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Talking about healthy relationships

My friend goes through many hook-ups and short-term relationships. She seems to really enjoy the attention and validation (as well as sex). However, some of these relationships have verged on being sexually abusive. She also doesn’t use condom on the account that her partners do not like them. Both of these have me worried for her health and wellbeing, but she denies the abusive element in the relationships and isn’t open to the idea of STD test. How should I start a constructive conversation with her about my worries?

It sounds like you’re really concerned about your friend. It’s understandable that you wouldn’t like to see your friend contract a sexually transmitted infection (STI), or experience an unplanned pregnancy – which are both possible when a person has unprotected sex. No one wants to see their friend get hurt, whether physically or emotionally.

Sex can be a tricky topic to talk about – even with friends we’ve known for a long time. Sometimes, bringing up this type of conversation can result in a friend getting defensive or shutting down. In many cases, this can be because they might be worried about being judged negatively, or that you’ll somehow think less of them.

It can be helpful to start the conversation by asking your friend how they are doing generally and how they are feeling about their relationships.

As the conversation unfolds, listen to your friend, and try your best to put any judgments or assumptions you might have on hold. While it can be unsettling to think of the potential risks involved in her situation, ask her how she feels about it. Some helpful questions could be:

• What does she like or enjoy about her relationships and sex life?
• Is there anything she doesn’t like about it? Does she have any concerns her situation?
• Have there been any times that she has felt uncomfortable, threatened, scared, or unsafe?

Before you start sharing your concerns, ask for permission. Your friend may not want to talk about it and that’s her decision. Tell your friend you’re not trying to lecture or control her – you just really care about her health and safety. It can be helpful to express your concerns based on what you have observed, rather than any assumptions you might have about your friend’s behaviour or feelings. For example, “I’ve noticed you’ve had a few relationships recently, I’m a little concerned if you’re doing OK, can we talk about it a bit?”

Be ready to offer support. If your friend shares your concerns, you could offer to talk more about what her reasons are for navigating her relationships this way. If there are concerns about her physical or emotional wellbeing, you could encourage her to talk about her sexual health with a health professional, or speak to a counsellor. It can help to talk through what’s involved in getting a sexual health check. You can even go with your friend if she’d like some support. The Melbourne Sexual Health Centre is another great resource.

If your friend doesn’t share your concerns, let her know that you appreciate the chance to talk openly and are still her friend, even if you have different viewpoints. Maybe you can leave it with letting her know that there are some great online resources to draw on if she ever feels unsure or confused about whether what’s happening in her relationships is ok. If she is ever worried about unhealthy, abusive, or violent behaviour in her relationships, she can also contact 1800Respect on 1800 737 732 or through online chat.

At the end of the day, you can’t make your friend do anything – having or not having sex is a personal choice, and ultimately, she will be the one to decide if she wants to make any changes. It can also be important to bear in mind that people have casual sex for different reasons – whilst for some, it can be associated with depression or low self-esteem; for others, it can be empowering, or for pleasure.
Of course, if you ever feel that your friend is at risk of immediate harm from someone, it’s important not to keep it a secret and get urgent help.

Your friend may make decisions that you don’t agree with, or behave in a way that may not align with your own beliefs or values. Try and remember that open communication is important so that she knows she can come to you for support if she needs it further down the track. As her friend, you can remind her that you are there to be supportive, not to judge her for her sexual behaviour.

No matter what she decides, acknowledge your courage to speak up – she is fortunate to have a caring friend who is looking out for her.

Feeling negatively

I’ve been feeling empty most of the time for about 2 months. I’m disconnected from any of my friends. I feel useless and myself being disgusting as I have no living difficulties at all. I do try to perform to be normal in front of everyone and I can be ok in front of them, but I just suddenly start crying when I leave for the washroom. Now I am completely disconnected socially, spending time alone most of the time. I don’t want to get up in the day and afraid and anxious about falling asleep. I can eat nothing for the whole day or eat till disgusted. Am I just too lazy and weak or am I sick?

Thank you for asking this question as many others students would have experienced similar situations during their degree. I am sorry to hear changes over the past 2 months are having such an impact on your daily life. When changes like these persist over time, it may be a warning sign that something is out of balance for you and needs to be addressed. Being aware of these signs and reaching out for advice are two important steps, so good on you for taking them.

There are many things that can lead to feelings of emptiness or disconnection. Students sometimes feel like they have lost interest in their study, like nothing is exciting anymore, or that they have lost sight of meaning or purpose in things that are usually important to them.  Sometimes this can be related to specific events, such as changes in relationships with family or friends, or due to increased stress, such as through the changing demands of work or study.  At other times, people can experience changes to mood, motivation or connection with others without being able to identify a clear trigger or reason. All this can lead to lowered mood and impact daily functioning like concentration on studies, sleep or eating patterns.

