BLOG

by: Dian

Have you watched the movie The Father (https://www.imdb.com/title/tt10272386/)?

The movie depicts the reality of someone living with dementia, illustrated from the perspective of the sufferer. It is a rare opportunity to enter the world of someone whose fabric of reality has been wrecked and afflicted by the condition.

Thanks to the award-winning acting by its cast (Sir Anthony Hopkins was amazing!), the movie pulls us in, often in an uncomfortable manner, and forces us to relinquish our cognitive power and lean on our emotions to truly journey with the story instead.

The scenes illustrate the typical confusing, blurry, and disturbing reality lived in by dementia patients as The Father starts mixing people up, timeline, places, and events. Many caregivers of people with dementia in real life struggle with acceptance of the condition of their loved one, and often label them as simply being “difficult”. However, what we need to realize and remember is that our loved ones are not intentionally being difficult, but they are having difficult times themselves.

Related to my previous blog entry about person-centred caregiving (https://www.elephant.com.sg/blog.php#8Apr21 ), the movie highlights that the importance of staying in the present moment, and being attuned to emotions and needs (ours and our loved ones’) cannot be emphasized enough.

In one of the last scenes, the movie showed a state of regression as Anthony (The Father) was feeling distressed and asking for his mother. Instead of re-orienting him to reality and explaining that his mother is no longer around, the caregiver understood his need for comfort and embraced him in a hug before redirecting him to an invitation for a walk in the park. 

The movie is disorienting, even for me as a professional caregiver for people with dementia. However it is disorienting in a good way, because not only it shows a realistic experience of someone afflicted with dementia, but it also teaches us a sense of empathy and compassion. A highly recommended watch!

by: Dian

So...someone we love has been diagnosed with a certain condition that needs ongoing care, and we find ourselves unexpectedly assuming (or being assigned) the role of a caregiver. 

How do we go from here?

As caregivers, our natural instinct is often to prioritise our loved one’s safety above all else. Our world may start revolving around the newly established care routines as prescribed by the professionals. What medications, how many, and how often? What food is to be avoided? What about the daily routines of sleeping, toileting, bathing, etc? 

What can’t he or she do? How can I afford the therapy and medicines?

Soon our minds start to be preoccupied and even obsess with fulfilling these care routines and tasks amidst our own busy schedule and multiple responsibilities. We become hypervigilant to monitor our loved one’s symptoms, and we often beat ourselves up if something unexpected happens.

We feel somewhat satisfied when we manage to complete our tasks for the day, but we may start noticing fatigue, stress, and burn out soon setting in, especially if we feel incapable of ensuring that the prescribed care routine is followed.

How else can care-giving be approached?

Just in the domain of elder care, it is estimated that there are over 210,000 caregivers and counting in an ageing Singapore, with some 70 per cent of them aged 40 and above. Segmented studies have revealed that Singapore’s caregiver population is certainly facing higher mental health risks. (Ng, 2019)

Being time-strapped and having financial constraint are some of the main contributors to the stress experienced by caregivers. However, there are other factors that are often overlooked in the process of caregiving: the personhood of our loved one post-diagnosis.

Focusing on the person

Upon receiving a certain diagnosis, our loved one’s identity is often overwritten by the newly received diagnosis, and this might also take away their voice, opinions, experiences, as well as needs, including psychological needs.

Some caregivers work hard towards acceptance of the loved one’s condition, but at times overlook the much needed acceptance of the person him/herself in the process.

As an example, in the case of dementia diagnosis, spouses/ children of persons living with dementia often resort to systematically disengaging their loved one from his/ her usual routine and from society, in a bid to keep them safe and protected at home. In the cases of young-onset dementia, many patients were still working when they sought diagnosis for cognitive impairment symptoms, and found their world shut down upon receiving the final verdict from the medical team. Jobs are often lost...which leads to a shrinking social network...which leads to disengagement and lack of the much needed meaningful stimulation. At home, their routines and responsibilities are often taken over, as it is perceived to have become too risky to let them carry on with their usual activities. Despite the promise of safety, such disengagement typically is likely to lead to other issues including emotional, psychological concerns, and even physical decline over time.

What is often overlooked is that everyone, including people with dementia, have key psychological needs that are essential to their being. 

Tom Kitwood’s framework of five psychological needs of people with dementia reflect that the needs of people with dementia remain the same despite the diagnosis. Just like the caregivers/ people around them, they want to be connected and experience positive attachment, they want to be included and have a sense of belonging, they want to have meaningful occupations (learning, working, hobbies), they want to maintain their sense of identity, and they want to feel comfortable and safe. 

With this knowledge and insight, we may progressively be more mindful in our care  approach and tasks prioritization. Some questions we can start asking ourselves are for example:

  • How can my loved one and I feel more connected? How can we experience love and attachment beyond the caregiving routine?
  • If my loved one is resisting care, is it because he/ she is physically uncomfortable? Is there a way that the environment can be made more comfortable?
  • How can we remain together as a strong unit and ensure that my loved one feels included as the way it always was?
  • If my loved one’s mood is bad and negative, is it because he is not well engaged? Is it due to lack of meaningful activity? 
  • How does he/ she see himself as a person? How can I support that sense of identity and sense of self? 
  • What does he/ she need at this very moment? 
  • Does it matter if we “break” the rule once in a while? 

By focusing on the personhood of the patients, caregivers may find the journey of caregiving more pleasant as stronger connections are built, and the focus is shifted from tasks to needs. Frustration over resistance to care, and missed routines can be alleviated through the understanding of our loved one’s needs and unmet needs. This is more likely to lead to a more positive caregiving experience and outcome in general.

Turning to yourself

Lastly, knowing what our loved one’s needs also requires attunement to our own needs and emotions. Beyond our role as caregivers, we are humans first. If we are able to hold the space and try our best to meet the needs of our loved ones, we should ask if we have done the same for ourselves.

Most of the time, we want to be competent caregivers. We want certainty and assurance. However, we do not always have those within reach, and we may experience negative episodes and circumstances from time to time.

When that happens , let’s ask ourselves: What do I need at this moment?

----------------------------

References

Kitwood T. (1997). Dementia Reconsidered: The Person Comes First. Open University Press, Buckingham, UK.

Ng, Desmond. (2019, May 5). When caregivers are burnt out, who cares for them?. Channel News Asia. https://www.channelnewsasia.com/news/cnainsider/when-carers-caregivers-burnout-who-cares-them-ageing-elderly-11504380 

by: Celestine

Life can get stressful at times and during times of stress, we can feel overwhelmed and unable to cope. However, there are simple things we can do to manage when we are feeling overwhelmed in the moment. Try some of these suggestions and experience what they can do for our overwhelming moments.

1. Go back to basics
When we are feeling overwhelmed, looking after our basic needs can go a long way. Often, in our hectic schedules, we neglect taking care of ourselves, not realizing how doing so can have huge impacts on our emotional and mental well-being. Have you been getting enough rest? Could you be hungry in the moment? Are you hydrated? Are you eating well? Have you been exercising? Are you getting enough down time? Are we on our devices too much and need to get unplugged for a while? Taking care of ourselves even in these simplest and most basic ways can make such a huge difference.

2. Let’s get oriented
During times of stress, it can be useful to get oriented to our surroundings using our basic senses. Here are some ways you can get oriented right now:

  • Look around you. What are five things that you can see in your immediate surrounding. Instead of taking a quick glance at them, see if you can pay attention to an item a little longer before moving on to the next item. Notice the item’s texture, colour, shape, size, or any other characteristics that might stand out to you.
  • Take a sniff. What scent is in the air? Is the smell pleasant or unpleasant? Or perhaps, it is neutral. Where is the smell originating from? Is it strong or faint?
  • Notice the sounds around you. What sounds do you hear? Are they loud or soft? Are the sounds of a high or low pitch? Are the sounds made by living or non-living things? Are the sounds far away or near?
  • Try touching anything that is in your surroundings. What are the textures that you can feel? Notice the sensations on your fingertips as you feel your surroundings.
  • If you are eating or drinking, notice the tastes swirling on your tongue. What do you taste? What textures or sensations are on your tongue?

After you have spent some time getting oriented, notice how you feel

3. Try not to get distracted
Conventionally, it is not uncommon for people to suggest distraction as a method to manage stress or overwhelming moments. It may work sometimes but other times, distracting ourselves from our internal difficulties might only provide temporary relief and might even increase our sense of restlessness. Notice what you typically do to distract yourself from your emotional distress or difficulties. Do you turn to your devices? Do you go on social media and surf mindlessly? Do you eat? Do you watch TV? Do you try and get busy? Noticing your tendencies when you are feeling stressed is a good starting point to recognize how you typically distract yourself.

4. Turn towards and notice
Instead of distracting yourself, it can be helpful to simply notice the thoughts and feelings happening inside of you in the moment.

You can try doing this:

  • Scan your body to notice where you are holding these difficult feelings. page1image47659264 page1image47658688
  • Pay attention to the sensations in that part of the body.
  • What sensations are there? Is it a tingling sensation? Or does it feel like a solid
  • unmoving block? Are the sensations moving or are they still?
  • If you had to use a pencil to draw around the sensation, what shape would it take on? Are there any colours or textures to the sensations?
  • Notice the urge to get rid of the sensations arising and simply allow the urge while continuing to pay attention to the sensations.

In the beginning, turning towards and noticing might feel unnatural because we have the natural tendency to avoid or get rid of anything that is unpleasant or makes us feel uncomfortable. However, with practice, we may be able to start creating space in our lives for even the unpleasant and uncomfortable. And as you turn towards and notice instead of distracting yourself, you may start seeing changes in the relationship between yourself and overwhelming moments.

Overwhelming moments are bound to happen from time to time. We cannot make them disappear. However, there are things we can do to stay grounded and anchored even in the face of an overwhelming moment.

by: Kar Heng

What does the painting mean?  - Expressive Therapy: I am not an artist

My colleague, Im May and I were talking about the common questions we get from clients during our expressive sessions the other day.

“I drew this, could you tell me what am I thinking?”

“Look at this colour, does it mean I am very depressed?”

“Does the colour in my painting suggest I have serious trauma?”

“My child drew this, does he has a violent tendency?”

Well, here is our answer: Unfortunately, we don’t know what it means when you pick up that colour. We can’t read your mind by looking at your painting. So, what is expressive therapy then? 

Expressive therapy is a unique method in psychotherapy, where the practitioner is able to adapt different approaches such as art therapy, play therapy, sandplay therapy, or use of sandtray, clay, dance movement, music, drama, poetry, drawing etc. Depending on the therapist’s training and personal preferences, the choice of tool(s) or modality will vary. When you are in the therapy session, the therapist may simply begin with a quick scribble, stretches, simple movements, or humming a familiar tune as a warm up, before introducing the session’s chosen modality. Sometimes, the expressive approach may be used simply as a form of relaxation.

Why expressive therapy and How?

What if, you are not good at art-making? Let me share a secret with you: ME TOO! I am also bad in art-making. My art teacher in primary school was probably crying when I submitted my art homework (sorry, my teacher). I am not an art teacher. We are not required to have any artistic talent or experience in expressive approaches. I often tell clients, it is not about the end product, but the process. My job is to ensure you have the freedom to express yourself in any way you like and facilitate the process to help you make sense of the experience. There is no judgement or grading towards the “art”.  Okay….I lied. There might be a little bit of judgment and it is often coming from you - you will be the judge of your art.

While expressive therapy may have some techniques for conducting assessments, the approach is focused on the process to make sense of what is happening in your life, and gain awareness of your inner world. It helps to connect and express the part of the self that is hidden inside of you. Using art as a medium to tells your story in a non-intrusive manner. Often, the role of the therapist is a “container”, to contain your emotions, memories, fears, and to accompany you to achieve your healing.

