English Speaking Therapist | Forward Therapy Stockholm

Tag: Depression

How to Expose Covert Abuse, Coercive Control and Gaslighting
The red-flags for covert abuse, coercive control and gaslighting in a toxic relationship usually take time to notice. We enter into coupledom in a state of vulnerability, with an open heart, and assuming our partner has the best intentions. When things go wrong, we might blame ourselves or start thinking we are unwell. Then we notice the warning signs in the form of patterns of dominating conduct. Becoming aware of manipulation and controlling behaviour in intimate relationships is the first step in managing and ultimately refusing it. Recovering and healing from the psychological harm inflicted by an abusive ex-partner can be better helped by counselling and other professional support.

Manipulation through Deception and Abuse Erodes Self-Worth

As an online therapist for English-speaking expats in Sweden and around the world, I work with many individuals struggling with coercive control and gaslighting. Sometimes clients contact me for couples therapy when they are actually looking for a referee or help in escaping the relationship. Often, in their initial emails, my counselling clients outline problematic behaviour by their spouse, sambo or lover that is clearly inconsistent with the signs of a healthy relationship. I’m referring here to the trust, respectful communication, mutual support, shared decision making and commitment to each other’s growth. Most of us are seeking those when we start sharing a life with someone.

Examples of controlling behaviour in relationships are abundant. Gaslighting, for example, is a specific type of manipulation that leads a person to self-doubt. It could be via outright deception or ‘crazy-making’ (pathologising). I often hear stories from people who arrive in Sweden from to start a new life only to find themselves pseudo-diagnosed by their partner as depressed, anxious, ‘bipolar’, obsessive compulsive disorder, or ‘ADHD’ or as suffering from borderline personality disorder. The effect on my English speaking clients is to undermine their sense of self and distort their reality. They feel sick, wrong or broken. Covert abuse, consistent coercive control and gaslighting can make a person mentally ill.

Self-Worth and the Adjustment to Swedish Culture

In other cases the controlling behaviour is more subtle. It might include prioritising friends or family over a partner, consistently making unilateral decisions or demanding particular outcomes without any offers or negotiation (also known as ‘my way or the highway’). Some clients are repeatedly infantilised. Their partners are not prepared to accommodate the time it might take a new immigrant to adjust to Swedish culture. In some cases my clients are being ‘abandoned with care’: made important but worthless at the same time through the provision of limited financial support but a disregard for emotional needs. These are all situations that result in an erosion of self-worth.

What to do when your partner refuses to attend couples counselling

More obvious abusive relationships involve the denial of autonomy, or monitoring and surveillance of activity. Name-calling, mockery, put downs and other forms of bullying are further examples. Threatening harm to pets, or children, or even violence to the person themselves might be accompanied by a suggestion that the victim would somehow be responsible for the abuser’s behaviour. These are clear signs of abuse that will have a person living in fear. The turning point for my talk therapy clients in Sweden is often the realisation that they can choose not to live in fear and that everyone has a right to an intimate relationship free of dread, coercive control and gaslighting, even when socially isolated in an unfamiliar country.

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Vulnerability to Coercive Control and Gaslighting for Expats in Sweden

Abusive and controlling behaviour in expat relationships arises in combination with a number of factors. Moving to a new country can be stressful and the person immigrating often leans into their partner for more support in the initial months and years. There are sometimes massive Swedish cultural differences not always apparent when first arriving. Language and communication difficulties can erode a person’s confidence and lead to further reliance on the native partner. Social isolation and financial dependence can play a part in ceding to a domineering spouse or lover. When one partner starts disregarding or disrespecting the other, it often leads to loneliness within the relationship.

But these instances don’t explain every situation. What about so called Third Culture Kids (TCKs), adults who spend a good deal of their childhood moving countries with their parents? I assist many TCKs via webcam therapy sessions from Sweden other countries. They also often report symptoms of toxic relationships despite often being adept at adjusting to new countries and cultures and having advanced language skills. So what might be happening for TCKs?