It is possible that the changes you describe could be symptoms of depression. However, it is not appropriate for a psychologist or doctor to provide a diagnosis without a proper assessment and I would encourage you to consider seeking professional help so that you can get some clear answers about what might be going on.

When we experience depressed or anxious mood, our reaction is sometimes to avoid things (e.g. withdraw, procrastinate…) because we think we won’t have the required energy, or we are worried about what could happen. This can be an attempt to deal with what is difficult in the moment but as you may have experienced, in the medium to long term, it doesn’t help us to feel better. When we are unsure of what is happening to us it can be common to make moral judgements about our behaviour (e.g. lazy, wrong, stupid…). However, this may lead to more negative thoughts about ourselves and leaves us feeling even worse. This vicious cycle may then lead to further symptoms of depression, which can impact many areas of our lives like our relationships, sleep or appetite

The good news is these changes don’t have to be permanent and counsellors at CAPS can support you in finding ways to improve the situation. Further exploration and discussion with a counsellor could help you understand what is going on, why you have the reactions you have observed and to find better coping strategies. If you don’t want to speak with a counsellor you may find it helpful to take a look at some of the self-help resources or workshops that are offered by Counselling and Psychological Services. There is also online support available via services such as eheadspace. Another option is to see a GP at the Health Service who can assess your eligibility for a Mental Health Treatment Plan which allows Medicare rebates for accessing private practitioners (e.g., psychologists, social workers).

Racism

I hate going on trains. I’m an Indian and people always stare at me. Sometimes they get up and change seats if I sit near them. I really feel bad and it ruins the rest of my day.

Firstly, thank you for raising your concerns in regards to this matter, feeling discriminated against is something that many people feel, yet often do not talk about.  So, it is great that you have spoken up on this. Unfortunately, overt and hidden racism can be a part of the fabric of any multicultural society. While it is beyond my role and expertise to address the broader social issue of how racism can be addressed in Australian society, I will try to offer a few suggestions about how you may be able to cope with the difficult emotions that come up for you when you feel discriminated against. I want to emphasise that this does not mean that feeling discriminated against is something that is your sole responsibility to manage or just “put up with”. For instance, if you have experienced or witnessed any incidences of racism, I would like to encourage you to report this to your local police or to the Victorian Equal Opportunity and Human Rights Commission. If you experience or witness incidences of racism on campus then you can report this to the Safer Community Program on campus. The University of Melbourne has a zero- tolerance policy on racism.

 

But back to coping strategies you could implement:

  • Acknowledge the feelings that you experience in these moments, but try not dwell on them for long periods of time. Talk to your family or other like-minded students about your experience, or express yourself in a journal. You could also practice meditation or relaxation exercises on a regular basis.
  • Attempt to distract yourself by focusing on music or reading so as not to get into a loop of a self-fulfilling prophecy, for example: expecting to see acts of racism and therefore spending a lot of time looking around to see if anyone is acting in a discriminatory manner.
  • Try to be pro-active in your social life by reaching out to people from other cultures and to local Australians (also from diverse cultural backgrounds!) by joining extra-curricular activities according to your interests or work. The university offers a range of clubs and societies that may offer you a good opportunity to do this. Surrounding yourself with people of diverse backgrounds that you feel safe with may help you to feel more connected to others and remind you that not everyone holds racist views.

If you would like to explore this further, or if you find this all too hard to implement by yourself, feel welcome to talk to one of our counsellors at Counselling and Psychological Services.

Competitive friends

It just hit me that I have not smiled or laughed in weeks. I am not exactly unhappy because I am thankful for everything I am given. But instead I definitely do not feel happy. I have a really competitive friend that I spend a lot of time with, as I live alone, and it makes me worried whenever I tell her things for I am afraid she would judge me and use it against me. As a result I have been distancing myself with this person and I am left alone most of the time. Making friends is hard when we are half way through the semester and since I don’t have my family with me I feel very alone.

 

Thank-you for reaching out to Ask Counselling. It very much sounds as though you are struggling with loneliness, which has been described as the experience of negative feelings when there is a mismatch between the quality of our perceived relationships, and those we wish to have. We’ve all felt lonely at some time, and it is very common among university students, both international and local. It can be especially hard when, like yourself, students are far away from their usual support networks.

Research studies have focused on four main strategies for helping to reduce loneliness. These include improving social skills and social support, expanding opportunities for social interaction, and challenging unhelpful beliefs about social interactions.