You will decide what does the creative process means to you, and you will tell me what the colour represents. Sometimes, you will not know at the time and that is just part of the process. Hmm, if is still sounds stressful to you, I often say that expressive therapy is like you and I going to visit a gallery. Your story, emotions, memories, and experiences are the ART in this gallery. You are the artist that created the art pieces and we will make sense of the ART-of-Yourself together in this gallery. My wonderful clinical supervisor once said “Nothing is random in the session, it’s just that it may not make sense at the time, but it will come to you”.

Would you like to learn more about Sand Therapy?

References

Friedman, H. S., & Mitchell, R. R. (2002). Sandplay: Past, present and future. Routledge.

Kalff, D. M. (2003). Sandplay: A psychotherapeutic approach to the Psyche.

Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process. Guilford Publications.

Turner, B. A. (2017). The Routledge international handbook of Sandplay therapy. Routledge.

 

by: Roy

Gaslighting in relationships. Noticing the emotional costs of confusion, insecurity, and self-doubt.

What is Gaslighting?

Gaslighting in a form of psychological abuse whereby a person creates a situation which causes someone to doubt their perception of reality, their memory, or even their sanity. It is done so that a person can evade responsibility for their actions. This leaves the person who experienced gaslighting feeling confused, angry, unsure, or even guilty for trying to speak about their experience.

Noticing the presence of gaslighting in relationships

If you feel yourself feeling hurt because your emotions are not validated, angry that someone is always having the upper hand, or guilty for creating tension in the relationship and always apologising, or wonder if you are good enough for that person, it would be helpful to check for the presence of gaslighting in your relationship. Let me share a few examples.

1. “Stop trying to always make things personal/ about you”

When the opportunity to speak about things that matter to you is taken away, your experiences are invalidated. This means that you are made to feel that your personal experiences are not important. It also creates an obstacle of having to wonder if your opinions are important enough to be raised which helps to protect the gaslighter.

2. “The other people/ couples don’t seem to have a problem”

Off-the-cuff social observations about the opinions from most people may be raised by the gaslighter. In some cultures, traditional rules of roles in the relationship may also be brought up to silence someone. This makes you doubt the validity of your concerns, if your concerns are out of the norm. In addition, it is hard to determine how prevalent are the opinions of others as raised by the gaslighter, or how valid the statement is. This causes the argument to change into a debate on the validity of the statement, and distracts the conversation away from your initial concerns.

3. “Why are you always choosing to talk about unhappy things”

When you accused of rocking the boat, and a disrupter of peace, the gaslighter succeeds in placing themselves in the role of an innocent victim. By making you feel bad, or even the aggressor for bringing up a topic, it automatically puts you in a weaker position and helps to protect the gaslighter.

4. “Are you sure this even happened?”

In more extreme scenarios, a gaslighter may pretend that what you are talking about did not actually happen or does not make sense. It makes you feel that your memory of the event may not even be real. Grounding or the trust the validity of your identity and perceptions is important in helping you feel stable and secure. When you start to question your own perception, identity and reality, you begin to feel insecure and pessimistic, and more reliant on the gaslighter for approval, safety and security.

Why does someone practice gaslighting?

Unfortunately, gaslighting is practiced because it works. It is in a powerful tool to protect oneself and to control others. Due to its subtle nature and reliance on a state of confusion, it can be practiced on someone without them being aware of it. Gaslighting stems from a desire to control the relationship, to feel ‘in charge’, and a difficulty with accepting that someone has wronged another person.

A person who practices gaslighting may have themselves experienced being controlled in a similar fashion by someone in authority. Knowingly, the gaslighter may just be replicating the strategies that have been applied to them as they are so effective. Unknowingly, the gaslighter may be replicating this approach to problem solving, as they feel that it is normal, having not had the chance to experience other healthier approaches. Finally, they may not have the awareness or appreciation of the long-term emotional cost to their relationship, in exchange for the short- term gain of protecting themselves.

What should we do?

If you are experiencing gaslighting in your relationship, or notice that your practice of gaslighting is causing damage to your relationship, it would be good idea to speak to a clinical psychologist. This would help you notice your blind spots, why you are susceptible to being controlled by others, or why you find it difficult to stop using gaslighting as an approach to problems. 

I wish that you all find happiness and balance in your relationship.

by: Im May

Ganit and Adir Levy wrote the series of ‘ What should Danny do ?’ books with the intentions to support children in developing their awareness on how they can make wise choices to empower themselves.

A story has about  8 or 9 different mini stories in it.  While reading, the children get to choose different types of choices and those choices will impact Danny positively or negatively. The story encourages the children to consider what are wise and not so wise choices.

The series are good resources for children aged 6 to 10 years old as the stories are interactive and engaging. The series can be found on opentrolley.com.sg and bookdepository.com. For more information , please visit www.whatshoulddannydo.com.

 

Lifelong Impact of Distressing Events in Childhood

The formative development phase from birth to adolescence (up to age 25) is critical. To develop, a young brain needs a healthy and nurturing environment, comprising secure attachment to both parents, coaching, guidance and modelling. Such an environment promotes healthy brain growth and maturation, enabling more complete social-emotional-cognitive learning. This results in an integrated and stable sense of self, a person who is responsible and has a "growth" perspective of life.

Conversely, the opposite is also true. Research studies over more than two decades on childhood maltreatment and Adverse Childhood Experiences (ACEs) (see Fig. 1) found a strong dose-response relationship with early drug and/or alcohol use and other addictions, schooling dropout, poor psychological health, chronic physical illnesses, suicide attempts and early life termination (Fig. 2).

The key findings include:

  1. ACEs are common. All ACE studies conducted globally repeatedly conclude that more than 50% of participants surveyed have 3 or more ACEs
  2. There is a strong dose-response relationship between ACEs and undesirable outcomes in physical and psychological health, including addictions and suicide.
  3. ACEs are inter-generational and pass down from one generation to the next. This is also known as the hidden epidemic.

According to the US Communicable Disease Centre, “Childhood experiences, both positive and negative, have a tremendous impact on future violence victimisation and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue”.

Besides ACEs, other disturbing childhood experiences such as moral injuries afflicted by people in respected or authoritative positions, death of family member(s) or close friends, or witnessing of traumatic events, cause distress and disruption to the healthy development of a young and immature brain-body system that has an inadequate way of dealing with or addressing them. The ill-effects perpetuate into adult life.

An adult I worked with who himself had a history of substance abuse, reported his history of ACEs. He knew his father as one who became violent after a few drinks (any resemblance of this example to anyone is purely coincidental):

  1. Household substance use: Father who drank alcohol till drunk and out of control
  2. Physical Abuse: physical beating such as punching, kicking or pushing
  3. Emotional Abuse: Yelling, scolding and cursing, use of harsh words such as "You are an idiot!", “You are useless!” etc.
  4. Emotional Neglect: Mother who was abused, feared for her life and unable to soothe her children; father was unable to show any warmth and affection
  5. Physical neglect: Father addicted to alcohol, used all available money to fuel his addiction, and not enough for school fees, food, clothing or to pay utilities.
  6. Household violence: Frequent verbal or physical fights with Mother and other household members
  7. Incarcerated household member: Father jailed for causing hurt or nuisance in public while intoxicated
  8. Household mental illness: Mother was depressed but not diagnosed

During his school years, this adult described the following:

  1. Inability to focus in class, and had ADHD-like traits
  2. frequent sleeping in class, having had to stay awake at nights to protect himself
  3. early teenage start to smoking
  4. constantly late for school, academically weak
  5. frequent absenteeism eventually dropping out of school

The client as an adult faced great difficulties progressing professionally. He drank daily, and often found himself with financial difficulties. Relationships were not maintained due to frequent misunderstandings.

While there are legislative measures to stop or prevent the propagation of ACEs, it is difficult to police or prove one’s case against a perpetrator, especially where physical injuries are not present. One such ACE is emotional abuse – yelling, cursing, threatening or use of sarcasm, rejection or gaslighting. During the lockdown periods in 2020, there were increased reports on emotional abuse and domestic violence.

The good news is that the impact of ACE exposure can be mitigated:

  • constant presence of a trusting and nurturing adult such as a teacher, coach or mentor who spends time with the young victim
  • safe and fun school environment where healthy socialising and fun learning takes place
  • engagements in non-school environment that promotes sense of safety, learning, achievement and confidence involving peers and other trusting adults
  • early childhood or teenage psychological intervention by a professional specialised in addressing these psycho-developmental injuries. 

Intervention in adult years by a specialist can also occur with good outcomes as the therapeutic alliance and nurturing resets the neuropathways to promote re-integration of the self and holistic growth. With new insight and awareness, the adult is empowered stop the propagation of ACEs to the next generation. As Professor John Briere commented "If we could somehow end child abuse and neglect, the eight hundred pages of DSM would be shrunk to a pamphlet in two generations."

References:

Dube, S.R., Miller, J.W., Brown, D.W. et. al (2006). Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. Journal of Adolescent Health 38, 444.e1-444.e10. doi: 10.1016/j.jadohealth.2005.06.006

Felitti, V.J., Anda, R.F., Nordenberg, D., et. al (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults – The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 14(4), 245-258.

Hsieh, Y., Shen, A.C., Wei, H., Feng, J., Huang, S C., Hwa, H. (2016). Associations between child maltreatment, PTSD, and internet addiction among Taiwanese students. Computers in Human Behavior, 56,209-214. doi: 10.1016/j.chb.2015.11.048

Le-Scherban F., Wang X., Boyle-Steed K. H. & Pachter, L. M. (2018). Intergenerational associations of parent adverse childhood experiences and child health outcomes. Pediatrics, 141 (6). doi: 10. 1542/ peds. 2017- 4274.

Mersky, J.P., Topitzes, J. & Reynolds, A.J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse Negl. 37(11), 917-925 Doi: 10.1016/j.chiabu.2013.07.011.

Thompson, R., Proctor, L.J., English, D.J., Dubowitz, H., Narasimhan, S. & Everson, M.D. (2012). Suicidal Ideation in Adolescence: Examining the Role of Recent Adverse Experiences. J Adolesc. 35(1), 175-186. doi: 10.1016/j.adolescence.2011.03.003.

Windle, M., Haardörfer R., Getachew, B., et. al (2018). Multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students. J Am Coll Health, 66(4), 246-251. doi: 10.1080/07448481.2018.1431892. 


written by: Im May Tham

WHEN TO LOOK FOR HELP?


When do I look for mental health services?

For some people, seeking mental health services is not as easy as seeking medical attention. Unlike physical injuries, aches and pain, bleeding or flu symptoms, which are visual or felt, it is very challenging to decide whether one needs psychological intervention.

As everyone's life development and experiences differ, not one model fits all. Here are some suggested considerations when deciding whether to seek a psychological consultation.