The acceptance and tolerance of controlling behaviour often relates back to past relationships. It can evolve due to or childhood experiences or religious trauma. Often my clients realise they have a pattern of abusive relationships that defy transnational migration and transcultural relocation. Interpersonal conflicts re-emerge. The emotional support yearned for is distinctly absent. The awakening to a relationship as controlling is a shock. But moving to a new country represents a new start, a way of leaving a difficult or shameful past behind. Unfortunately it can also mean a replication of the enmeshment or co-dependence that occurred in the family of origin or church along with similar abandonment, isolation, loneliness, and neglect.

Toxic Relationships: A Pattern from Childhood and Family

We are usually drawn to people who offer the promise of a missing experience, something we seek in childhood but never receive. Yet the person who attracts us can also be somewhat familiar. Ever heard the expression ‘They married their mother / father’? For those with backgrounds of neglect, abuse or abandonment, where a parent is distant, absent, critical or authoritarian, it can be easy to slip into yet another unsatisfactory and abusive relationship. But if you start to recognise a pattern in your relationships, that they are abusive or mirror somewhat the relationship you had with a parent, it’s important not to give yourself a hard time. Now you can use self-compassion.

Some clients report a kind of low mood that persists since childhood. They manage go about their lives, appearing somewhat functional, but never feel particularly happy for long. The trauma therapist and Licensed Independent Clinical Social Worker (LICSW) Patrick Teahan refers to this as Refrigerator Buzz Depression. You live with it for so long that it becomes background noise. Processing childhood trauma, and awakening to how bad it is, are integral to recovery but can initially inflame mood disturbances. At the same time, changing one’s life by moving to a new country like Sweden can also bring the realisation that you no longer have to put up with the sadness you have lived with for so long.

Treatment, Healing and Recovery from Coercive Control and Gaslighting in Relationships

Finding your way out of a controlling relationship involves awareness, accessing support and taking practical action. But it also means trusting yourself. We evolve with emotions for good reason. Noticing your anger, shame, fear or sadness is part of realising that something is wrong. Developing a kinder and less critical relationship with yourself can be the key to accessing a way out.

The isolation of being in a foreign country like Sweden can cause confusion. If you are struggling to understand how to cope in your relationship, an individual consultation might be better help than couples counselling. For a relationship beyond repair, couples therapy can only involve supporting the relationship to end. An individual session might reveal you have been over-tolerating bad behaviour. You could be in a state of self-blame or toxic shame. You may find it difficult to navigate relationships and deal with coercive control and gaslighting. Getting good with yourself through the encouragement of an English speaking therapist can assist you to manage emotions and develop a course of action. If you are in danger, go to the police.

Therapy for Managing Controlling Relationships

Therapy for those experiencing manipulation by their intimate partners can involve:
- Stress management techniques;
- Problem solving around boundaries, risk and managing safety;
- Psychoeducation to understand the signs of coercive control and gaslighting and other forms of covert abuse;
- Strategies for de-escalating, responding to and eliminating abusive behaviour;
- Development of a plan around financial independence and social and emotional support;
- Grief counselling, particularly around the sense of betrayal and emotions that accompany separation.
Good talk therapy is not simply about venting or offloading your feelings. Being able to talk and be heard are important but an experienced therapist will not only listen, they will assist you to develop your self-agency or your capacity to change your circumstances. They will encourage and support you to take action and reach a turning point. This might involve practising self-compassion, assertiveness or prioritising new habits over fast gratification. In any case, a willingness to take new steps is part of recovery. Even the best psychologist in Stockholm will not be influential if you are not willing to do something yourself about the situation.

Identifying, dealing with and recovering from a relationship involving coercive control and gaslighting can take time. This is particularly true for those who find themselves isolated in toxic partnerships that resonate with abusive childhood experiences. In the beginning, it can feel overwhelming. But with the right support, it is possible to change your circumstances and recover both a sense of safety and a nurturing relationship with yourself.

Make an appointment now for therapy online with Ash Rehn
October 16, 2023
How to Reduce Rumination and Stress by Doing More and Thinking Less

Ruminating. Catastrophising. Panicking. All describe the breakdown of logical reasoning that happens when we are in such a state of anxiety that our thinking is paralysed. So how is it possible to stop going over and over a source of worry? The answer to reduce rumination isn’t more thinking, it’s more doing.

