your wishes

Now that you have a good understanding of the conflict and the attempts to solve the conflict, you and your practitioner will jointly examine whether there are other possibilities for expressing and/or getting your wishes fulfilled in a better way. You will discuss every possibility and what the consequences of these possibilities could be. We always discuss a concrete situation and the various options for reactions. We can practise this through a role play, for example, and then you can start working on it at home. During the next session, we will discuss how it went, what you said, what you felt and how the other person reacted. We call this a communication analysis. We can also involve the other person if they are open to it.

Source: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocol-based treatments for adults with psychological complaints.

Writing assignments are often used to process unpleasant experiences, such as the loss of a loved one. There are a number of topics you can write about. Some assignments are easy, whilst others are a bit more difficult. This is different for everyone. It is also possible that some assignments evoke strong emotions; it is normal to experience these emotions! When the emotions get too intense for you, take a break. When you have calmed down a bit, you can continue.

General instructions

Set up a place in your house that will be used exclusively for working on the writing assignments. Sometimes it can help to put up a picture of the person you are writing about. Before you start writing, it is important to ensure that your phone is turned off and there are no children, friends or visitors that can disturb you. It is important to allow yourself sufficient time, for example 45 minutes.
You can write using pen and paper if you like, but you can also work on them digitally. Find out what works best for you.

Assignment A

Write about your loved one’s personality.
What kind of person was he/she? What did he/she enjoy doing? What did he/she think was funny? What did he/she always live up to? What was his/her favourite food/colour/season, and why? Write down as many details as possible that come to mind!

Assignment B

Write about a nice moment you experienced together with your loved one, such as a holiday, wedding day, anecdote or another beautiful moment.
Try writing this from the ‘I’ or ‘we’ perspective, as if you were reliving it again. Where were you? What did you do? What day was it? What was the weather like? What did you feel, what did they feel? Try to write down as many details as possible!

Assignment C

Write a letter to your loved one containing everything that comes to mind and your thoughts when you think of him/her.
Write in second person perspective (so ‘you’), directly to the person in the photo.
This letter is for yourself only. It will never be sent, so you can write anything you want in it, both positive and negative feelings. Try not to feel inhibited! Write what comes to mind. Sit at the designated workplace and look at the photo. Let the photo influence you, let memories begin to arise; both feelings about the past and feelings about the letter itself. Try to let the emotions run free. Write down your feelings and any thoughts that surface.

You might find it difficult to write something at the beginning, but be patient! Just sit quietly until the time you set aside has past (e.g. 45 min.). Try to put some loose words on paper or read back parts of your letter. The idea is that you work on this letter every day and keep adding things that come to mind. Each time you begin writing, start by reading what you wrote previously and then continue writing.
You can keep the letter to yourself, but you can also share it with your coach or practitioner.

Assignment D

When you have finished the letter from assignment C, during which you have put all your feelings and thoughts on paper, it is time for the last assignment. Here you will write a ‘worthy’ letter that you would like to send to your loved one. In this letter, you say goodbye to him/her. It must be a letter that you can be proud of, in which you tell them what you have experienced and how it has affected you without any anger or aggression. The letter should do your feelings justice, but it should not blame or harm the addressee. The letter is not only about the past, but also about the present and the future. The letter can then be sent symbolically, by burying it at the grave of the addressee, keeping it in a special place or by being burned. You can decide how you would like to do this.
Keep in mind that this is all about you. Use your own interpretation!

The concept of ‘grief’ is described in the Dutch National Grief Guideline as ‘the entirety of physical, emotional, cognitive, spiritual, and behavioral reactions that occur after the loss of a person with whom a meaningful relationship existed.’ Loss not only means the death of a loved one but also losing a loved one to a serious illness such as dementia. However, grief can also arise from other losses, such as losing a job, relationship, home, or independence (e.g., due to a chronic illness).

• Physical reactions: decrease or increase in sleep and/or appetite, headaches, loss of energy, decrease or increase in the need for intimacy and sexuality.
• Emotional reactions: sadness, loneliness, fear, guilt, shame, aggression, helplessness, pessimism, nightmares, relief, satisfaction.
• Cognitive reactions: decreased concentration or self-esteem, confusion, tension, compulsiveness, being preoccupied with the deceased, hopelessness.
• Spiritual reactions: loss of perspective on life, decrease or increase in faith.
• Behavioral reactions: becoming easily irritated, withdrawal, avoidance of people or situations.

What is a grieving process?

After a loss, there is a period in which you learn to cope with the loss. This is a natural process that everyone goes through in their own way. During this grieving process, you will be confronted with the reality and the pain of the loss. You will notice that you start to sort things out for yourself, try to acknowledge or realize the loss (some say they never realize it), recall memories, and experience many changing emotions or emptiness. It is also very normal to suddenly think about themes such as life and death, the future, your norms and values, family and friends, children, or other ‘big’ topics.

It is difficult to determine when someone has successfully gone through a grieving process, but there are some natural changes that can be a sign. For example, when there is space again for positive feelings or memories of someone alongside the sadness. Or when the loss fades into the background a bit, and it becomes possible to resume daily life. Or the emergence of a new so-called ‘post-mortem’ relationship with the deceased. This is a relationship that promotes growth in which you are aware that someone has physically died, for example, if visiting the grave monthly gives a sense of calm or connection.

Complicated grief

When grief reactions persist for too long or are very severe, and they obstruct your daily functioning, this is also referred to as complicated grief. This happens, for example, when someone suddenly dies in a traumatic or violent way, someone has suffered excessively due to a long illness, someone’s death could have been prevented, with the loss of a child, with multiple deaths at once, or with a lack of social support. There are several forms of complicated grief:

• Absent or denied grief. Grief when death is not confirmed. For example, if the body has not been seen, in disappearances or disasters.
• Delayed grief. When grief (un)consciously is suspended. For example, when you got in a situation where you have to take care of others due to the loss.
• Chronic or prolonged grief. A permanent state of acute grief. For example, when you had a very dependent relationship or don’t get enough space from your environment to grieve.
• Wry grief. A form of grief with aggression or guilt instead of sadness. For example, in an ambivalent relationship if you had cut off contact or if there were conflicts or unfinished business.
• Traumatized grief. A form of grief where you remain stuck in post-traumatic stress.
• Somatic grief. A form of grief where someone develops somatic complaints instead of emotional reactions. These are sometimes even related to the cause of death (e.g., chest pains if someone has died of a heart attack).

Grief and depression

Confusion can sometimes arise between grief and depression because they are very similar. It is possible, however, that someone eventually develops depressive symptoms due to persistent grief symptoms. Below you can see the major differences between grief and depression:

Sources

Keirse, E., & Kuyper, M.B. (2010). Richtlijn Rouw. Versie 2. VIKC, Vereniging van Integrale Kankercentra. (www.oncoline.nl)