Silva Neves

Silva Neves
Psychosexual, Relationship and Couples Therapist

Thursday, 25 May 2017

The Manchester Terrorist Attack: What now?

What happened in Manchester this week was horrific and despicable. The entire nation is upset and we are in a state of critical threat level.

This blog is for the people who were at the Manchester Arena on Monday night and who are traumatised by the terrorist attack. I am writing this blog also for their friends and loved ones.

These first three months are going to be crucial for your trauma recovery and wellbeing. There are some specific ways to look after yourself in these first three months, and if you do so, you are less likely for this traumatic event to develop into PTSD (Post-Traumatic Stress Disorder) or other trauma-related issues later, which would then require professional help.

Here are my suggestions of what to do after this traumatic event:

1-  Don't read posts on Facebook or Twitter that says: 'you shouldn't be angry' or 'you should focus on what's positive'. One type of posts I see a lot: 'let's not go into hysterics'. Although these Facebook posts are well-meaning they are not for you. They may put pressure on yourself to just be calm, rational and kind about it all. But the point is that right now, you are not calm. It is normal not to be calm. It is normal to be angry. It is normal to even be full of rage. It is normal to be deeply sad. It is normal to want to shout and scream. 

2- In order to allow a good recovery after what happened in Manchester, give yourself the time and space to do all that: be angry, shout, cry. Don’t fight the tears, don't try to calm down your anger. Let it happen, and let it happen in a safe way. 

3- Some suggestions to discharge you anger safely: Take a boxing class at the gym (this is popular amongst people who have been traumatised). Or go for a long jog if it’s more your thing. You might want to scream on your own in a forest, or at a pillow. You can write whatever you think and feel without censoring yourself. If you think 'I shouldn't say this or feel this way' it is censoring yourself. At this stage, you are very upset, all of your intense emotions are normal, so keep writing with no censorship.
Do not discharge your anger towards others as you might put yourself in danger. But when you are on your own, you can allow yourself to say outloud all the things you want to say but couldn't in front of others: don't judge yourself for feeling anger, rage or hate. It is normal to feel all that at the moment. If you discharge those emotions safely now, those unpleasant feelings and thoughts will be less potent and more manageable later. 

4- Find friends and loved ones to talk to. This is one of the most important part. Meet carefully selected friends and talk, talk, talk, with a cup of tea, a biscuit and a comfortable armchair. Ask for hugs. Cry on a loved one's shoulder. Don't feel embarrassed by your big emotions. Allow yourself to ask for a loving friend's time. Friends and loved ones will come to you if you ask. 

5- Remember that Feeling distressed, angry, sad, rage, confused, depressed is normal. If you notice your body shaking, it is normal. Let it happen.

6- Take care of the rest of your life, one step at a time: Engage in your favourite hobby. Find some routine back in your life, even if it is to remind yourself to do small things like having a shower and eating breakfast. Meet carefully selected friends to talk about other things that the traumatic event.

7- Give yourself a break from watching news. Often, people who have been traumatised feel compelled to keep looking at what happened. Try not to. At this stage, it will only re-traumatise you. You won’t be able to make sense of what happened now, so don’t try. Instead, spend some time watching other things that are completely different: a funny movie, for example.

8- Be mindful of your critical thoughts. It is common for traumatised people to have thoughts like: ‘I could have done more to help’, ‘I am stupid’, ‘I am worthless’. If you catch yourself having similar thoughts, get away from those thoughts. You have the control over your thoughts and you can make yourself think of other things that are more useful, like kind thoughts about yourself. Don’t judge or criticise your big emotions, allow yourself to feel your emotions with no judgements.

For the friends and loved one who can listen to the traumatised person, here are a few tips: 
1- Don't encourage your traumatised friend to make sense of things now. Just allow them to talk and talk and talk even if what is said doesn't make sense. They don't want to be listened to for facts, they want to let things out, whatever it is. 

2- Don't offer advice. Usually traumatised people don't want advice just yet. Just a friendly ear. 

3- Don't ask questions. Just listen. The only questions to ask are: 
'How are you?' 'Tell me more'. 'Is there more you want to say?' 'Would you like a cup of tea?' 'What do you want for dinner?' 

4- Stay present with your traumatised friend expressing distress and repeat back what you hear: it is a really good way that your friend will feel that you are just right there for them: For example: 'What I hear you say is that you are so confused with it all. You have so much anger towards that suicide bomber, you wish he was still alive so that you could kill him. Yes I hear you.' And then, you can validate what they are saying: 'It makes sense to me that you have these thoughts given what's happened to you'. 
They don't want to hear your opinions at this stage because you just can't know how they are feeling. So stay with them, parking your own opinion on the side. Later on, in about three months time, your friend might then be ready to hear your opinion or advice to start to make sense of things. But not now. 

5- Offer hugs.

6- Allow for silence to happen. If your traumatised friend doesn't want to talk. Don't talk. Just sit with them, in silence. You might want to ask if they want a blanket, or a cuddly toy (no matter how old they are), or touch your hand or a hug. 