Why Can’t I Stop Thinking and Switch Off My Brain?

The coronavirus has most of the world on edge. It’s limiting our possibilities for movement and making our lives even less predictable challenging us to manage our mental health. And in the social distancing of these new conditions, some find themselves alone and obsessively thinking about the same things over and over, causing them to feel physically sick with worry or having a panic attack. My English speaking clients in this situation plead with me, How can I change my thoughts?

But the key lies not in changing thoughts but changing activities. When a person’s physical stress response is so high, the logical reasoning part of the brain fails and the survival part of the brain kicks in. This is the legacy of our evolution, an animal instinct to withdraw, like crawling back into a shell for protection. Unfortunately when humans withdraw they stop participating in activities that benefit them such as engaging with others and physical movement.

Those of us who have been conditioned by work that uses our brains in preference to our whole bodies try to think-through and problem-solve unpleasant feelings instead of addressing them directly through physical means. But the best way to lower the acute stress response is to get physical and use more of the whole body, not just that little part of the brain behind the forehead that is responsible for cognition (thinking, judging and problem solving).

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How to Escape the Isolation Chamber and Reduce Rumination

Ruminating on a problem without the benefit of more information or a different perspective is akin to trying to make a decision from inside an isolation chamber: we have to get out and experience the world through the senses. The way to reduce rumination and ‘catastrophising’ isn’t more thinking, it’s more doing. And specifically doing activities that engage the senses. Not only will doing something physical help you to relax, it will loosen up your thinking and help you gain perspective.

Exercise is the obvious first go-to. I don’t recommend high-intensity exercise for stress reduction because it can spike the sympathetic nervous system that is responsible for elevating the body’s stress response. But moderate intensity exercise such as brisk walking, light jogging, kicking a ball around, moderate swimming or dancing can help a person to get out of their head and into the body. These activities will help relax the muscles, releasing physical tension. Even in the middle of winter, many Swedes will go out and walk in the brightest part of the day because they know that moving the body and experiencing the world through different senses is key to lowering the stress response.

The other activities that work well for reducing the stress response are anything that involves hand and eye co-ordination or acts of companionship. Research has indicated that activities involving hand and eye coordination actually repair neural pathways. Sharing time with friends who are experiencing a lower stress response can actually reduce your own anxiety. So what does this look like in practical terms?

Strategies to Treat Acute Stress Response

I’m aware that those who have recently moved to Sweden or other foreign countries do not always have much living space or many friends. So hobbies like car restoration, carpentry or bee-keeping might not be possible. Here are some suggestions for activities that don’t require a lot of space or capital outlay and that you can do alone…

The 5 Fundamentals of Stress Reductio n

Creative activities that engage the hands and eyes will help you relax and also assist with anxiety and depression. For example: painting, drawing, photography, jewelry making, building things with Lego or completing jigsaws, podcasting, making Youtube videos or creative writing. Hobbies like video-gaming, geocaching, collecting antiques, coins, toys or memorabilia, playing chess (even against a computer), learning to program, code or make apps, sewing, knitting, making clothes, cooking, genealogy, learning and playing a musical instrument or learning a language could also take your mind off your worries and reduce rumination. If you only have your work or relationship to think about, is it any surprise that your mind has nowhere else to go?

Then there are relaxation treatments such as getting a massage, enjoying a floatation tank, playing with pets (your own or someone else’s), walking in nature, colouring-in books or watching comedy videos on a streaming service. Chilling out is a great way to lower stress response.

And thirdly the companionship of spending time with friends and reaching out to someone you love like a son or daughter or cousin or long-term friend, even if they are in another country, can lead you to feel better. Physically or virtually not being alone is beneficial and it’s amazing how showing interest in someone else can assist you to get out of your head. Try it!

