By WENDY ANDERSEN

WE may have left everything behind for a life in the sun, but even Andalucia can have its  downside – especially in these mid-COVID post-Brexit times.

Not knowing when we will be able to travel makes family feel even further away.  Perhaps you have lost someone this year but have had to grieve alone.  Is the rapid return to restriction-free living making you feel anxious?  Has the stress of being stuck in together put a strain on your relationship?   There are a  number of studies looking at depression as a long term effect of Covid – with up to 29% of people who had Covid being affected.

Of course it is a normal part of life to suffer from sadness or grief from time to time, which may leave us wondering if what we’re feeling is normal or something more serious.   For 15% of the population it is more than just something you can shake off.  The leading cause of people taking time off work, across the globe, is depression.  The world was shocked when actor Robin Williams took his own life in 2014 – but every year one million people commit suicide. 

There are signs to watch out for in yourself or those you care about. A good rule of thumb if you’re unsure:  is what you are suffering stopping you from living the life you want to live? If yes, then help is out there, even here in Spain for non Spanish speakers. 

Depression

Firstly:  If you are suicidal, you can go directly to urgencias.  You will be able to talk to a psychiatrist to help you get through the crisis.

There is also a suicide hotline in Spain: 902500002 and the Samaritans 902 883 535 

For non-emergency situations, you can make an appointment with your GP (médico de cabecera).  With the help of a friend or Google translate, you can explain the basics of what you are feeling and, if you choose to, request a course of anti-depressants or anti-anxiety medication.  Most GPs are very sympathetic and helpful.  You should start to notice the difference within a couple of weeks.  If you do not notice a difference, remember that there are many types of antidepressants on the market, each with an efficacy of about 60%. This means that for nearly half of the population the first prescription will not work.  In which case you will need to go back to the doctor after 6 weeks (the length of time for the tablets to take full effect) and request a different type.  It is not unusual to have to try 2-3 types before you get the one that suits your chemistry.  Do not give up if the first ones have no impact.

The pharmaceutical solution is a good starting point, but it is not a permanent solution – it lasts while you are taking the medicines (and for some they can kick start a complete recovery) but it is common to have a relapse once you stop taking the tablets if you do not address the issues that caused the depression/anxiety in the first place.  I often tell clients it is a bit like liposuction – it will provide immediate help, but if you don’t change your lifestyle you will be back where you started before long.  Thus the ideal is a combination:  use the medication to give you a window for making changes – and therapy to ensure that the changes you make will have the biggest impact. 

Unfortunately, long term psychodynamic counselling with a native English speaker is not an option with the Sistema Sanitario, the public health service, in most areas. And unlike a broken leg, where you can trust any doctor to work it out and put a cast on the affected limb, the subtleties of discussing emotional issues requires complete understanding between patient and doctor. 

There are private options available – a quick Google search will provide a list of English speaking psychologists in the bigger cities.   Expect to pay €65 /hour for a therapist or €75/hour  for a psychiatrist (who can also write prescriptions).  These are covered with some medical insurance plans – you will need to get in touch with your insurance provider for details.

If heading to the city is not convenient, another option is tele-therapy or web-therapy.  This option offers lots of convenience:  you can do it from home, in English, at a time that suits you.  It may be harder to form a good relationship with a therapist that you do not meet in person – but as with any therapy, you may need to try a few before you find one that clicks.   A couple of things to be careful of – do your research.  Always verify the therapist’s identity – ask to see their passport photo.  Check that the therapist is licensed – this includes contacting the accrediting body and checking that the therapist is indeed registered with them (and that that body is a reputable one such as the BACP – the British Association of Counselling and Psychotherapy).  Also check for confidentiality and privacy rights.   

Critics of Online therapy, the ones available on the big platforms you see advertised on Facebook, warn that the platforms take the lion’s share of the fee.  This means you tend to get inexperienced therapists with little supervision.  You might find a private therapist that works online provides a better service and is less expensive than the big platforms.

Tech options also include apps for your smartphone. They’re a nice idea, but unfortunately not advanced enough yet to be of use.  I looked through a few of the options and quickly realised they are based on a set-script with little room for individual insight.  

An economical alternative to one-to-one therapy is support groups.  In the Malaga/Gibraltar area there are English speaking support groups for substance misuse (Alcoholics Anonymous and Narcotics Anonymous) and impulse control groups (Gamblers Anonymous, Sex addiction, and food related disorders such as anorexia, bulimia or overeating).   

You will also need to consider which type of therapy you want to try.  There are a vast number of therapies available – so it’s worth doing a bit of googling to know which is right for you.  In a nutshell, there are two broad types to chose from:  psychoanalytic therapy – which is a long term treatment looking at the causes of your issues; and Cognitive Behavioural Therapy (CBT) – which looks at what maintains your current problems (usually 10-15 sessions depending on the presenting problem).  CBT is quite a wide umbrella, with many subsets, such as mindfulness and couples therapy.  In all, about 75% of UK based therapists are CBT therapists, with another 10% focusing on Cognitive therapy and 10% Behavioural. 

Keep  in mind, the process of therapy can be uncomfortable at times – facing the things you may have been trying to ignore for a long time.  A good therapist will make that process a lot easier, and more likely that you see it through. 

Wendy Andersen [Ph.D. MPCBT (AAC)]  is a CBT therapist specialising in ex-pats living in Spain.  More information is available on www.cadiz-therapy.com   Appointments are available face-to-face or online.   

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