  1. Feedback from others on patterns or themes related to:
    a. Emotions: Getting easily agitated, irate or anxious from external cues such as words or tones
    b. Beliefs: Blaming or shaming oneself, black or white (all or nothing) thinking, believing self as helpless victim
    c. Actions: Repetitive/compulsive/addictive acts such as washing, checking, use/abuse of illicit drugs or prescribed medications, gambling, unhealthy gaming to escape reality, or impulsive/compulsive spending, prolong delays at starting important tasks
    d. Physiological: feeling trapped/frozen or gripped with fear, or having anxiety symptoms such as heart palpitations and abdominal discomfort not due to other biological reasons
  2. Unexplainable medical syndromes for which medical specialists are unable to identify the source or diagnose. One good example is sudden acute pain, or chronic pain. Another type of pain is phantom limb pain after amputation or being involved in a severely traumatic event.
  3. Experiencing disturbing events during childhood and teenage years, collectively known as Adverse Childhood Events. These include but not limited to receiving harsh scoldings, shaming or humiliation, witnessing violence at home between household members, loss of very close friends, family or important people/pets due to death, divorce or physical separation, bullying or peer isolation. Research has repeatedly found that significantly disturbing events during childhood and teenage years cause a major disruption in healthy brain development, resulting in psycho-emotional instability at a young age. Such events can continue to haunt victims through the trajectory of life, manifesting through visual/auditory hallucinations, relationship difficulties, emotional roller-coasting, lifestyle of thrill, etc.
  4. Having no direction in life or a sense of emptiness, meaninglessness or hopelessness. This may be due to sudden losses of family members, a profession, or accumulated through long period of time.
  5. Experiencing burnout due to work or as caregiver, overwhelmed with physical and emotional lethargy
  6. Repeated exposure to death, injuries or illnesses. Those who commonly experience this are medical professionals and frontline responders such as firefighters, paramedics, police and other law enforcers. Prolonged repeated exposure results in vicarious or secondary trauma. Any other individuals who had been involved indirectly with an accident such witnesses or acquaintances of victims can also suffer from secondary trauma.
  7. Direct involvement in a major incident or accident that resulted in death or serious injuries to others and/or self. This includes being sexually or physically assaulted and vivid re-experiencing or reliving of the event.
  8. Feeling unusually emotionally flat, down, high or roller-coasting for prolonged periods with or without any reason.
  9. Difficulty relating to others or relationships always seeming to fall flat
  10. Repeating unhelpful and sometimes harmful acts and choices of words that one's own parents used on you.

The first objective in seeking professional psychological consultation is to understand what is going on beneath the surface. Thereafter, you may decide the next course of action together with the counsellor or psychologist. At times, the practitioner may guide the understanding but unable to provide the necessary intervention, and the practitioner will then refer you to another specialists. If the practitioner is able and willing to provide intervention, it is important to work out realistic outcomes as many require longer periods of regular sessions to experience the change.

Counselling and psychotherapy which seeks to resolve the core issues, rather than simply patching over the symptoms which can later resurface, takes time and is a journey which requires perseverance and patience.

MOVIE REVIEW OF DISNEY'S "SOUL"

by: Joy

There is so much to reflect upon after watching the movie <Soul>. As a psychologist, I see the movie trying to answer the two important questions. These two questions are also common questions people bring to therapy/counselling room.

What does it take to begin your (soulful) life?

“You do not have to be perfect to be a human, you just need some inspiration to begin your life.” This is what popped up in my mind after watching the movie. No single soul is fully prepared to come to the earth and go through this life, but for some reasons or other we are already here. No single soul knows what exactly will happen in this life, but one thing you and I are certain about is: we have this life. So, find what sparks you and let life unfold itself.  A “dark” way to put it: go ahead, be courageous, you have nothing to lose, since all of us are going to die (eventually) anyway.

How not to get lost in your (soulful) life?

What strike me the most in the movie are the lost souls, those giant gloomy weirdos. They are totally self-absorbed, just keep searching and searching…searching for the euphoric state their passion used to bring them to. A soul becomes a lost soul when its passion turns into obsession. The little soul is hidden or dormant inside the huge gloomy weirdo, covered by layers and layers of obsessions, ruminations, and worries. What is passion? In my opinion, passion is the lasting-genuine-interested-curiosity in doing what you are doing, and this lasting-genuine-interested-curiosity would naturally bring a person to a state of pleasure or even euphoria. However, if not careful, this curiosity can easily turn into obsession when we keep wanting more and more of such pleasurable or euphoric feelings, and even start to fear or worry about not getting them. The soul keeps searching for pleasure or euphoria (i.e., the effect) but forgets what brings out the pleasure or euphoria (i.e., the cause) in the first place. That is why and how a soul gets lost and will never find what it is really searching for. The soul is searching for sparks, not ashes of the sparks! Therefore, protect your curiosity, find your sparks, and watch out for obsessions.

If you are suffering from depression, you may doubt: Do I ever have a soul? Yes, certainly. But why can’t I feel my soul? Ask yourself: What is my obsession? The little soul may be buried by thick layers of obsessions to be happy, ruminations over unhappy past, and worries about being unhappy forever. Paradoxically, obsession of happiness drowns a little soul further into depression.

Though it was a great attempt for the movie to answer the ever-bewildering philosophical questions of where we are coming from before life (The Great Before) and where we are going to after life (The Great Beyond), the truth is as human beings WE DO NOT KNOW! We only know where we are now, we only know this life, and we only live this life once, so…

“Tell me, what is it you plan to do with your one wild and precious life?”

-from Mary Oliver <The Summer Day>

If you are a LOST soul, may you let go of obsessions and find your sparks to begin this wild and precious life.

If you are a FOUND soul, may you keep your genuine curiosity and guard against obsessions in this wild and precious life.

Wish you all the best in your journey to the soul in 2021!

Bringing Mindfulness into Your Routine



Mindfulness is  “awareness that arises through paying attention, on purpose, in the present moment and non-judgmentally” (Kabat-Zinn).  When one is being mindful, they are practising concentration, consciousness and being non-judgmental in a given moment. The goal of mindfulness is not to empty your mind of thoughts. Rather, it is to notice and acknowledge that thoughts, feelings and sensations may arise without pushing them away or holding onto them. 

There are many benefits to mindfulness, including improved anxiety management, stress reduction, mental clarity, improved attention, improved affect regulation and relationship satisfaction. 

There are many ways in which you can practice mindfulness in your daily life and bring it into your routine.

1) Set your intention for the day

When you wake in the morning, allow for a few moments to bring yourself into the day. Take a few breaths. Then, set your intention for the day. 

What mindset would you like to hold for yourself during the day?

What are my needs today?

What can I do to address those needs?

How can I strengthen connections with people in a healthy way?

Say it back to yourself. For example, Today, my intention is to have a flexible mindset. I aim to be non-judgmental with myself and others. I will practice mindful listening when in conversations with others. 

Over the course of the day, check in with yourself. Come back to your intention for the day and bring consciousness to it.  

2) Pick a moment in the day to practice mindfulness

If you’re a beginner to the world of mindfulness, it can sometimes feel overwhelming. Setting a realistic goal can often be helpful. One such goal is to practice a few minutes of mindfulness in whatever task you are doing. 

Perhaps, you enjoy an evening walk, or you have a long commute to work. Perhaps you enjoy a warm shower or you have a hot cuppa in the morning. Pick one thing that you do regularly and bring awareness, intention and non-judgmentalness to it. Use your senses and be in the moment. 

By using moments in the day that are familiar to you, you may find it easier to incorporate mindfulness into your life. 

3) Meditate

Meditation is a form of mindful practice. Use the meditative space to focus on the moment and on whatever arises for you. Using the breath is often a helpful way to anchor oneself in meditation. 

Here is a counting meditation you could try: 

Find a comfortable position and close your eyes. When you’re ready, focus on your in-breath and out-breath. Begin outing each in and out-breath. 

Breathe in 1

Breathe out 1

Breathe in 2

Breathe out 2

Breathe in 3

Breathe out 3

(until you reach the 10). 

If you lose count, notice it non-judgementally and begin again. You may end the exercise when you reach 10 or whenever you feel ready to do so. 

Set aside 10 minutes in a day to practice a form of mediation that sits well for you.

Dr Kavitha’s tip: Practice makes progress. 

Aim to practice mindfulness on most days for a few months. Over time, you may notice that you are able to direct your attention away from unhelpful thoughts with less and less effort. You might also notice the helpful effects that mindfulness can bring to your mind and body. Build mindfulness into your routine and frame it as a commitment to nurturing your mind and body. I will you all the best in this journey. 

written by: Im May

 

UNDERSTANDING FEELINGS AND WHY THEY MATTER

by: Adriana

Feelings, especially the unpleasant ones, are often misunderstood and stigmatised, being perceived as something negative, to be avoided, suffocated, numbed dismissed or eliminated. In fact, feelings make us human (Hauke, 2005). Furthermore, they contain precious information about the world as we perceive it and about ourselves, thus offer us opportunities to respond effectively to our emotional needs and to life situations. It is therefore important to develop the skill of understanding and making sense of feelings, what they intend to communicate to us about ourselves and life events. 

As children growing up, the relevant caregivers act as a mirror; in so doing, through such foundational relationships, children begin to develop the language of emotions. In certain cases, this process is hindered or does not take place effectively for multiple reasons, including misattunements and misunderstandings, or a “basic fault” (Balint, 1968, p. p. 16) with the relevant caregiver/s during the developmental phase, as a result, the fundamental language of emotions and the ability to relate/attune to self and others become impaired.

When people do not know what they suffer from - aka they cannot name their feelings - and do not know the paths to exit from their sufferance, they are left without tools. What can be done?

  1. A paradigm shift: be willing to feel your feelings.
  2. “Befriending the body” (Van der Kolk, 2014): begin to observe your body sensations with curiosity as if you are undertaking a body scan. Name each and every sensation with an emotion. Be willing to observe them with curiosity as if to capture the information they carry about what is going on inside you and what you may need in the moment.
  3. Be patient with yourself. This is a new skill. Give yourself time to practice. 
  4. Develop a personalised emotional dictionary based on your body sensations and their emotional parallels (for a list of emotions see link below in the resources section). 
  5. Practice, practice, practice.
  6. Lastly: you may wish to read some of the great novels of the 1900s (eg. Kafka; Tolstoy; Mann) to learn more about the entire range of feelings including love, sufferance, boredom, desperation and agony. By identifying with the novels’ characters, you may learn more about your experiences and emotions. 

REFERENCES

Balint, M. (1968). The basic fault: Therapeutic aspects of regression. London and New York: Routledge.

Hauke, C. (2005). Human being human: Culture and the soul. New York, NY; London: Routledge.

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. New York: Penguin.

RESOURCES

List of emotions: https://www.healthline.com/health/list-of-emotions

WHO DOES WHAT?



There are several professions in the mental health sector and it can be very confusing who to see first. Sometimes you are advised to see another when you are already seeing one.

So let's identify and be clear who does what.

Psychiatrist - a medical doctor who specialises in psychiatry and holds a MMED (Psychiatry). He or she gives the diagnosis after taking some history and patient's current difficulties. The psychiatrist prescribes psychotropic medications such as anti-depressants, anxiolytics, anti-psychotics to reduce the symptomology. He or she also writes a medical report when required. Some psychiatrists receive further training in psychotherapy. They may also further specialise in forensic, geriatric, child or neuro-psychiatry.

Psychologist - One who has obtained a postgraduate qualification in psychology such as Clinical, Counselling, Education, Organisational, etc. A psychologist does not diagnose nor prescribed medications, but works with the client to address their difficulties, challenges or "stuckness". Psychological tests and assessments may also be conducted. In a private practice or public healthcare settings, one would normally find clinical or counselling psychologists. In an educational setting, students having learning difficulties are referred to a educational psychologist. A psychologist is also likely to have received specific further training or qualifications in therapeutic approaches. In some organisations, the job title "psychologist" is used but the job holder only has a bachelor's degree in psychology.