Finally, if you are so stressed up that you are unable to exercise or get into a hobby or reach out to a friend or family member, consider consultating a doctor at the Vårdcentral about medication to assist in the first instance. Some people self-medicate with alcohol or recreational drugs but it is better to get professional support to assist you until you are able to take more steps on your own. Any form of medication is only a short-term fix and does not address the cause of anxiety. The use of prescription medication needs to be monitored by a medically qualified person.

If, after lowering your stress response, you still need to reduce rumination, you can talk to a professional therapist who can guide you through problem-solving strategies.

To make an appointment for coaching, advice, support or therapy, please contact me.

October 23, 2020
Anxiety Therapy in Stockholm: Walk and Talk or Talk and Tea… You Choose!

Treatment for Anxiety is now attracting the same attention given to Depression over recent years. And it’s no wonder. Many people are unaware that Anxiety is affecting their lives and as a result become confused as to how to better approach their symptoms. Talk therapy can offer new ways of responding to Anxiety, and you don’t even have to do it sitting down!

Expat counselling brings me into contact with a wide range of people and personalities. I meet bankers and barmen, teachers and tradies, researchers, roadies and radio journalists. Some come to Sweden for relationships, some for money and some for recognition. It isn’t easy being an immigrant in Scandinavian culture regardless of how advanced Swedish society seems to be. Relocation, cultural differences and relationships are stressors and how we respond to stress affects how well we adjust and how happy we are.

When people come to me, they have often already researched their symptoms on the Internet and tried to diagnose themselves. So what is actually a stress response has been interpreted as ADHD, or OCD, or Depression, or Aspergers Syndrome, or Bipolar. These are the most common diagnoses people are concerned about. It is quite common for Depression to be preceded by Anxiety. However misdiagnosing yourself with the help of the Internet can mean using an ineffective treatment for the condition or falling into a sense of hopelessness. Some even come to the conclusion they have a genetic fault or biological deficiency that cannot be fixed.

I reckon that most people have come to these understandings because we don’t hear enough about Anxiety and how we can respond more effectively to it. Hopefully that is about to change. However this brings another danger: the idea that there is a ‘quick fix’ to Anxiety. My experience is that those suffering from Anxiety are also susceptible to promises about ‘fast results’ or ‘cures’. Taking medication can sometimes help but some drugs are addictive and only worsen the problem. A promise of complete recovery can be much more appealing than the idea that we might have to work at reducing Anxiety or even learn ways to live with it.

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How Can I Reduce Anxiety?

Firstly, most people with Anxiety know that it can affect how their physiology works including changing the way they breathe, their heart rate and the feeling of control over their body. But not so many have learned that the reverse is true as well: you can lower physical and psychological Anxiety through consciously changing your breathing, using relaxation techniques and getting back in touch with your physical being. It is much easier to read about these methods than put them into practice. So getting the help of a therapist to try them out can make a huge difference. Let’s talk about the acute stress response of flight / fight / freeze and how important it is to drop out of that if your really want to get a handle on Anxiety.

Secondly, the practice of Mindfulness. Mindfulness is about being right here, right now. Not in the fear of the future or the regret of the past, but physically present in the moment. It is about focussing attention, without judgement, in calmness and clarity. It is not new but at least 2500 years old and it has stood the test of time. Mindfulness offers you a way of observing your feelings and emotions (including Anxiety) without being pushed around by them. It is highly effective but requires work and practice. This is where the therapist or counsellor can support you by explaining the practices of Mindfulness and helping you monitor your progress. If you are interested in reading about Mindfulness and Stress reduction, I recommend A Mindfulness-Based Stress Reduction Workbook available here on Amazon.

Thirdly you can work with your thoughts. This is why Cognitive Behaviour Therapy (CBT or KBT in Swedish) has become so popular. It can be effective but so much depends on how the therapy is undertaken, the relationship between you and the therapist and, most importantly, whether you are outside of the stress response enough for your cognitive capacities to function properly. There are other approaches to working with Thoughts as well. Deconstructing ideas and concepts and working out how the thoughts arose in the first place can be a significant aspect to talk therapy. Again it requires a degree of trust is established between you and your counsellor.

