Relationships are hard, whether with yourself, friends or significant others. eniGma’s Omnia Zaied talks to psychotherapist Carine Karnouk on how to take care of your mental health to maintain good relations with yourself and others.

Carine Karnouk has Master’s degrees in Counselling Psychology and Community Psychology from the American University in Cairo. This dual study has allowed her to develop expertise in counseling with a focus on broader community interventions. She is currently working on her PhD at Charité Berlin and taking part in a nationwide German research project focused on providing culturally sensitive mental health care services to Arab refugees in Europe, while still offering online counselling for her clients at Nūn Center in Zamalek, where she has been practicing since 2015.

Karnouk took some time off her busy schedule to answer some questions for our readers…

What are the signs that a person needs to see a therapist? And do you think the stigma about being in therapy is slowly disappearing?

Some factors seem to be necessary in seeking help. For example, a person must acknowledge that he/she is in pain and facing a difficult situation and it is affecting the person’s social, occupational and/or familial functioning; thus, the pain that the person is experiencing must be greater than the perceived barriers to seeking help.

What may seem like a big deal to someone, may be a small bump on the road to someone else. Individuals experience different barriers to therapy, such as, shame/guilt with regard to seeking professional help, financial barriers, cultural stigma, fears about exploring problems more deeply, or concerns of feeling exposed or judged. These are all reasonable fears and unfortunately they get in the way of seeking the proper care and treatment needed.

I can’t go as far as saying that the stigma is “disappearing”, but I can say that things are improving steadily. One of the reasons for the stigma is a misunderstanding of what psychotherapy is. People still struggle in differentiating between what we do and what psychiatrists do. With enough exposure to ‘psychotherapy’ and how it can help, through mediums, such as this article, individuals can gain a greater understanding of how psychotherapy works, how it can help, and thus reduce the barriers to treatment.

From your experience, what is the most common mistake we tend to do towards ourselves?

Well, this question is an example of such a mistake. We often focus on terms such as ‘mistakes, deficits, setbacks, regrets, etc…’ While ‘identifying mistakes’ helps us improve and change, by focusing on what we are doing wrong, we continuously get stuck in a vicious cycle – a negative view of ourselves that discourages us from believing that we can become resilient, thrive and overcome any challenges that come our way.

When we accept ‘failures’ and ‘mistakes’ as a part of learning any skill and a realistic component of any process, they suddenly become less damaging. Think of anything you’ve learned to do during the course of your lifetime. Think of the simplest thing, such as reading or writing. As a five-year old, did you start off where you are now? Surely not. Just like everything else, it is a process.

I’ve always believed in the power of phrasing things differently. When we get stuck in thoughts, such as “I am a failure” or “I am not good enough,” we are basically informing our minds that we should stop trying, because we’ve already concluded that we can’t get any better.  Imagine what it would be like to phrase things differently, such as “I might not be doing well at this right now, so maybe I can try a different approach.” If we face adversity by experiencing it as a challenge and an opportunity for growth, then this can promote thriving and nurture positive experiences and well-being.

How important is it for people to really “love themselves”?

Popular wisdom says that having a healthy relationship with oneself, coupled with a positive view of our thoughts, feelings and behaviour, is a prerequisite to loving others. People with negative self-views are often drawn to those who see them as they see themselves, in a negative light.  And that is where the danger stems.

The terms ‘self-love’ and ‘self-esteem’ are often used interchangeably, which is not an accurate depiction of their underlying meanings. One of my favourite definitions of ‘self-love’ is, “finding peace within ourselves – resting comfortably within the depths of our being.” We might find a temporary respite by doing something to nurture ourselves. But a deeper inner peace requires cultivating a certain way of being with ourselves – “a warm and nurturing attitude towards what we experience inside.”

For some individuals, taking a warm bath or getting a manicure constitutes an act of self-love. For others, loving themselves stems from helping others.  In contrast, self-esteem is defined as “confidence in our ability to think and to cope with the challenges of life. Confidence in our right to be happy, the feeling of being worthy, deserving, entitled to assert our needs and wants and to enjoy the fruits of our efforts.” Social scientists have clearly linked self-esteem to life satisfaction. I think that self-love is one of the prerequisites of having high self-esteem. But, remember that too much self-love or self-esteem can move towards narcissism, which involves self-centeredness and inflated self-views. In relationships, people with narcissistic traits often choose partners who enhance their self-image. Thus, what may seem to be love and admiration, may actually be exploitation and abuse.

To make matters simple, being gentle with yourself and with others can often lead to a healthy relationship with yourself, and in return with others. I personally prefer the term ‘self-acceptance’ over ‘self-love’, that is, viewing yourself as a good person who is worthy of love without needing to prove anything to others. This results in less reassurance-seeking behaviour or excessive criticism within the person and also has a more positive effect in relationships.

In your opinion, what is the basis of a healthy relationship with a significant other?

I believe that a basis for any healthy relationship is unconditional positive regard, warmth, understanding, non-judgment, mutual respect, honesty, genuineness, fairness, good communication, support, encouragement and mutual enjoyment.

Do you think there is a difference in the way women and men deal with relationships?