Counsellor - A person who has a postgraduate qualification Masters or Doctorate, in Counselling . Some organisations also use the term for those with Bachelors in Psychology or Counselling, such as schools, uniformed organisations, Family Service Centres and VWOs. A counsellor does not diagnose nor prescribe medications, but journeys with the client towards improving his/her psychological health, usually in a limited area such as addictions, social integration, etc. A counsellor does not administer psychological tests and assessments unless certified and registered to do so. Many counsellors also seek out additional training and qualifications in psychotherapeutic methods. The local professional bodies for counsellor registration are the Singapore Association for Counselling (SAC) and the
Association of Psychotherapists and Counsellors Singapore (APACS).

Social Worker - A person who works towards promoting socio-financial health and addressing issues in human relationships usually within the family context. He or she starts with a bachelor's degree or graduate diploma in social work. Medical social workers (MSWs) in government hospitals and clinics facilitate applications for medico-financial assistance and source for community resources to aid the individual or families in need. Community social workers at the family service centres (FSCs) also source for financial aid and community resource. They also tackle household dysfunctions such as domestic violence, abuse, neglect,etc. Some specialise in psychotherapy such as Family Systems, trauma, addiction, community work, etc. All social workers are required to be registered with the Singapore Association of Social Workers (SASW).

Psychotherapist - Refers to a mental health professional who has undergone many years of training in specific therapeutic methods. Psychiatrists, psychologists and counsellors may become psychotherapists upon attaining certification and registration with the related professional international bodies. Schema therapy, Emotion-focused therapy, EMDR (Eye Movement Desensitisation and Reprocessing), Cognitive Behavioral Therapy are just a few forms of psychotherapy.

Behavioural Health Consultant - A specialist mental health professional who is an expert in integrating both physical and mental health care, and is usually found in medical settings like the general hospitals. They often use behavioural approches to facilitate better management in overall well-being, such as diabetes, pain, smoking, migraines and addictions with the mental illness.

Who should you seek?
That depends - what you want, situation you are in, location, etc.
The first question to ask isdo you want a diagnosis and medications? If so, then you'll want to consult a psychiatrist.
If you do not need a diagnosis and medications, then you may want to seek out a clinical/counselling psychologist, or a counsellor. As psychological tests are costly, obtaining a preliminary opinion from a counsellor may be a good start.
If you like to or is required to do psychological tests, then the psychologist is a better option.
If you are in high distress or crisis, you can go to the nearest FSC or direct to the Institute of Mental Health.
If you are being harrassed, threatened or abused, please make a police report.

Can I choose the "clinician"?
In the public healthcare system, you do not get to choose the clinician unless you are willing to pay private rates which can be double the subsidised rates. The clinician assigned is based on availability, unless you have specific requirements such as gender or language.

In private healthcare, you get to choose as you are paying fully for the services. In choosing the clinician, some areas to think of include
- costs and pricing
- duration of session and therapy
- expertise and certifications (and registrations) to address your concerns more effectively
- professional history, if any

Can I change the "clinician"?
Yes, there are circumstances where change can be requested for such as
- there are challenges in relating to each other due to language difficulty, personality, clash of values or principles
- the clinician is not sensitive or addressing your needs
- the clinician is unable to journey with you with your challenges
- you feel very uneasy with clinician
Depending on the factors and availability of expertise, sometimes the change may not occur, and instead the supervisor may join a session to really understand the dynamics in session.

Seeking out the most appropriate clinician is vital in your healing journey. The clinician whom you are able to build a strong rapport and feel safe with is much better than one who has numerous years of service or many accolades.

HEALING FROM DEPRESSION

by: Adriana

as featured in:

1. What is “Depression”?

Depression is an impairing low mood that can last weeks, months or even years. A sense of isolation, disconnection and alienation resulting from a lack of safe attachment, attunement, emotional nurturance, care, sense of belonging, connectedness and unconditional acceptance during the developmental age underpin depression. Also, an underdeveloped self and enmeshment with relevant others deriving from an environment whilst growing up that engendered dependency, did not foster belief in self, free self-expression and hindered the development of self-confidence represent dimensions correlating with depression. Developmental trauma – including neglect – often also result in depressive symptoms.

2. How does one tell if they’ve got it? What symptoms should they be aware of? 

Depressive symptoms manifest along a continuum, from the more mild to severe. A sense of meaninglessness, low self-esteem, apathy and hopelessness, often alongside suicidality, are common symptoms.

3. How can therapy/speaking to a psychologist help someone suffering from depression, especially as a first step towards getting better? 

The focus of therapy is on identifying maladaptive coping behaviours, on developing a strong and caring healthy adult that can meet core emotional needs such as those for self-acceptance, self-kindness, meaningful and authentic connection with self and others. The therapist also supports these processes and aids the processing of traumatic past experiences to eventually break negative life patterns and facilitate the befriending of the body such that the client can feel safe therein.

4. Do you think people in Singapore are more open to talking about mental health, in particular, depression? Or are we still a long way from de-stigmatising it? 

I see Singaporeans are becoming more welcoming to psychological support, especially the younger generation. We do have more access to information today, as such the historic stigma is progressively diminishing.

5. What advice do you have for those who may be suffering from depression but are afraid to ask for help, or don’t know how to?

Joining a support group or a support system of caring and competent people, even online, could help to break the initial hesitation and developing familiarity with the idea of being worthy of help and happiness in life. We are all worthy of thriving in life, therefore we all worthy of a sound therapeutic process.

6. What is one thing we can do for ourselves as an everyday tool in managing/overcoming depressive thoughts/moods? 

I would say unconditional service and support for other people, planet Earth and/or animals, physical activity and exercise, especially yoga, pranayama breathing exercises, mindfulness and meditation. Developing one’s spiritual dimension is paramount as an integration with psychotherapy in order to experience stillness and peace from within. 

HELPING THOSE WHO ARE STRUGGLING



There is a suicide in every 40 seconds, according to World Health Organization. Sometimes, it is obvious when someone we know is struggling but other times the signs can be a lot more subtle than we think. The story below shows how a suicidal person could look ‘okay' at work:

“Sarah, one of the vets working for me, came into the clinic one day and asked for my permission to get some tranquilizers to put down a bull on-site which broke its hip in an accident. Having the experience working with big animals myself, I gave her my permission to bring some tranquilizers out of the clinic to ease the animal’s pain. No one would have expected Sarah to use those tranquilizers on herself to commit suicide. She was always so cheerful and happy at work.”

Some individuals with mental health issues have learnt to wear social masks in order to blend in with other people and to avoid the social stigma that mental health issues often carry. We may not notice any obvious signs or symptoms and it can be hard to put ourselves into their heads to understand what is going on for them. With that, we are often poorly-equipped to know what to say to people who are struggling with mental health issues. We risk sounding insensitive, inconsiderate and dismissive, even though we do not mean to be any of those things.

Here are some examples of what not to say when someone with mental health issues (a struggler) who confides his or her struggles in you:

“Look at those kids in Africa. You should be grateful with what you have.”

Emotional pain does not discriminate. We can be famous, rich, intelligent, and still struggle with depression and anxiety. The struggler is not asking to be compared with anyone else. He or she is talking about himself or herself. No matter how perfect things look like from the outside, their feelings are feelings, and all feelings are valid.

“Everything will be alright.”

It does not matter when the struggler is overwhelmed and cannot see the future. At that moment, things do not look like they are going to be alright to the struggler. Such encouragement can be misplaced and misinterpreted. Besides, are we going to be responsible if anything happens to ‘everything is going to be alright'?

“What were you thinking? Stop focusing on the bad stuff.”

People who have gone through intense and extreme times in their early years can still be overwhelmed thinking about it later in their lives and their feelings can be just as intense. If they could help it, they too, would choose not to have such thoughts. Saying that could be giving the wrong message that the struggler is being blamed for struggling.

Here are some examples of what we can say to the struggler instead:

  1. “Thanks for having the courage to share your struggles with me.”
  2. “Is there anything I could do to help you?”
  3. “Your sharing of the pain you experienced does not change how I perceive you.”

The aim is to acknowledge what the person struggling has been through with inserting our own interpretations of their emotional pain. More often than not, they are not looking for someone to correct or fix them, they are looking for someone to listen without judging and to validate their pain.

SELF-SOOTHING IS A SKILL



Self-soothing refers to the actions we take to regulate our emotions. Babies learn to self-soothe by sucking on their fists or a pacifier, or perhaps rubbing their ears as they feed. They feel calm when their caregivers pat them or rock them to sleep. As we grow up and grow older, we will learn varied self-soothing techniques to manage distress and anxiety. It is important to remember that these techniques may be helpful and unhelpful.

Techniques to self-soothe that can become unhealthy habits include biting of nails, sucking thumbs or fingers, picking skin, foot tapping, leg shaking or even pulling hair such as eyebrows and lashes. Techniques that give pleasure and relief in the short-term but may result in difficulties in the long-term are ineffective. More examples include alcohol use, smoking, gambling, over-eating, impulsive spending or excessive gaming/tv-watching or social-media use.

Self-soothing can be extremely effective in managing anxiety, anger, pain and other distressing feelings in the moment. The key to using it effectively is to treat it as a skill. One needs to be learn to use self-soothing techniques in a way that is helpful in both the short-term and long-term, and to use it in a way that is in line with their values. 

To self-soothe effectively, we may use our six senses (Sight, Smell, Sound, Taste, Touch and Movement) to guide us. Here are some suggestions: 

Sight

  1. Look at nature- e.g. look out the window, go for a walk, examine a potted plant.
  2. Keep a favourites photo album of someone or something that brings you great joy (e.g. your grandmother, your child, a niece/nephew, your dog/cat). Look through this specific folder when you need to. If no one comes to mind, make an album of quotes that you find validating and inspiring.
  3. Find a safe spot and people-watch.

Smell

  1. Use aromatherapy or light scented candles.
  2. Imagine the smell of freshly baked cookies, or if possible, bake some cookies.
  3. Use your favourite hand cream/shampoo/soap or perfume.

Sound

  1. Listen to soothing music at a low volume or listen to invigorating music.
  2. Play an audiobook of a much-loved novel (e.g. Harry Potter as told by Stephen Fry).
  3. Listen to the various sounds around you with intention and without judgement.

Taste

  1. Mindfully eat a piece of dark chocolate.
  2. Drink a warm drink that can help you feel calm, or drink something that reminds you of happy times (e.g. a hot chocolate or bubble tea).
  3. Treat yourself to a little bit of special food that you usually wouldn’t spend money on .

Touch

  1. Take a warm shower (or a cold one).
  2. Pat your dog or cat or cuddle a stuffed animal.
  3. Put a cold towel on your forehead.

Movement

  1. Take a few moments to stretch mindfully. Lean into these stretches.
  2. Dance like no one is watching.
  3. Do some exercise.

Now that you have some ideas, here are tips to get the most out of this skill:

  1. Make a list: Write down some self-soothing techniques that you would be willing to use when you are distressed. It can be challenging to remember these suggestions when you’re in anxious/distressed mode so making a list can help remind you of them.
  2. Prepare: Make a self-soothing kit for home, work, or to carry around with you. For example, keep some chocolate or mints in your bag or a package of cookie dough in your freezer, or have a beautifully-scented hand cream in your desk drawer, or ensure that you have a playlist of music that would be helpful in your phone or curate a photo album of someone who makes you smile. Preparation will allow you to access a technique quickly and this could assist greatly in managing distress.
  3. Indulge: It can sometimes be helpful to use the best that you can get your hands on. When you are distressed, allow for that iced latte, play your favourite song or purchase that movie that you have been meaning to see, use your favourite soap or shampoo, spritz the expensive perfume, take a longer shower or go for a walk in a pretty part of the city.
  4. Be effective: Use the techniques in a mindful way. Worrying while going on a walk isn’t going on a helpful walk, it’s just worrying outside.
  5. Be aware: Notice any over-use of the techniques. Overindulgence or overcompensating of self-soothing could lead to unhelpful avoidant behaviours, and would result in more distress in the long-term.
  6. Do “YOU”: We’re all different. It might be that none of the suggestions above appeal to you or work for you. Use your creativity and problem-solving skills. Find what works for you and is in line with your values. Have some “go-to’s” in your repertoire that you can access quickly when distressed.