Walking Talk Therapy

I offer a unique approach to working with Anxiety which I call ‘Walking Talk Therapy‘. Of course, you are always welcome to take a comfortable armchair in my consultation room and chat over a cup of tea (including herbal tea), coffee or glass of water. But if you prefer to walk and talk, we can do that and get some exercise at the same time. It is generally well known that exercise helps alleviate many forms of Depression but it can also be effective for Anxiety. This is at least partly because we are using our whole body when we walk and we can work with the breath in different ways as we walk. These are the most effective means to reduce an acute stress response. It can help us to access a more relaxed sense of ourselves, feel more free and clear our thoughts so we have capacity to think differently.

We aren’t all the same and some of us respond better to some Anxiety treatments than others. So apart from face to face appointments in my consultation room and Walking Talk Therapy, I also offer therapy for Anxiety over the Internet through Skype webcam, Instant Message and Email Exchange. So it doesn’t matter where you are in Sweden or anywhere else in the world, through web technology we can communicate and work cooperatively to reduce Anxiety and change your response to stress.

If you are ready to make an appointment or if you want to know more about my availability and fees, contact me now and let’s make a start. There is more information about me and how I work in these pages but if you have any questions I would be happy to answer them directly.

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I look forward to hearing from you!

Ash Rehn.

May 8, 2013
Life Coaching in English to Turn Your (Swedish) Life Around
Not adjusting to life in Sweden? Worried about your mental health? Can’t concentrate and think you have ADD or ADHD? Struggling with the winter? Don’t let the darkness, Snökaos (snow chaos) or winter blues drive you to depression. Whether you choose to do it in-person or by webcam, you might just need a few sessions of life coaching to get back on track.

Here’s how therapy and life coaching with an English speaking coach and counsellor might make a difference to life in Sweden.

Bollplank, Sounding Board or Reflective Surface

Talking with your partner sometimes is not enough. Sometimes we are just too close to someone to offer a different perspective and it can seem like a lot of pressure if a sambo, husband or wife is the only one to talk with. The Swedes have an expression ‘bollplank’ which in English is akin to ‘sounding board’, someone or something we can throw our thoughts against to test them out. (Literally it is a plank of wood for kicking footballs against). In my work I call it the Reflective Surface.

There are many ways to employ a reflective surface: some people keep a journal or diary, video blog, artwork, cooking, craft… In fact any activity that combines structure and imagination with a product can provide a means to reflect your identity and ideas back to you in a positive, affirming way that supports change. A conversation can also be a reflective surface. In my office I use a whiteboard which is a literal reflective surface and sometimes I use it to hold onto the expressions or words that come up in a session. But even without the whiteboard, meeting with a coach serves the same ends because you hear yourself saying things and the coach can hold onto your words and ask you about them. A life coach can help with:
- Sharing what has been happening
- Working out what is important
- Making goals
- Following through with intentions
- Acknowledging and celebrating progress.
If everything seems to be going well for your partner but not for you, don’t take it out on your sambo. Make it you New Years Resolution to get your own ‘bollplank’ and let the relationship be what it should be.

Seasonal affective disorder (SAD)

A lot of people approach me thinking they have ADHD because they can’t concentrate at home or work, or both. And there is a lot of discussion at the moment about ADHD, particularly in Sweden where there is a huge expectation that people are on time, focussed and ‘get with the program’. The norms of behaviour in Sweden are very influential. If you have seen preschoolers being marched around the city in pairs, you will get what I mean. This is a society where, to a large extent, cooperation and compliance are unspoken rules. I mention this because it is important to understand that cultural influence and social expectations can play a part in how we feel and how quickly we adjust.

But difficulty concentrating can also be a symptom of depression. When we feel low, unmotivated, frustrated or insignificant, it can be harder to stay on task. In a way this is our instinct or animal side at work, trying to get our bodies moving again. Movement and exercise to treat Depression has been recommended.