In terms of your own situation, there may be opportunities you could explore to make new connections with others. Sometimes this means overcoming initial anxiety about interacting with new people. You might need to practice introducing yourself or making small talk to feel more comfortable initiating conversation with others. Some examples include starting a conversation with a classmate, going along to an interest group, volunteering or getting involved in a university club or society. Each semester, Counselling and Psychological Services run a number of workshops, often on creating social connections.

It may be that there are existing friendships that you could foster or improve. It sounds as though you were worried about being judged, and this caused you to pull back from a previous source of support. The assumptions we make about others can have a powerful influence on our behaviour. I wonder if you think it is worth talking through your concerns about being judged with your friend? Although it might initially feel uncomfortable to discuss relationship issues directly and assertively, you could also see it as an opportunity to potentially improve the quality of the friendship. Some specific strategies for assertive communication can be found here.

Meaningful, mutually respectful relationships can take time to develop. If you have tried a few things and don’t feel as though your mood is improving, you might like to talk things through in more detail with one of the professionals at Counselling and Psychological Services.

Detached

Hey, I’ve been feeling very disconnected with everything recently. I don’t feel sad or angry, but I just feel empty? Detached? Frankly, this is affecting my study quite a lot. I have no sense of urgency. I don’t feel panicked when deadlines for my assignments are coming. Last semester, I submitted all my assignments late. Everyday I feel like getting up is a chore, but not to the point that it completely hinders my overall functioning. I can’t distinguish if this is only my laziness or it’s really something serious? I don’t know if my situation warrants enough reason to seek professional help.

Awareness is the first step to address problems. So good call to connect with us! Your question actually highlights a very important issue for people wondering whether or not they should seek professional help. It is useful to remember that people seek professional help for a variety of issues of varying severity, all of which are equally valid concerns.

The changes you are describing may be warning signs of a mental health problem, even if you are not experiencing symptoms (e.g. persistent depressed mood) that are commonly seen as a reason to seek professional help. Equally, they may not be a sign of any underlying problem at all. It is hard without further exploration to identify what could be at the bottom of this change. Many of us from time to time will experience periods of reduced productivity. For some, this may be related to life stress or loss of motivation. For others, a loss of interest in things that are important to them can be a symptom of emerging depression or another mental illness.

What stands out to me is that you have identified a change in the way you feel that has had a big impact on your ability to function academically. This in itself is certainly reason enough to book a session with one of our counsellors. We are a low-threshold service for exactly that purpose: to identify what could be going on, and to find out if there are mental health concerns, or if there is something else that should be addressed.

An appointment (or more if required) where you can talk frankly in an open-minded atmosphere might just help you to figure out what is going on and what steps you can take to address this before things get out of control. There is no particular criteria you have to meet to access professional support, in fact, most of the time it is better to seek help before things get too severe.

To connect with us you can book an appointment here. You may also find it helpful to take a look at some of the self-help resources or workshops that are offered by Counselling and Psychological Services. In addition, an appointment with your GP may be a good first point of contact. They can work with you to review any physical health issues and discuss other referral options for with you.

Body symptoms of stress

I’ve been seeking psychological help for depression and anxiety and while this therapy has helped I can’t kick the physical toll stress takes on my body. When I’m stressed my skin crawls with dermatitis and acne and makes me hot and itchy, regardless of the prescription cream I use and my digestive system goes into pendulum mode swinging from constipation to diarrhoea at the drop of a hat. My doctor says I need to work on managing my stress levels through the therapy. But when I’m sitting at my desk I can’t escape my anxious mind, and my dysfunctional body.

Thank-you for your question and sharing your experiences,

I encourage you to continue working with the psychologist you are seeing, as you have indicated that this has been helpful. It may be important to raise with your therapist the physical symptoms you are experiencing and to discuss whether any of the strategies suggested below could be practiced in your sessions together.

Excess stress can certainly manifest in a variety of emotional, behavioural and physical (somatic) symptoms. Common somatic symptoms can include: tiredness, headaches, muscular tension and pain, changes in sleep/eating patterns, and as you have mentioned – digestion and skin issues. Symptoms of pre-existing medical conditions can also become worse when we are stressed.

Stress can differ significantly from one person to another, both in how it affects us, and in how we respond to it.

At times, people can engage in unhealthy behaviours as a way of coping with stress. Such behaviours may include: over-consumption of alcohol, cigarette smoking, misuse of prescription drugs, illicit drug use, unhealthy diet, or over-committing to events and deadlines. Whilst these behaviours may provide some brief temporary relief, these unhealthy behaviours tend to make stress symptoms worse in the longer term.