As you embark on your journey to self-soothe as needed, acknowledge your fears, be patient and be open to stepping outside of your comfort zone. It is a skill that develops over time. I wish you all the best and hope you find self-soothing techniques that are effective for you. 

APPRECIATING THE POSITIVES IN LIFE

To balance against the mind’s negativity bias

By: Joy


In the tradition of psychology and psychotherapy, there has been much attention paid to mental illness, abnormality, and suffering, but little attention paid to happiness and well-being. In this article, I will bring you through a step-by-step guide on how to savor and appreciate the positives in life.

But first of all, what prevents us from enjoying the positives in life?

Do you find it hard to pause and appreciate the positives in life, especially during the COVID-19 pandemic? You are not alone. This is probably due to the 2 key neurocognitive mechanisms that are hard wired in us – negativity bias and discrepancy monitor.

Negativity bias” is our mind’s natural tendency to constantly scan through and detect the potential threats or dangers in the environment, so we could stay safe and free from harm. “Discrepancy monitor” is our mind’s natural tendency to constantly monitor and evaluate our current state against an ideal or desired state, so we could get what we want or achieve the desired state. Both mechanisms are crucial for our survival, as the former keeps us alive, and the latter motivates us to get adequate resources to sustain livelihood.

However, we can see how we could get stuck when these two come together. First, with the negativity bias, our mind almost automatically detects the negatives, either an external stressful situation or an internal anxious/depressed mood; second, with the discrepancy monitor, our mind would be focusing on the gap between the reality and the ideal and finding ways to minimize the gap. Unfortunately, when the two comes together, our mind can become preoccupied with trying our best to eliminate the negatives, instead of discovering and cultivating the positives, just as we often ask: “what’s wrong with you?”, but seldom ask: “what’s right with you?” (what a strange question!).

With these in mind, let us try out a mindful way to savor the positives in life:

*Note that this does not mean you should ignore the negatives. The negatives are still present and we still need to find ways to manage them, but here we are learning to shift the “bias” to the positive experience whenever it comes to your life or when you intentionally make it happen.

Step 0: pre-condition to savor a positive experience

Create a safe space for yourself, both physically and mentally, so as to take yourself out from a threatened or pressured state. Give your mind and body a space to rest, not racing, so you can be mindfully present in the moment.

Step 1: Recognize

Recognize the positive experience. When you are fully present in the moment, instead of being mindless or mind racing to the past or future, you may find recognizing the pleasant experience easier, e.g., seeing beautiful flowers on your way home, sipping a cup of coffee/tea during a break, feeling the cool breeze in your hands, etc.

Step 2: Allow

Allow yourself to be drawn into the pleasant experience. Immerse yourself in it, no matter how small or trivial the experience may seem. If any negative belief comes, such as “I do not deserve it”, acknowledge that it is an unhelpful thought in the moment and release it, then gently bring your attention back to the pleasant experience again.

Step 3: Linger

Linger with the pleasant feelings and body sensations evoked by the experience. Pay full attention to the residual pleasant feelings and sensations as long as they are present.

Step 4: Let go

Savoring and appreciating the positives does not mean holding on to them, or wanting positive feelings to be always with you (which is unrealistic). Hold the pleasant experience in your awareness when it comes, but don;t hold on to it, so when you notice that the pleasant sensation or feeling is gone, let it go. Let go of the urge or desire to retain the positive experience.

Step 5: Rest & Wait

Lastly, rest yourself in your own safe (physical and mental) space again, and wait for the next moment of pleasant experience to arrive, with patience and curiosity. Keep your heart open to discover and appreciate the goodness in life.

Paying a bit more attention to the positives in your life each day can give you a more positive outlook on life over time. You could start by practicing the 5 steps for a short while every day. Lastly, let me end with a quote from Dr Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction (MBSR) programme:

As long as you are breathing, there is more right with you than wrong with you. No matter what is wrong.

RECOGNISING IMPOSTER SYNDROME



“Oh, it was just luck!”

“I was fortunate to win today, the competition had a bad day.”

“I can’t believe I got that grade, I'm not sure I deserve it.”

“If it was not for my colleague, my pitch would never have won that work.”

Sound familiar?  Ever felt like you do not fit in and that your friends or work colleagues will realise you are not what you portray?  That you are unworthy of your success?  Not as capable as others?  If so, you may be experiencing Imposter Syndrome.

Imposter Syndrome is also known as Imposter Phenomenon and was discovered by Dr Pauline Clance in 1985 while working with high achieving women.  Dr Clance found that Imposter Syndrome sufferers tend to believe they are ‘intellectual frauds’ and fear that they may be recognised as imposters.  Sufferers also tended to struggle with anxiety, fear of failure and dissatisfaction with life.  As research has evolved and greater understanding about Imposter Syndrome has been possible, it has become clear that both men and women experience Imposter Syndrome but that women are more susceptible and likely to be intensely affected by it (Carol Kinsey Goman, July 2018).

Imposter Syndrome can often be experienced alongside difficulties with perfectionism and procrastination (both of which have had blogs previously written about them. See below) as both these issues tend to leave their sufferers fearing failure and the possibility that they or others will realise their flaws and they will be somehow exposed.  While living with the discomfort of feelings triggered by Imposter Syndrome can be debilitating, it may be helpful to know that there are ways to manage this struggle.

A helpful starting point can be learning to recognise some of the unhelpful thinking that may come with Imposter Syndrome:

  • All or nothing thinking – believing if we are not perfect, we have failed.
  • Mental filtering whereby we only pay attention to our failures and cannot see our successes.
  • Disqualifying the positives – overlooking good traits because they somehow do not count.
  • ‘Should’ thinking – when we attach critical words such as ‘should’, ‘must’ or ‘ought’ to our expectations of ourselves it can lead to anxiety about failing.

All therapeutic work, irrelevant of differing theoretical approaches, involves working with, understanding and making sense of our thoughts.  When our thoughts become unhelpful, they can lead to uncomfortable emotions and feelings such as those associated with Imposter Syndrome.

So… what can I do about this?  These are some tips and ideas for changing unhelpful thinking to better manage and overcome Imposter Syndrome feelings:

  • Try to become aware of and recognise your imposter thoughts – observe them but try not to engage them. As children may sometimes be taught, “You can look but do not touch”, try to apply a similar principle to the process of observing the thought but not engaging it.  By asking yourself questions about the thought such as whether it is helping you or how it may be unhelpful, this enables the process of observing but not engaging the thought.  This process helps to diffuse thoughts rather than hold onto them and offer them the opportunity to take over.
  • Reframing thoughts – Valerie Young (2011) notes the only differences between those experiencing Imposter Syndrome and those who don’t, is how they respond to challenges. Not feeling like an imposter does not make the individual any more intelligent, competent or capable; they are just thinking differently.  So if we can think like a non-imposter, we may feel less trapped e.g. reframing our thinking so that asking a question or asking for help is valued as being efficient rather than a sign of failure because we did not have the answers.
  • Accept compliments and note successes – imposters tend to dismiss compliments, so when someone compliments you, try saying thank you and accepting the positive affirmation. This can help build self-recognition of positive personal attributes.  Taking this a step further, it can also be helpful to recognise personal successes and positive achievements.  Keeping a thought journal or writing a list about what you have done well can help train you to recognise and genuinely feel your successes.
  • Consider the opposite – when imposter unhelpful thinking strikes and you recognise the thought, it can be helpful to ask yourself, “What is the opposite thought? This can open one’s mind to considering a new helpful perspective e.g. rather than “I only won because my opponent had a bad day so I don’t deserve the win ” could become “I won because I played well today and deserve to win”.
  • It can also be helpful to share your fears with a trusted person who can offer some insight, understanding and reassurance.

Imposter Syndrome feelings may not go away completely and we may all have them at times, however it is possible to learn to manage them so that they do not take over and control us. 

(For further reading about perfectionism and procrastination mentioned, you may find previous articles ‘The Cry Beneath Perfectionism’ by Jean Cheng and ‘Tips on How to Tackle Procrastination’ by Adriana Giotta of interest.)

THE CRY BENEATH PERFECTIONISM


In a society that hails productivity and high standards, perfectionism is more frequently celebrated rather than seen as a quiet cry by the individual. However, behind the achievements, the praises, and the approval that the person may receive for perfectionism, is an exhausted person who is stressed, anxious, and fatigued from working overtime on their jobs, to take care of family members and friends, or to look their absolute best at every occasion.

Underlying perfectionism is often anxiety. Perfectionistic-driven anxiety says, “I need to be outstanding at what I do, if not I will be shamed”. People who become perfectionists often started off as children who were heavily criticised or ridiculed for making mistakes, even though making mistakes is a necessary component of human development.

Over time, these children learnt to cater to their parents’ rigid and unrelenting expectations, because to do so meant to receive praise, attention, affection. In other words, to live up to their parents’ expectations ensured that a basic human emotional need was given to them: connection to their parents. (Note: expectations are not bad, but unrelenting expectations can be psychologically paralysing.)

Connection to caregivers is meant to be unconditionally given. But when it is intermittently delivered to a child as part of reinforcing them to behave in ways that a parent wants them to, it can be highly effective simply because children need connection to their parents. It is akin to depriving a child of food. The starved child will be motivated to do whatever he/she needs to get that basic physical need met. When parents use a basic emotional need of connection as a tool to reinforce their children (whether consciously or unconsciously), they would have higher success in molding children who live to meet their expectations.

Over time, these very children grow up externally successful but internally on overdrive, deeply fatigued, and unable to find a “you can safely rest just as you are” button. They believe that only when they have reached a certain achievement, would they finally be able to rest, but even when they achieve that, they can’t seem to rest peacefully and find themselves off to seek out the next achievement, like a hamster on a wheel.

What is needed is for these individuals to recognize that their perfectionism – although hailed by many (including themselves) – is actually a defense mechanism to protect them from feelings of shame and abandonment. They should have been loved and held just as they were: as normal human beings whose right is to make mistakes in order to learn. But they weren’t. It was cruel to be reinforced with a basic human emotional need. Part of their healing would be to reclaim their human right to make mistakes, to rest, to play, to be unproductive, to think of their own needs too, to be ordinary, and know that they are good, worthy, and lovable just as they are – not because of what they do. 

If you struggle with perfectionism, here are some quick tips on reducing perfectionistic behaviours: 

  1. List your current expectation for yourself in a particular area of your life (relationships, work, studies, appearance, etc)
  2. Ask yourself whether or not you would impose such an expectation to a person that you love dearly. It is often easier to honour another person’s humanity, than to honour our own.
  3. Ask yourself what a more reasonable expectation would look like that you’d prefer to give to your loved one. Some people find it helpful to seek others’ opinion and feedback on what a reasonable expectation would look like.
  4. Give the same to yourself. You deserve your own compassion, kindness and love.

I highly encourage you to find therapeutic support to heal the deeper wounds driving perfectionism for you. If it helps, you can reach out to one of our clinicians to accompany you on this journey towards more deeper healing. You deserve your healing.

Some helpful books on perfectionism and parenting include:

The gifts of imperfection by Brene Brown

The book you wish your parents had read by Philippa Perry


I was tutoring a child one Sunday when her mother walked into the room and asked me to leave after learning that I worked as a counsellor. My supervisor warned me about the social challenges a counsellor might face but I did not expect to experience it first-hand. It saddens me to say this, but there is still a stigma around mental health all around the world.