Here are some other signs and symptoms that you might not be alright:
- You are spending all day inside and not going out at all
- Mood swings or constant irritability
- Feeling like a zombie or not feeling anything at all
- Eating constantly and more than you need to (or a loss of appetite)
- Drinking alcohol everyday or most days on your own
- Not engaging with friends
- Ruminating thoughts, ‘overthinking’ and dwelling on failure
- Less attention to self care or neglecting basic hygiene (not showering, brushing teeth or changing clothes)
The good news is that you don’t necessarily need a psychologist or to go on medication simply because some of these are present. The benefit of working with me is you can tell your friends / family / sambo that you are seeing a coach for adjusting to life in Sweden. You can even meet me online, over webcam or for instant message counselling if you don’t want to take on the snökaos or you are living in Uppsala, Västerås, Nyköping or otherwise on the outskirts of Stockholm. Likewise if you are in Malmö, Gothenburg or Umeå or somewhere more remote, online coaching means you save the travelling time and can get help from the warmth and comfort of your own home.

Of course, if you are at any serious risk or your health is deteriorating quickly, you should not hesitate to consult a GP.

From Therapy for Depression or Adjustment to Coaching for Life Goals

When life seems to be stuck or falling apart, it can help to talk it over, make a plan and have someone to engage with and help you to monitor progress. A lot of people start to meet with me for therapy around a particular issue and end up feeling better to the point that our sessions become more about coaching and moving forward. Recently I have been speaking with people about:
- Rejection, Heartbreak and emotional counselling associated with relationships
- Managing Anxiety and finding new ways to respond to Stress
- Career decisions and changing direction with work
- LGBT counselling around developing a positive self-identity
- Life purpose and pursuing goals.
If you have found me through ForwardTherapy.se price and cost of coaching might not be your main concern. You are probably more interested in finding a professional who understands what you are going through and offers the advantage of sessions in English. But just send me an email (preferred) or call and leave a message for a callback if you would like more information about my fees and payment options.

Engelsktalande Samtalsterapeut (English Speaking Counsellor): A Word For Spouses and Sambos

If you think your partner, wife or husband might benefit from coaching, kognitiv beteende terapi / cognitive behaviour therapy with an english speaking coach (kbt på engelska) or just a bollplank with someone other than yourself, feel free to send me an enquiry. I am used to working with people in relationships where one partner is struggling with culture or climate or relocation adjustment and there is some conflict in the relationship as a result. There is more information here på svenska.

Next year I will be relocating my office from Kungsholmen to Södermalm in Stockholm. But you can make a start now and put yourself on a better track for 2013. Start making your New Years Resolutions.

Write to me and I will send you full details of availability, fees and answer any questions you have. Please let me know if you prefer in-person (face to face in Stockholm) or online consultations.
December 7, 2012
Can Depression that Started in Sweden be Treated with Exercise?

Improvement to mood is one of the most obvious effects of exercise. But can exercise actually be used as a treatment for depression?

An article recently featured in the Stockholm daily newspaper Dagens Nyheter says it can. Jill Taube, a Swedish psychiatrist, has written a book about how exercise can help to cure mental illness. She points to studies that show the effects of exercise not only last longer than those of antidepressant medication, but physical activity appears to prevent the recurrence of depression better than antidepressants.

Exercise: A Prescription for Depression

Taube’s exercise ‘prescription’ echoes what the health and fitness experts have been saying for at least 20 years: a combination of cardio and strength activities for 30-45 minutes, at least 3 times a week. Obviously those who have not been exercising need to take it easy to begin with and build up to this. But the idea that there is something people can do themselves about depressed mood is great news for those who want to recover from depression and need more hope in their lives (although it might depress the drug companies!).

Antidepressent Use in Sweden, an Increasing Trend

What makes this research so remarkable is that Sweden has one of the highest rates of antidepressant prescription. According to OECD statistics, Sweden has the 3rd highest consumption rate of antidepressants in Europe (after Iceland and Denmark). And antidepressant prescription is on the rise in Sweden. The National Board of Health and Welfare (Socialstyrelsen) has issued guidelines to try to cut the rise of prescribed depression medication and encourage the use of talk therapy. But these changes will take time because the culture around prescribing antidepressants needs to change. A survey of GP attitudes from 2004 indicated that most doctors considered drug treatment with antidepressants alone was effective and sufficient in most cases of depression. Less than half the doctors thought that psychotherapy was required as a complement. This is despite reliable evidence of the effectiveness of talk therapy against moderate depression and the combination of counselling with medication being considered best practice. There is also evidence that effectiveness of antidepressant use really depends on the therapeutic relationship between doctor and patient.