Stress is common in daily life and is part of being human. In fact, we need a certain amount of stress to feel motivated and energised to do the things that are important to us. If it is prolonged, or at extreme levels however, it can have a significant impact on our mental and physical health. Thankfully there are simple steps we can take to help manage our stress levels:

  • Make time for regular exercise (small changes can have a big impact)
  • Schedule in time for enjoyable activities and socialising with people that make us feel good about ourselves
  • Avoid long studying or working hours
  • Not over-committing to things – trying to get a healthy balance between work/study and things you enjoy doing
  • Taking time out to relax
  • Breathing and mindfulness exercises
  • Getting enough sleep – this will vary from person to person but aim for 8 hours per night
  • Addressing the causes of our stress in a constructive way such as problem-solving and tackling challenges directly rather than avoiding difficult tasks.

The way that we think about situations can also impact on how much stress we experience – if we can view stressful situations as challenges that we can rise to, rather than as a threat or something to fear, this in itself can reduce the negative impact of stress on our body and mind.

Where we focus our attention can also impact the amount of stress symptoms we experience – for example if we are preoccupied with physical symptoms of stress this can make us feel worse. It can be more helpful to try to focus our attention and energy on engaging in helpful stress management techniques such as those listed above.

See further information for managing stress on the Counselling and Psychological Services website.

Bad break-up

I just had a really really bad break-up. It’s not really because we broke up. It’s because of a handful of other factors. I cannot concentrate on anything. It’s affecting every part of me. There is additional financial stress from different angles. Now I’m thinking it is a mistake coming to Unimelb. I feel like I have lost so much and I cannot concentrate or do anything. Please help.

I’m sorry to hear about your break-up. Break-ups can be devastating and it is normal to experience a range of emotions following a break-up including: grief, sadness, anger, fear, loneliness and guilt. For some people it can be hard to stop thinking about their ex or the break-up and they may experience difficulty concentrating, reduced motivation and other changes to sleep or appetite. Depending on the circumstances, it can be especially hard to accept a break-up when there are still strong feelings of attachment or love. This resource from headspace has some helpful information on dealing with relationship break-ups.

In addition to the break-up it sounds like you were already under stress because of financial issues amongst other factors in your life. The university has services to assist students who are experiencing financial difficulties. It might be worth getting in touch with Financial Aid to see if they can help you at this time. In times of stress, our brains can revert to focus on information relevant to survival, which takes power away from our rational mind. This can affect our concentration, motivation and ability to do things such as study or work. When we experience cumulative stressors it can be pretty common to feel distressed and to have difficulty coping for a period of time.

When we feel overwhelmed it can help to do the basics and show ourselves some kindness, physically and emotionally. Maintaining diet, exercise and connections with others are all still important, yet we can easily neglect them in times of emotional distress. See here for more suggestions on how to manage stress. As people often engage in self-critical thinking during and after break-ups, it can be a compassionate step to lower expectations of yourself for a little while and reduce pressure. It may help to spend time with supportive and caring others. The relationship sounds like it was important to you – give yourself some time to grieve this significant change in your life. If your difficulties continue, professional help is available. Don’t hesitate to get in touch with us at CAPS.

Managing psychological disorders

I live with severe depression and borderline personality disorder (the former is being treated). Being new as a MA it has been very challenging to manage my study, work, Centrelink and the constant symptoms of my illness. I often have low energy, feel overwhelmed and cope in destructive ways. BPD is very hard to talk about because it is still highly stigmatised, despite there being hundreds of ways you can experience the disorder. How do I go about discussing a stigmatised disorder on campus? At the moment I’ve managed to apply for extensions when I need it, but it also affects my (part time) contact hours.

Thank-you for your question, and sharing your difficulties. I agree with your observation of borderline personality disorder (BPD) still being a stigmatised mental health issue that can be misunderstood. It is understandable that the symptoms you describe may affect your study at the moment. Embarking on a postgraduate degree is also a challenging task in itself.
In regards to your question about how to go about discussing BPD on campus, I imagine that your approach might depend on who you are talking to and the reasons for discussing it. For example, talking to a friend, compared to a GP or counsellor, or to teaching staff in your course. It is difficult to offer specific advice around this without knowing your particular circumstances but there are some helpful resources available online to help others understand BPD such as this fact-sheet from Orygen Youth Health or the Spectrum website. These may be useful when discussing BPD with others.