If this negative spotlight constantly shines on people struggling with anxiety and depression, it can hinder them from getting help. Misconceptions about mental health issues and counselling work arise due to lack of public education and awareness. The following are common myths about mental health and counsellors:

1. People with mental health issues are baddies.

With or without mental health issues, people commit crimes and harm others. No matter how ostensible it is, this is unquestionably a stereotype. It has no basis in fact

2. People who suffer mental health issues are just emotionally weak.

Quite the contrary, actually. Not many of us have the courage to put our ego aside and talk about our pain and fears with a stranger (i.e. a counsellor). They are overwhelmed, yes, but certainly not emotionally weak.

3. People with mental health issues cannot work with other people.

Some of them are extroverts who can work quite well with other people. Others have also lived with mental health issues long enough to know how to ‘be okay' around people. They often use work as a coping mechanism and I have clients tell me that work keeps them in focus and gives them a sense of identity.

4. Counsellors work with crazy people.

Counsellors work with people just like any other occupation that provides services to people. Besides, counsellors must abide by a code of ethics and we must treat every client fairly regardless of their background without imposing our values, beliefs, and personal opinions. The stigma is already detrimental to those who needs counselling help, an ethical counsellor would avoid labelling and judging his or her clients.

Psychiatric cases such as schizophrenia and multiple personality disorders are less common. These cases are usually referred to psychiatrists and sometimes, we would work together with the psychiatrists to help clients cope with symptoms while continuing with their daily activities.

5.If a client sees a counsellor, it puts the client or family and friends to shame.

This is another undesirable effect of the stigma attached to mental health. Why is seeing a doctor for a cold or getting acupuncture from a physician considered okay but not seeing a counsellor or getting therapy?

We all feel happy, sad, angry, scared and so one sometimes but there are times when we can feel really overwhelmed and not see the light at the end of the tunnel. Waking up every day and interacting with family members can become a chore when we are emotionally drained.

Join me at #BreakTheStigma and be kind to everyone.

CONDITIONING OF THE MIND



I came across a story about elephants kept in captivity and the story goes like this:

One day, a man saw a herd of elephants being tied to pegs. The elephants could easily have broken the small ropes tied to their strong legs to free themselves from captivity anytime they wanted.

 Confused, the man approached the elephant trainer and asked why the elephants made no attempt to be free.

“Well,” the trainer said, “when they were very young and small, we used the same rope to tie them to the pegs and, at that age, it was strong enough to hold them. As time goes by, they are conditioned to believe that they cannot break the rope. Growing older with that belief, the elephants are stuck to where they were.”

Our concept of self is often influenced by our childhood experiences, upbringing, family values and interactions, cultural and social norms, etc. The story of the elephants being conditioned into believing that they could not break free of  a small rope reminds me how we can become enslaved by our conditioned beliefs when it comes to doing, being, and living in the present. Some of us might be able to relate with the following:

“I remember feeling really dejected when I failed my Maths exams. I decided not to have anything to do with Maths in the future.”

“I wanted to do ballet ever since I was a child. My parents said it was too girly for boys to do it so I abandoned the idea. I don’t know how to bring myself to do it now that I am in my thirties.”

According to the Human Ecology Theory developed by Urie Bronfenbrenner, it is posited that a child's development is dependent on her or hid environment (Bronfenbrenner, 1992). The direct contacts we had when we were young such as parents or other parental figures, friends in school, and neighbours all have a role in forming our early perception of how we view ourselves. It is helpful for us to be aware of any significant factors in our lives that have laid the groundwork for our present view of ourselves and others. An askew worldview of ourselves could affect us in our decision-making and critical thinking.

Some children tend to seek approval or some sort of validation from their parents in their performances. A conditioned need for approval, like the rope tying the elephant's legs, puts a handicap on an individual’s sense of self when it comes to doing things independently in his or her own best interests. It holds us back from exploring our potential in all areas of life if we constantly need validation or approval from someone else who does not live our lives.

We also tend to be drawn to things that confirm our existing beliefs. There is a sense of familiarity when cognitively, we refer back to our experiences to guide us through similar situations. Failing a Maths test as a child does not mean we cannot develop a sense of numbers as we grow older. We have an affinity to an identity formed when we were younger but as we grow older, we have responsibilities and roles to play in our families and at work. The person we are now is not 100% the same person we once were.

Just as the adult elephant could break the rope, you have the choice to break that rope too. 

BREAKING DURING CIRCUIT BREAKER?



Are You Breaking during the Circuit Breaker?

If you are, you are not alone.

This circuit breaker is now hitting everyone hard. The clock is ticking slower, the sound of water from the tap is louder, the need for money is real and, on top of that, privacy seems impossible with family members working from home. Things that were already complicated enough already have become even more challenging as our minds playing tricks on us within these four walls.

Here are some nuggets to think about how you’re going to get through this.

Catastrophizing about the Future

The fear of the unknown is said to be the basis of anxiety and presently, there is loads of uncertainty. It is not surprising that we start spiralling downwards with catastrophizing thoughts such as “What if I am asymptomatic and I am already infecting my loved ones?” or “I just lost my job. What am I going to do?”

It is valid to be terrified because this is a worrying time. But excessive worrying is not helpful and can make us feel trapped, powerless, and even breathless when our fight-flight-freeze mechanism kicks in to a higher gear. What can we do? I’ll talk about it later in this article.

“My Kids are Going Bonkers!”

It is a hard time for kids too. At a developmental phase where they ought to be exploring and playing, they are now at home bored and transfixed to electronic gadgets to attend school, talk virtually to their friends and play. Parents are wringing their brains dry trying to find things to keep their kids engaged, while struggling to find the time and space to work from home themselves. For people who find it challenging to deal with different dynamics and interactions at home, this circuit breaker is testing our patience as we long for some breathing space for ourselves.

Here are some suggestions that might help us from breaking during this circuit breaker:

Find Rest in Small Things

A client once told me “I get lost when I am showering. I let myself feel the water on my skin.” Small things like cutting vegetables, listening to the sound of the fan, laughing along with kids, etc. can be restful and it helps us connect. Too often we forget to get in touch with ourselves as we become preoccupied with other things. Connecting with our inner selves and let us rest in the moment instead of binding ourselves with matters of alarm clocks and deadlines. Burying ourselves in ‘bad’ news is just not constructive and we end up scaring ourselves and our loved ones more than the virus itself.

Be Funny

We are all a child once. Remember when with limited resources you could easily create something out of nothing? Currently, we are also quite limited because of the circuit breaker but hey, we used to make sandcastles out of sand and draw silly faces on blank pieces of paper? When was the last time you were funny? Laugh or find things to laugh. Besides, laughing together helps us to connect with those around us and it makes us feel less lonely.

Set Future Goals

Take this time to think about what you want to achieve or can we do better. Perhaps draft a plan on what you need to do or where you need to be. It doesn’t have to be big. It can be something small like...what’s for dinner tonight?

Do Your Part

Yes, we are stuck. But we are stuck for a good cause. The impact of this pandemic is unprecedented and there is increased social isolation, loneliness, stress and uncertainties about the future economy. As long as we are doing our part in keeping ourselves and everyone safe during this circuit breaker, the sooner our kids can go back to school, businesses can open their doors again, and life start to roll. We are not a drop in the ocean here. Each of us has a responsibility to overcome this pandemic.

With that all said, at the very least, if I could offer you some comfort, you are not alone in this fight. We are all in this together.

We are here for you if you need someone to talk to. Book at an appointment with us at https://www.elephant.com.sg/appointments.php

BEATING STUDY STRESS



Your mind seems to be have developed a life of it’s own and will not focus on the task at hand… facts and information do not want to stick and you would rather be anywhere or doing anything other than where you are now… clammy hands and heart pounding your deadline is upon you – time to hand in that assignment or time to head to the exam room… you are a student!

While being a student can be an exciting journey of discovery about the world, you and your place in the world, it can also be a time of uncertainty and worry.  Do you find yourself worrying about how others may perceive your academic abilities?  Do you worry about what your parents think?  Your teachers?  Your friends?  Do you find yourself trying to live up to expectations that at times feel unattainable?  Have your eating habits become unhealthy?  Do you feel as though you are not getting enough sleep?  Have you stopped spending time with friends or doing activities you enjoy?

If you answer yes to some of these questions, the stress of being a student may be having an unhelpful affect on you.  When under pressure to perform well it is often the case that students will conclude the number of hours spent in front of books and academic work, will automatically equate to success.  However, spending less time doing more focused and unburdened study, can be a lot more effective to knowledge attainment and retention.

The famous activist Mahatma Gandhi is quoted as saying, “A man is but the product of his thoughts; what he thinks, he becomes”.  When stressful thoughts become a focus of our thinking, we become stressed.  While stress can be a normal physical response to things that we find threatening or disturbing, our bodily sensations become more reactionary and alert to be able to protect us in flight or fight mode. Such heightened feeling is not conducive to or helpful for effective studying and can leave us feeling anxious and unable to focus and give attention needed to study and acquire new knowledge.   

Reducing stress is therefore an important way to study more effectively.  This may be easier said than done, however there are always things we can try do to reduce our stress!

Top tips for reducing study stress:

  • Take a break! Even if you do not believe you have time for a break, take one! A few minutes away from the books taking a walk, having a cup of tea or chatting to a friend can help clear your mind and make the time in front of the books a lot more productive.
  • Do something you enjoy: Plan time into your diary to do things you enjoy. Whether it’s going out with friends, going for a nature walk or reading your book in your favourite coffee shop… whatever you enjoy… plan to do it!   It can be a lot harder to face a study session or assignment when you have nothing to look forward to after.  Sometimes we can focus more on getting a challenging task completed when we know we have something good to look forward to after.  Doing what you enjoy becomes a reward for hard work and can help us feel more motivated.
  • Physical exercise: Exercise can be helpful for reducing all sorts of stress. Getting our bodies active and our blood pumping can be a great way for taking our minds off of what is causing our stress.
  • Breathing: It may seem simple but taking deep breaths can be a helpful way to reduce stress. When we breathe deeply, messages are sent to our brains telling us to co calm down and relax. Our brains then send this ‘calm down and relax’ message to our bodies. If you find yourself feeling particularly unfocused or distracted, sitting still and closing your eyes while breathing deeply can help minimise stress and rapidly bring calm.  Breathing is a common mindfulness exercise and is known for helping us to focus. 
  • Get away from where you study: When taking a break, it can be really helpful to do so away from the environment or physical space where you study. This can give your mind and body a break from the space where you are feeling stressed and help you think about something else for a while.
  • Manage your time: However much you may like or dislike using a diary and planning your time, it can be a very helpful tool for reducing stress. Knowing what needs to be done and when you might get it done, can help relieve stressful or distracting thoughts of “I’m never going to finish!” or “There isn’t enough time to get it all done!”  We are unlikely to travel somewhere knew without working out how to get there, similarly it can be a much easier journey to achieve study success when we have a plan for how or when to do it.
  • Brain food: There are certain foods that are recommended for improving brain function and memory. Some to consider snacking on while studying are ‘fatty’ fish high in omega-3 fatty acids such as salmon and trout; blueberries, broccoli, nuts and seeds, oranges, eggs and you may be pleased to know that coffee and dark chocolate are also believed to provide some brain power!  This is not an exhaustive list and you may find more through research, but ensuring we get food to help us concentrate and focus can certainly help us when studying.
  • Sleep: Getting enough sleep is important for being able to focus and assimilate new learning. Planning time for sleep is therefore also an important part of successful studying.
  • Study support sessions: A number of education institutions have guidance counsellors or academic staff who are experienced in providing study tips and support in developing study methods and styles. We all process and receive information differently and sometimes we need to simply ‘find our groove’ to utilise a study method that suits our individual processing and thinking styles.  I would recommend utilising any such formal support that may be provided or do some personal research yourself to find a way that works for you.