Relief for Anxiety and Depression through Exercising

As a doctor, Taube is concerned with biochemical explanations of how exercise actually works and the article in Dagens Nyheter explains some of this. For the layperson it’s enough to know that it does work. Therapists are familiar with the way depression often goes hand in hand with anxiety (I often describe them as hanging around together, like schoolyard bullies) so it’s no surprise that exercise appears to help relieve anxiety as well.

Taube, who has herself experienced depression, is a dancing enthusiast but explains that other exercise like taking a walk or spin class can give the mind a break from Anxious Thoughts. We know that mental health difficulties can generally lead to poor physical health not only because problems like anxiety and depression stop us from getting out and enjoying life, but because the drugs that are prescribed for them have a slowing down effect on those who take such drugs. So people who are taking medication because they are affected by anxiety, depression and other mental health problems often gain weight and suffer cardiovascular difficulties or musculoskeletal problems because they don’t move themselves as much. Of course it is important to still seek the help of health professionals, particularly if you are experiencing a severe depression or having thoughts of wanting to end your life. Talking together regularly with a doctor, counsellor, therapist or psychologist is a better alternative to just taking drugs on your own.

In 2012 I will be continuing Walking-Talk Therapy for those who want to have therapeutic and coaching conversations ‘on the go’. Going for a walk together through Rålambshovsparken, along Norr Mälarstrand or around Riddarfjärden is a great physical alternative to sitting down. Of course, if you prefer to talk inside, we can still meet over a tea or coffee in my private consulting room at Fridhemsplan. And for those who are outside of Stockholm or prefer more privacy, online counselling is always available over the internet.

Send me an email or call me on 08-559 22 636 and leave a message if you would like to make an appointment.

Jill Taube’s book “Själ och Kropp” is widely available from book retailers and online, but unfortunately only in Swedish at this stage.

December 11, 2011
Therapy for Winter Depression or Seasonal Affective Disorder (SAD) in Stockholm

Depression? Seasonal Affective Disorder? The cold and darkness of Sweden at the end of the year is one of the hardest issues for expats. For those of us from relatively warm countries (take note Aussies and South Africans) and others who have never lived this far north, the Swedish climate can be a real shock.

In Stockholm in December it is dark by early in the afternoon. I’ve talked to many expats who really struggle at this time of year. Some have even internalised the problem and have started to think they are depressed or have seasonal affective disorder (SAD). Actually, it is really normal and natural to have trouble with the Swedish winter even if you have been here a long time. I’ve gathered the advice of a range of expats and long term visitors to Sweden who I have met in my counselling work as a therapist. Here are their practical suggestions.

1. Get Active

It’s natural to not be as active at this time of year but it’s also good to still move your body. Too cold outside? Try training indoors. Friskis och Svettis offer lower cost fitness memberships that include classes for around 3000 crowns a year (even less if you are a student). That’s not even the cost of 1 glass of wine each week! And you don’t have to be particularly athletic to get something therapeutic out of a gym. Try a 30 minute brisk treadmill walk while listening to your favourite music on an iphone or mp3 player. Taking in the scenery of everyone else working out while you go at your own pace can make you feel alive again. Get a Jawbone and set a goal of 10,000 steps a day on your Jawbone. There are plenty of sports you can do in winter as well, like indoor volleyball and swimming. This is the time of year that hot saunas are really appreciated.

2. Rug Up

Feeling colder can make a difference to your mood so it is worth making the effort to be as warm and cosy as you can when you are walking around outside. We lose most of our body heat through our extremities so pull on a wooly hat that covers your ears (called a mössa in Swedish), gloves, warm footwear and a scarf. Have you discovered the advantages of long underwear yet? A decent winter coat is also helpful of course.