I am wondering what kind of treatment you are undergoing to address your symptoms of depression and whether you are receiving psychological or psychiatric treatment. If so, I’d encourage you to bring up your concerns with your psychologist or psychiatrist who may be able to support you in making a plan. If you are not currently receiving psychological therapy it may be something to consider, as there are specific psychological treatments for BPD that can be effective in overcoming destructive coping patterns and managing your mood and stress. If you don’t have an existing psychologist you are welcome to book an appointment with a counsellor at the Counselling and Psychologist Services who could discuss these options with you and assist in finding a suitable referral option for you if this is something you would like to pursue.

It sounds like you are taking proactive steps to improve your mental health by seeking treatment and also applying for extensions when you need it. I am wondering if you are aware of the option of registering for ongoing support from the Student Equity and Disability Support service (SEDS). This is for students whose study is impacted by their health or life circumstances in an ongoing way. You can read more about this and the eligibility criteria from the SEDS website.

Stress and how to seek help

I often find myself overwhelmed with stress and that I worry excessively about things. I try to manage and plan my time well so that I don’t stress about deadlines however I still find myself feeling overwhelmed often to the point of feeling ill. I want to seek help and talk to someone about this but I’m not sure how to go about starting a conversation about this and I find myself nervous about talking about this.

It sounds like you’re experiencing something that is quite common for anyone who faces deadlines, that being stress and anxiety. Whenever we face something that is considered final, such as a deadline, loss, a breakup, then the human brain can struggle to reconcile this and it results in stress. When we can foresee something like this coming, then we often become anxious about this pending threat or problem. This is actually a biological process and can have a number of effects on the body, including feeling physical ill, poor concentration, or memory issues.

You mention that you’re not sure how to go about starting a conversation about this, well, the good news is that you already have! If you want to take the next step then I would suggest either booking an appointment with us here at CAPS, or maybe seeking some online support via services such as eheadspace. We have further information on our website, and run various workshops throughout semester that may be helpful. You could also see your GP to talk about other referral options. That nervousness you experience when you talk about this, well it tends to subside the more you get use to talking about it. Anxiety is a very common problem, and it is also one of the most treatable problems people face, as long as you can rally yourself to take the necessary steps.

Coping with anxiety about physical health

Last week, I found out that I have big lump on my neck. I went to the GP last week to consult. However, the GP was unable to determine what’s wrong with me and asked me to do some tests.

While waiting for the result of my tests and the next consultation with the GP, I have found that I am unable to concentrate, especially to do the mounting assignments because I’m worried that the lump on my neck is something dangerous. I have a mild anxiety problem, and this anxiety causes me to think about the worst scenario that will happen.

I try not to think about it too much, but I can’t. What should I do?

Thank you for your question. It sounds like a time of uncertainty for you, and the anxiety or concern that you are having about the lump is an understandable and normal reaction. Sometimes when people are already feeling anxious (e.g. about health concerns) additional stress, such as your university assignments, can increase anxiety and also affect concentration. As you have noted, your concentration is affected because you try not to think about the lump, which makes you think about the lump. Often, that is the paradox of trying not to think of something – it makes you think about it. In some ways, thinking about the possible scenarios or worst scenarios can be seen as functional during that time, as it is often seen as preparing oneself for the uncertain future. However, once that starts affecting your ability to do what you need to do on a daily basis, it can become problematic.

Sometimes, practicing mindfulness (try some of our guided exercises here) can help us be aware of where our attention is directed, so we can redirect it back to the task at hand. This could be useful for you when you are completing assignments and you find yourself worrying about the lump. With the practice of mindfulness, you’ll hopefully find it easier to redirect your attention back to your assignment.

It may also be useful to schedule some “worry time”. This involves setting aside 10-15 minutes during the day (preferably not close to bed time) to allow yourself to worry. When you find yourself worrying, remind yourself you will have time to think about it later, write down a short note about this worry (only a couple of words) in a notebook and turn your focus back to the task at hand. Here is a fact sheet and an app to help you practice.

This chapter from Centre for Clinical Interventions offers a good summary of these strategies and provides activity sheets to help containing your preoccupations about health.

While you are waiting for the results and feel anxious, you may also need to adjust your study strategies to your current level of concentration. Don’t hesitate to divide your work in smaller blocks of study, set a time for each task, alternate between tasks demanding different levels of concentration and use active learning strategies to keep you more engaged. Academic Skills have good resources to help you plan essay writing and revision.

Remember that this period of uncertainty and anxiety will not last forever. As you have mentioned, you will be seeing your GP to confirm the results and this could be something to remind yourself when you start to worry about possible outcomes. If you are finding that the anxiety is becoming worse or less manageable, you can also talk to one of our counsellors. I hope you find this information helpful, and I wish you all the best.

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