Gandhi also said, “The future depends on what you do today”.  To this end, if you are a student, new or old, struggling to manage study stress, please know that you are not alone and it is possible can change your path by being mindful of what you are experiencing and deciding to change it.

I hope you will find these tips for reducing study stress helpful in some way.  However, if you are finding your studies and academic work a source of significant stress and you do not feel you are able to cope, Elephant Therapy and Training have a range of therapists who can support you.  Please feel free to contact us for more information or consultation if this could benefit you.   

MANAGING YOUR EMOTIONS WHEN THE WORLD FEELS CHAOTIC



The terms “unprecedented” and “pandemic” are seemingly everywhere, along with emotions such as fear, stress, frustration and grief. In psychology, we know that emotions exist for many reasons. At the same time, if they are not managed, they can be unhelpful to our wellbeing and relationships. We need to manage them so we are not panicked, burning out, damaging relationships with the people we care about or invalidating our own needs. Below, I have listed three ways to manage emotions in a time of global crisis.  

  1. Choose facts over noise

Logic and facts are important allies in managing emotions. In Cognitive Behavioural Therapy, we look at the facts and the reality of situations. This skill helps calm the mind as we acknowledge the truth and at the same time, it assists with managing our tendencies to jump to conclusions, “catastrophise” or have all-or-nothing thinking. 

in practical terms, we need to be aware of reputable news sources. in Singapore, gov.sg and the related Whatsapp/Telegram channels are useful for obtaining facts. Ignore forwarded messages on WhatsApp or links reposted on facebook. If the content of such messages and posts intrigue you, go to the source and make an informed decision for yourself.

Being aware of the facts in this manner, will assist with managing your emotions as you will know the reality of the situation. You, and your emotions, will not be rising and falling at every piece of news that may come your way. 

2) Set aside “worry time”

This is a wonderful Cognitive Behavioural Therapy skill to help manage worry thoughts and worrying behaviour. These are the steps:

  • Step 1: Pick a time of the day and set aside approximately 20 mins to worry. For example, 6pm each night. 
  • Step 2: Notice worries over the course of the day and jot them down in a notebook. Postpone the worry. Mindfully return to the task at hand.
  • Step 3: At the designated worry time, pick a spot to worry. It should not be a space where you usually relax (e.g. bed or your spot on the couch), as we do not want to create an association between worry and a place to relax. Pick a lesser used space.
  • Step 4: Worry worry worry. What you will notice is that many of the thoughts you had noted down may no longer be relevant at the worry time. 
  • Step 5: Worry for the entire duration of the worry time. Then, engage in a mindful activity such as cooking or exercise to distance yourself from the worrying you have completed. 

3) Practice mindful self-care

Self care is about following through with what your mind and your body need. This may be easier said than done. It can be helpful to remind yourself that you are living through a period of crisis- an abnormal time in our lives. We need to look after ourselves. When was the last time you did something just for you? 

Self-care is not self-indulgence. To know the difference, ask yourself if what you choose to do is what you truly need and not just what you want. Needs tend to have both short and long-term benefits. For example, quickly eating a cookie as you wait for your next email to load is not self-care. Eating that same cookie, in a mindful space and frame of mind, may be exactly what you need to self-soothe in the moment while nurturing yourself enough to keep working for a little longer. 

COOLING DOWN AFTER THE FIGHT

Taking a self-compassion break in challenging moments with your loved one while staying at home

By: Joy

Have you ever felt overwhelmed by intense emotions and found it hard to think clearly when you are in a heated argument with your partner? What do you and your partner usually do to cool down so both of you could call back your rational mind to resolve conflicts?

Some people are speculating that divorce rate may go up after the COVID-19 outbreak, as couples might be having more fights staying together 24/7 in a confined space. Learning to take a compassionate break and give each other space (both mentally and physically) might be helpful for couples to ease through the tough time.

In couple/marital relationships, we may find one “chaser” and one “runner” (though not in all couples). When conflict or disagreement arises, the “chaser” wants to solve the problem (either real or perceived) right here right now, whereas the “runner” wants to flee away (either from the problem or from the intense emotions). The famous “time-out” strategy is usually favored by the “runner”, not the “chaser”, and if the strategy is mis-applied in a cold and mechanical manner, it may backfire and lead to more resentment, bitterness, and even a sense of rejection in the “chaser”, making the subsequent conversation more difficult.

How to take a break or time-out during a heated argument? The “how” is more important than the “what”. Here are 3 steps you may want to consider:

1. Pause

The first step is not easy: to notice your intense emotions and take a pause, or agree to take a pause, in a heated argument with your partner. In order not to misinterpret the “pause” as a sign of avoidance or refusal to talk, both of you need to have some prior discussion and consensus on this “pausing game”, e.g., agree on gesture of “pause” and place to take a compassionate break, either together or separately. For example, you could invent your own couple gesture to signal “pause”, and once the “pause” is signalled, you and your partner, as agreed beforehand, would go to your own soothing place to practice a self-compassion break, or practice it together in silence.

2. Practice self-compassion break*

Once you settle in a quiet and undisturbed place (it is good to shift out of the “battle” scene), slow down your breath, put a hand or two hands over the heart or elsewhere as an expression of kindness and compassion, send yourself an inner smile if you could, and silently repeat to yourself in a gentle tone:

  • “This is a moment of pain. I know it hurts.”

This is the mindful awareness, to acknowledge intense emotions and allow the emotional wave.

  • “Pain is part of any relationship. My partner is also experiencing pain at this moment, the same as me.”

This is a broadened sense of common humanity, to reduce the tendency to blame yourself or your loved one 

  • “May I be kind to myself"

May I be kind to my partner;

May I give myself the compassion that I need;

May I give him/her the compassion that he/she need.” 

This is the deep wish to be kind to yourself and your loved one. We’re not just taking a break, but taking a compassionate break to re-orientate the state of mind from a blaming stance to a more caring stance.

3. Positive response

After shifting the mind gear to a more caring mode and when you feel ready (only when you feel genuinely ready, this is important), send your partner a positive signal – a smile, a caring and warm phrase, or a gentle hug, as an expression of willingness to reconnect and resume constructive conversation. However, do not rush, if your partner is not ready yet, continue to wait with kindness and understanding. 

*Step 2 is modified based on the self-compassion break, an informal practice designed by Christopher Germer and Kristin Neff in their Mindful Self-Compassion programme. If you are interested to find out more, do check out their self-help book:

 


THE 'JOY' OF BECOMING A NEW MOTHER



So your bundle of ‘joy’ has arrived into the world but inside you are wondering where the feeling of joy is? Becoming a new mum is one of the single most significant and life changing experiences a woman can go through.  From the physical pain of labour and childbirth to the all-encompassing responsibility of keeping a tiny human alive and well to the altered reality of one’s freedom and independence.  Millions of women have walked this path and found it challenging and a struggle at times.  Millions of women are not wrong.  It simply can be hard.  If you are finding motherhood a challenge, YOU ARE NOT ALONE.

In writing this post I asked an international network of women whether they would be willing to share a personal quote about their experience of becoming a mother.  I am so grateful for how much mothers were willing to share.  It is not possible to include everything here but the motivation to share highlights how significant the experience of becoming a mother is.  Here are a sample of quotes from brave mothers:

“It wasn’t this instant love that everyone talks about.”

“For the first few weeks my husband was this incredible help.  We were a team and I couldn’t love him more than at that point.  I don’t know that changed but one day he couldn’t do anything right.  Everything he did wasn’t they way I would do it.  It took me a while to understand that because it isn’t the way that I do it then it is not necessarily wrong.  But don’t tell him that!”

“Being told you can’t have children, you see new babies everywhere!  You long for something you don’t have with such an ache it hurts, you feel left out, punished, angry!  At last when it happens you question yourself, whey do I feel angry, why do I feel guilty, I need sleep, no one understands me, this little person was going to solve all my unhappiness!  AND they don’t!  You still love them, but it is not all roses.”

 “All the routine I had planned for 9 months flew right out the window when we got home.  What happened to just being able to grab your keys and leave the house?!”

“In among the anxiousness, sleepless nights and baby poo, I felt I no longer had the time or energy to do the things I loved which made me feel like me.  Then I felt guilty because I felt a bit of loss when I ‘should’ have been all happy and smiles.”

“I felt overwhelmed by guilt for struggling.  I felt I was failing at everything because I never felt like a good mother, a good wife and later after maternity leave, I felt like I was no longer good enough at my work.   It was as though my confidence was gone and in its place was uncertainty and guilt.  It took a long time to find my ‘new normal’!”

“I wasn’t prepared for how much my relationship with my husband would change.  Our baby was a new person in our relationship and it has taken a lot of work, time and effort to find ways to feel like a couple again.”

“One of the biggest challenges is the pressure that society puts on women to do and be everything.  There should be no negative connotations around having kids and working.  Society puts a lot of pressure on mothers in particular to do everything and be everything.”

“Sometimes parenthood can feel like a constant judgement.  Judgement from yourself…. Am I a good parent, am I doing the right things for the family, should I lose weight, should I have a spotless house?  And from others… how you feed your child, is it too much or too little and the right foods, how much screen time you give them, how they behave.  You’ll never please everyone so its far too easy to feel like you’re not doing it well enough!”

“Becoming a mother is like your heart is floating out of your chest, but kept tethered by your fears.”

“Everyone says having a baby changes your life completely, but I wasn’t prepared for how completely it would change me and how I felt about myself.”

Struggling with new motherhood is a reality across cultures, communities and ethnicities – this is something millions of women experience around the world.  According to the World Health Organisation “Worldwide about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression.”  ( https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/ )

So, while the fact that adapting to motherhood is universally a challenge, we can still feel stigma associated with this struggle.  Such stigma can result in mothers avoiding talking about their challenges

or avoiding getting help.  This can however increase the difficulty and their vulnerability.  It can be helpful to recognise the signs and symptoms of post-natal depression in order to know when you or someone you care about may need some extra support.  Some common signs can be:

  • A sense of helplessness
  • Loss of interest in things that previously gave you pleasure
  • Being tearful often
  • Loss of appetite
  • Anxiety
  • Feeling guilt and self-blame
  • Feeling irritable
  • Feeling sad or low in mood
  • Feeling negatively about or toward your baby
  • Feeling as though you are unable to look after your baby
  • Struggling to bond with your baby and feeling no sense of joy in their presence
  • Struggling with concentration and making decisions
  • Thoughts of suicide or self-harm

This is not an exhaustive list but nevertheless, most new parents are likely to experience one or more of these symptoms at some point, and no single person will feel the same way.  It is also important to note that a previous history of mental health difficulties before or during pregnancy or other factors such as being a single mother or financial worries; can increase a mother’s vulnerability to experiencing symptoms. 

If you are experiencing a number of these symptoms persistently, you may be experiencing some degree of post-natal depression and you may be able to benefit from some extra support and/or using some strategies that may help curb the extent of your symptoms. 