3. Go easy on the grog (and the glögg)

The end of the year is a time for celebration but keep in mind that alcohol is a depressant. Bottled spirits tend to lift our own spirits for a short time but the after effects can pull us down the next day or for several days after a few too many. Drinking more than usual will lead to swings in mood and, in the absence of other helpful strategies, some people develop a dependency on alcohol that can create real problems for them, their partners and families (and I am not referring to Systembolaget being closed on a Sunday). Other ways of picking yourself up include exercising regularly, spending time with friends, attending expat group events and…

4. Getting yourself into the light

Fortunately Stockholm is not completely dark in winter (some places in Sweden are). But the daylight doesn’t last for long. Make sure you make the most of the light and walk around in it during the day if you can. There is some evidence that even a few minutes a day direct daylight on exposed skin (i.e. your face) can make a difference to your physiology and mood. It costs nothing but your time (most of which involves putting on and taking off your warm clothes). Some people use wake up lights and special desk lamps that reproduce the tone of daylight to enlighten their winter days. For example, the Philips Wake-Up Light (available here from Amazon) has a number of settings to replicate sunrise and and even a selection of natural sounds.

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5. Make plans and look forward to them

Fellow expats agree there is nothing like a break for a week or two somewhere warm and sunny to change your perspective. Swedes know the advantages of travelling during the darker months and flock to the Canaries (no pun intended!), Egypt and even farther destinations like India, Thailand and Vietnam during December and January. Book your tickets early to get the cheap deals. If you don’t mind the snow, there are some great ski-fields within Sweden. Or you can jump on a party boat to Helsinki, Tallin or Riga. If you can’t afford the time or cost of getting away, make plans to do some exotic activities at home or treat yourself to some special meals. Apparently the restaurant Koh Phangan on Skånegatan makes you feel you are really in Thailand.

6. It’s okay to hibernate a little

Winter is a time of closing down in contrast to the expansiveness of summer. In many ways we have lost touch with the natural rhythms that we see in the animal world. So what if you want to sleep 10 hours instead of 8? That’s how it goes with the cold and darkness. You aren’t depressed and you don’t need medication just because you don’t feel like going out and want to stay in bed more than usual. Lower your Expectations and stop giving yourself a hard time. You can make up for it in the Spring. That brings me to…

7. Embracing the experience

If you can’t beat it, make the most of it. Not all the Swedes take off to sun and sand in wintertime yet they still manage to stay sane and get on with their lives. It might take some time to get the knack of it but those who emigrated to Sweden a number of years ago tell me that there is something to be said for embracing the climate at this time of year. They have taken up photography or cross-country skiing (even with the skis that use little wheels when there is no snow), planned Melodifestival parties, visited the Christmas markets, lit up their apartments with small candles, played and recorded music, painted, drawn, read and written books. The Swedes are a nation of creatives. Even if you just document what you are seeing or hearing around you and how you are feeling in a journal or blog you will be in the company of many who have gone before you in the great musical, literary and artistic traditions of Scandinavia.

8. Remember: It will pass!

From 22 December the nights are shorter and the days start to get longer. When the snow arrives, it can make a difference as well, reflecting daylight or streetlights and generally making everything a bit brighter. Many people do find January is the worst month for them simply because they have endured the darkness and low temperatures for so long. So even getting a sense of the length of winter can help and this often happens for expats once they have been in Sweden for a couple of cold seasons.

If being in Sweden has lost its purpose for you at this dark time of the year, maybe it is time for a meaning-recovering conversation over a hot cup of tea or coffee. Narrative therapy and other collaborative counselling practices can provide you with the opportunity to reconnect with your motivation and find a new lease of life to last through winter. If you want some practical help, together we can construct a plan or strategy to get you through to lighter times. Contact me through the website or call and leave a message on 08-559 22 636 if you would like to make an appointment.

Thanks to Elin, Steve, Evelyn, Barbara, Marie, Matthew, Janet, Paul and Rob for their contributions as well as to all my clients who have found or are finding their own ways of dealing with the darkness and cold.

December 1, 2011