If you have lost a loved one or a child. 
Your grief is enormous and complex and will stay this way for a long time.  
The five stages of grief are (Kubler-Ross): Denial, Anger, Bargaining, Depression and Acceptance. These stages are not neat nor linear. It is very common to flip from denial, anger, bargaining, depression, back to anger, and depression, and denial, and anger, and bargaining, depression and anger and depression, anger, bargaining, depression, and so on and on, for quite some time. This process usually lasts for two years. 
When you reach acceptance, what does it look like? Acceptance is not to say ‘what happened is ok’. Because what happened will never be ok. You will never be ok that you have lost a child in this horrific circumstance. Acceptance is to learn to live with the fact that you will always miss your child. Your life will never be the same again. Professional help can help reach that stage. But before you find a professional, give yourself plenty of time and space to discharge all of your big emotions as mentioned above. 

My thoughts and deepest sympathy are with you all. 

Saturday, 13 May 2017

What is healthy sex?

Sex is a topic that is talked about a lot. If you go online, you can read thousands and thousands of articles about sex, one of the most popular headlines being: what is healthy sex?

Sex is also a topic which most people have strong opinions about. Naturally, we bring our own morals and values when talking about sex: I hear people talk about what is right, what is wrong, what is healthy or unhealthy, even what is normal and abnormal. I also hear professionals in the psychology field having the same rhetoric. When we start to think about sex with 'what is' we already go down a difficult path of debates. People asking the 'what is' imply that the focus should be on the sexual act. Thinking about sex from an act-centred framework opens the thinking to judgments, opinions, moralistic views. This idea of what is healthy sex is likely to be preached to the rest of us in the form of an article from an 'expert'. Well, the truth is that there is no agreed upon definition of what 'healthy sex' is.

Let's suspend our judgments and morals on sexual acts for a moment, and instead I am inviting you to look at sexual health. Unlike 'healthy sexuality', there is an agreed definition of sexual health (Pan America Health Organisation). The definition of sexual health is based on six principles. I believe that looking at sex with a defined principle-centred thinking is much more helpful than an act-centred thinking.

The six principles of sexual health are:

1- Consent. This should not need any explanation, but unfortunately many people seem to have difficulties with this. Consent can only be expressed from a person aged 16 or over, with a fully functioning brain. And 'no' means 'no'. Consent cannot be expressed from a person who has impaired thinking: under the influence of drugs or alcohol, for example. Anybody under the age of 16 cannot give consent in the UK.

2- Non-exploitation. This means to do what you and your partner(s) have agreed to do. For example, if you are in a monogamous relationship but decide to have an affair, you are exploiting your relationship. It causes great distress to your partner (often it is experienced as a traumatic experience). People in polyamorous relationships can also exploit their relationships if they deviate from what is agreed between them.

3- Protection from HIV, STIs and unwanted pregnancy. In the UK, there is still 45% of unplanned pregnancy despite having the best contraception technology. It is important to take your responsibility with contraception when you engage sexually with your partner. It is also your responsibility to make sure that you are at low risk of contracting a sexually transmitted infection. Often it requires an honest conversation with your partner, and an explicit agreement on how you are going to protect each other. If you have a STI that is infectious, it is your responsibility to disclose this to your partner or to put protection in place that won't knowingly infect your partner. The advances in HIV treatment has improved a lot over the last few years. It has now been shown that a HIV+ person on regular medication whose viral load is undetectable isn't at risk of infecting others.

4- Honesty. Being honest and upfront with your sexual desires and sexual needs is important. Everybody is different, and human sexuality is diverse. It is likely that your partner may not know all of what you like, need or want sexually. In fact, some people are not in touch with their own sexual landscape and all the parts of their body that is erogenous. Being able to express to your partner what you want or need is important. It can be difficult and it is a courageous conversation to have, because you can risk hearing your partner saying that they don't like what you like. When couples stay in a place of honesty and truth, often they can work some things out between them to achieve a fulfilling sex life.

5- Shared values. It is important that you and your sexual partner are 'on the same page' about what is acceptable and what is not. Our values are what we hold dear and it is difficult to compromise on those. If you decide to engage in a sexual practice that is against your own values, you are breaching an important part of yourself. Equally, do express your values to your partner. For example, for some couples, it is ok to play with a third person occasionally. But for other couples, it is unacceptable. Values can also be cultural or religious as those often play an important part in sex.

6- Mutual pleasure. Pleasure is one of the most important component of sex. For good sexual health, it is crucial that you make sure that what you do bring you pleasure and at the same time, to be able to hear what your partner finds pleasurable. It is a good idea to talk about it with your partner because it is not possible to assume. What one finds pleasurable can feel horrible to another person. Some people find pleasure in BDSM, others find it painful. We usually feel good when we bring pleasure to our partners and we also feel good when we feel pleasure ourselves.

We have sex for fun, entertainment, pleasure and also for procreation. Whatever purpose sex serves in your life at the moment, and whatever sexual activity you decide to engage in, it is all good sexual health as long as you can make sure that all six principles are being addressed. Most of my clients find this a really helpful guide to help them navigate through their sexuality and wondering what is healthy and not healthy.