Men and women have different communication styles and roles in relationships. These styles and gender roles are embedded within the culture in which a person grew up. Some societies have clear cut traditional gender roles that are ascribed in their relationships, such as in this part of the world. Whereas in the west, there are less rigid gender roles and expectations in relationships. Within the Arab culture, women are expected to take on a more nurturing role. They are encouraged to be more involved in acts of emotional expression, and caregiving, whereas men are expected to have more ‘real’ pressure on them, such as being the breadwinner and are in charge of legal matters etc…

I think that regarding relationships, there is no right or wrong way of doing things. It just simply depends on the couple, their experiences and their expectations of one another. As long as there is communication about these things, then things should go smoothly. It is only when there is resistance to a certain role that a storm may ensue.

What are the most common mistakes people do when they start relationships and how can we avoid them?

Instead of focusing on bad practices, I’d like to focus on the good practices of being in a healthy and fulfilling relationship. A healthy and functional intimate relationship is based on equality and respect, and NOT power and control. I like to use the term ‘partnership’ to describe this. In a partnership, both parties have equal rights in their views, likes, dislikes and choices. Some of the characteristics of a partnership are honesty and accountability, open communication, empathy, listening, negotiation, compromises, economic partnership, shared responsibility, shared power, trust, support, intimacy, physical affection and respecting each other’s personal integrity.

One of the most common mistakes is ‘withholding love and affection.’ I believe it is realistic to say that we have all done this at some point in our lives. Although it may seem like the right thing to do in a given moment or situation, when it becomes a pattern, it can often do much more harm than good.  The most common form of this is known as the ‘silent treatment’ which is when “coldness replaces warmth, silence replaces conversation, and dismissiveness replaces receptivity”. Although it comes from a vulnerable place, withholding is typically motivated by two goals- to punish the other person, or to maintain the upper hand: power and control.

What is the right way for people to end a long-term relationship?

I do not think that there is a right time or right way to end any type of relationship. In fact, I often find myself in situations with clients where they are delaying a break-up and waiting for the right time do it. I find myself having to remind them that there is almost never a right time to end anything. The reality is that break-ups are hard.

I think you have to realise that there is no way to avoid the stress or the emotional burden that comes with a break-up.  In my view, being genuine, gentle and thoughtful in how you communicate the break up, is an important aspect. Of course, it is very easy to break up with someone via a text message, a phone call or an email, but how do you imagine the other person will feel?

Remember the importance of respect, trust and open communication. It is not easy to confront someone with bad news; but how you do it does signify a level of respect and appreciation for their self-worth. Instead of focusing on what your partner did wrong in the relationship, you can communicate how you feel and your role in the relationship. Also, if you avoid sharing certain reasons with them, you will be indirectly withholding information that might be useful for your partner’s growth in future relationships. To sum up, I would say that open communication, along with genuineness and support, will almost always lead you in the right direction.

What do you tell people going through break-ups?

There is no right thing to tell someone who is going through a break-up. Think of yourself in moments when you sought support because of a break-up, has anyone ever told you anything that has made the pain go away? Surely not. You might find comfort in being heard non-judgmentally and empathically, but I think that is all a friend or a therapist can do. Very often, the individual who is going through a break-up just wants to keep revisiting certain realities and retrace where everything went wrong. We often underestimate the power of asking someone a simple question like “how can I help you move past this?” You would be surprised as to how clear and concise people will respond to your question, and that will help you give them exactly what they need.

What can people do to get over a break-up?

I’ve often noticed that clients rely heavily on sources of ‘social support’ when dealing with a break-up. Talking about unpleasant feelings and expressing sadness or anger can help a person move past them. Exercise can also help trigger happy neurotransmitters and can thus boost your mood. Yoga can also help ground you and teach you ways in which you can listen to your breath and body. Also, calm your mind when there are moments when you are ruminating about the relationship or what went wrong. Practicing gratitude by reminding yourself of the positive things you still have in your life, and being grateful for some things, can also contribute to a more positive headspace. The same goes for engaging in activities which make you happy, such as hobbies. But in addition to all of this, always remind yourself that ‘time is the healer of all wounds.’

Do you think being in a relationship with a significant other is key to happiness or can one be happy without really being in a relationship?

Happiness is generally defined as experiencing “frequent positive emotions, such as joy, interest and pride and infrequent (though not absent) negative emotions such as sadness, anxiety and anger.” So, can someone be happy without an involvement in a romantic relationship? I would say, YES! Each person has their own way of defining happiness, and so with my clients, I often create a list of things that make them happy. Interestingly enough, one of the top answers that come out in my practice is that fulfilling relationships have a direct link to our perception of what it is to be happy.

A study by a group of Harvard researchers found strong and fulfilling relationships to be among the strongest predictors of life satisfaction. Having someone to rely on, trust and connect with nonjudgmentally can help relax the nervous system, and thus reduce both emotional and physical pain, which will result in your brain staying healthy longer.  Fulfilling relationships do not have to be romantic ones. They can also be experienced through family members, friendships, community members, pets or even colleagues.

Do you believe some people are just ‘not-lovable’?

Definitely not.