Some strategies to try:

  • Mother’s groups can provide opportunities to socialise with other new mums and their babies and can help combat isolation.
  • A well-balanced nutritious diet can help both body and mind to feel stronger and provide energy, especially if you are breast feeding and producing milk for your baby.
  • Try to get as much sleep and rest as possible. Perhaps not so easy when one has a baby… some people manage this through support of their partner, family, friends and paid help.
  • Exercising can help both body and mind. Although it takes energy, the benefits of exercise can far outweigh the effort.  Exercise classes including your baby, such as mum and baby yoga, can provide opportunities for bonding with your baby as well as meeting others socially.
  • Try to get out the house! Sometimes just walking out the door and going outside can help – being around other people and getting some fresh air can lift spirits. 
  • If you have help and support, taking some time out to be alone or do something you enjoy can be really helpful for relaxing and reconnecting with your ‘before motherhood’ self.
  • Learning to say ‘no’ can help lighten the burden of responsibility mothers feel. When a new life is relying on you for their every need it just simply is not possible to do as much or be there for others exactly as you were before. Finding peace with drawing limits and saying no can help ease the sense of guilt we feel in motherhood.  Such limits will not necessarily be indefinite, but having a few you feel comfortable with, can ease the burden of responsibility and guilt one may feel.

Whilst this blog post is intended to focus on challenges associated with motherhood, it is important to recognise that fathers too face challenges.  This post is not intended to exclude or minimise this reality.  If you are a mother reading this post, or are concerned for a mother you know, and you feel access to professional support would be helpful, we at Elephant Therapy & Counselling would be happy to support you or your love one.

UNWITTING SERVANTS TO OUR MINDS



I was first introduced to the term ‘cognitive bias’ in my first lecture on Cognitive Behavioural Therapy and that lecture taught me to reassess my perception of things, people, and myself.

Our brain has evolved to help us survive – it alerts us when there is danger, helps us think critically to solve problems and the like. To help it do this, our brain has certain predispositions to connect the dots or fill in the gaps in our thoughts, ideas, and experiences. It also magnifies the details we are familiar and comfortable with amid all the other information around us and under the constraints of time (Gilbert, 1998).

Like all things, it is far from perfect. Our brain seeks the means to encode, store, and retrieve the data we have encountered. With the brain constantly working to form connections to help us make sense of what is going on, what happened, and what is going to happen, our brains sometimes form connections even when there is no meaningful basis of relationship between the two dots. This is where cognitive biases might have crept in without us being conscious of them in our daily interactions, thoughts, and perspectives.

“The eye sees only what the mind is prepared to comprehend.”

— Robertson Davies

‘Confirmation bias’ is one such bias. It is a tendency to be drawn to details that confirm our existing beliefs about ourselves and the world around us. This bias is thought to be an evolutionary adaptation to help us evaluate all the information we have and give us a sense of understanding over our experiences and important events in our lives. Living in this complex world, our brain understandably takes shortcuts to simplify the complexities of the world in order to give us a sense of control and a sense of knowing what is going on.

While this bias is a useful shortcut in simplifying a complex world, it comes at a price. Confirmation bias can give us a skewed perspective of things as we let unpalatable facts and evidence sweep past us just to justify our beliefs, feelings, and behaviour. Just because it reassures and complements our worldview, we cannot allow ourselves to take in whatever we hear on the grapevine, while disregarding facts and statistics.

Being cognizant about confirmation bias is a feat in itself but I think we can do better than this. Yes, it is mentally more satisfying and easier to accept information that validates what we think and feel, but do we want to be unwitting lackeys to our minds?

Keeping an open mind is not the extreme of questioning each and everything in our lives. I am sure our foresight and hindsight can be credible at certain times, but an open mind means an open mind. By having an open mind, it allows us to see things that we haven’t seen before, almost like reading the same book over and over again, and discovering parts of which we were not aware previously. By not presuming an outcome or assuming what others are thinking or doing, we can all be better learners and listeners.

SURVIVING TANTRUMS

Tips for dealing with tantrums and staying calm...



Parenting a young child can be a fun, exciting and joyful experience and yet it can also be challenging to manage tantrums.  Tantrums can exist in various forms and include behaviours such as crying, shouting, biting and hitting out.  Whilst it is natural to want to avoid tantrums happening and encouraging good behaviour can help, there is no certain way to stop tantrums from happening.  Tantrums are one of the ways young children express and manage feelings. It can be their way to try to understand or change what is happening around them. However, as their social and emotional skills are busy developing, toddlers and young children can feel frustrated if trying to express themselves and be understood.

If you are a parent of a young child, the likelihood is that you are facing the challenge of tantrums.  In managing tantrums, parents are trying to teach their children to be calm.  Parents can however only do this effectively if they themselves are also calm in their responses to tantrums.

It can be helpful to have some coping strategies in mind to tap into when tantrum moments arise.  Strategies for responding to the actual tantrum, as well as strategies to remain calm, can both be helpful.   

Tips for dealing with the tantrum:

  • Try to find out why the tantrum is happening: There are a host of reasons, for example hunger, tiredness, frustration or jealousy; that could be causing a tantrum. Understanding why the tantrum is happening can help parents identify a relevant way in which to respond, from ignoring the tantrum to giving love and attention.
  • Accept your child’s feelings: Acknowledging how your child’s emotions and how they feel shows your acceptance of their strong feelings of upset or anger. This can help prevent their behaviour escalating out of control and can give them a chance to ‘reset’ emotions.
  • Use distractions: Distracting your child’s attention to focus on something else can be helpful if you notice a tantrum is starting.
  • Wait it out: Once the tantrum has started it will not help to try to reason you’re your child, shout back or lose your temper. It is best to try to stay calm and stay close so your child knows you are still there.
  • Stay in charge and be consistent: In the long term giving in to a tantrum demand will not help as your child will think tantrums give them what they want. Being calm and consistent is important. 

Tips for staying calm:

  • Try to take the pressure off: It can be rather daunting and anxiety provoking as a parent to feel it is your job to prevent tantrums from happening. Accepting that tantrums will happen and are a normal part of your child’s development, can take the pressure off and reduce the ‘fear’ of a tantrum happening.  If we can accept tantrums will come, we may feel calmer when they do happen, and more able to focus on our response in the moment.
  • Limit words: It can be a lot more stressful trying to reason with or talk over a child who is screaming. It is not going to work as they cannot hear their parent, not in their emotional state or because of the noise.  Waiting until your child calms down to talk through the situation can help you both feel calmer.
  • Remove your child from the situation: If a child’s meltdown is in public, it may be hard to stay calm if it feels like everyone is watching. Your child may also be feeling watched and respectfully removing them can help them feel protected and accepted, and help you stay calm.
  • Remove yourself: If it is a struggle to remain calm, a moment away from the tantrum causing frustration or anger, may be needed. If it is safe for your child, try going into a different room as this can help you to calm down.  Taking some deep breaths can help slow thinking and bring calm.  (You may also find reading Dr Kavitha Dorairaj’s article, “3 Ways to Secretly Manage Your Anger
  • Considering what an observer might see: This is perhaps a more challenging tactic however I have had many parents acknowledge that they feel more in control when finding their child challenging, and motivated to stay calm and respond with love to their child, when other people are around and witnessing the moment. This seems to be attributed to seeing themselves as others will see them and this increases self-awareness.  When trying to stay calm, it may be helpful to try and pause and imagine what you would want an observer to see you do in response to a tantrum – this process can help visualise and follow our desired response.

I have never met a parent who finds dealing with tantrums easy - it is not an exact science and so keeping some helpful tips in mind can hopefully be helpful. I wish you well in your journey through tantrums and urge anyone struggling beyond their or their child’s coping capacity to seek further support through counselling or specialist intervention.


GOING WITH THE FLOW

Letting nature take its course to ease our anxieties. Learnings from martial arts.



I once had a client who described the feeling of anxiety as "worrying over an important exam that doesn't exist", and an anxiety attack as "trying to breathe but there isn't enough air in the room". 

Anxiety is said to manifest itself in a set of complex cognitive processes and behavioural responses to events or circumstances perceived as threatening (Chand and Marwaha, 2019). In my previous blog, I mentioned that fear was a fundamental contributor to anxiety. Everyone feels anxious from time to time when things do not go as planned or when our family members don’t not reciprocate in the way we think they should. Fear is indeed innate in all of us and it is meant to help us respond to danger. 

As in many things, when it goes beyond a certain threshold, feelings of anxiety and anticipation can go off the charts if left unchecked. We tend to draw a complete picture or a conclusion as to how things should unfold in our minds. When an outcome is unexpected and we are not prepared for it, we tend to feel that we are not in control. While some just adapt to unforeseen circumstances, others may feel like being on a rollercoaster that only goes up.


Going with the Flow

I was introduced to this term by my Ninjutsu teacher: uke-nagashi (收流). This term is used in most Japanese martial arts to describe a set of movements where one would receive an attack, without interfering with the flow or energy of the attack. Most attacks happen when we are mentally unprepared, as do impromptu quizzes at school or spot-checks at work. When we feel confronted unexpectedly, we are forced out of our comfort zone.

Worrying excessively over an unexpected comment from a friend or over a project presentation at work is mentally draining. It also limits one's potential to see the bigger picture of a problem or situation. Learning to go with the flow when the tides roll in, instead of staying fixated on what we are looking for, is a better way to manage our expectations of ourselves and of others. By adopting a more adaptive mindset, our scope becomes less myopic and it helps us explore and learn more about ourselves and other people.

We all have times when we are worried and worrying makes us feel restless. However, when we worry excessively and disproportionately about things that do not fall under our area of control, it impairs our ability to stay focused on our daily tasks. We can feel so overwhelmed that we lose sight of what is important at present and think too much about future or past events. It is not wrong to think or worry, but when unhelpful thoughts become so repetitive that we feel unnecessarily nervous with a sense of impending danger or doom, we may need help to cope with anxiety. 

Things can always go south or north without us knowing when or how. Letting nature take its course while we take what’s there would be a better strategy than being drowned by waves of unwanted thoughts. So, let’s grab our surf boards and go with the flow!

WHY DO I STRUGGLE TO SAY "NO"?

Reasons why it is hard to speak up for your own needs and how to overcome this


Do you struggle to say no?

Do you often feel that you have "no choice" but to say yes?

Do you say no, but carry a heavy sense of guilt or anxiety after (such that you wish you had said yes to begin with)?

Do you get angry whenever someone asks you for something because you feel that they are imposing onto you?

If you identify with the above, you likely carry a subjugation wound. These wounds are often formed when growing up with a domineering parent. This parent used anger, threats, shaming and withdrawal of affection in order to make us submit to their desires. Sadly, such methods work because it plays on a child's inherent desire for their parents' love and approval. To be separated from their parents' love is a child's greatest fear. A child would rather surrender their voice and intuitive wisdom, than to lose their parents' love.

The result is a painful emotional and relational captivity. As children, we learnt to bury our voices. We distrusted our feelings and opinions, thus couldn’t know what we wanted and sought other domineering personalities to "guide" us — perpetuating the cycle.

This made us more susceptible to low self-esteem, depression, anxiety, anger, fatigue, eating disorders, alcohol and drug problems, workaholism, and anything to mute our emotions. After all, our emotions contain our primal voice (e.g. babies cry to communicate needs). But if our family only had a dominating parent's voice, we would create ways (even self-damaging ones) to suppress our voices so as to ensure our survival.

As we grew and our worlds extended beyond our family, this was both liberating and terrifying. We were deprived of the nutrients needed for self-confidence to develop, how then could the world now ask us to show up confidently in our jobs, social interactions and romantic relationships? How could they ask us to speak with our voices and trust ourselves when we spent our entire lives denying these very processes from maturing? It is like asking someone to show up at an event wearing white when they have spent their entire lives wearing grey. They do not even know what white feels like on their bodies.

How do we heal?

1. become aware of your wound.

Feel the pain that your inner subjugated child has carried. Promise your inner child that you will end its captivity — for you (your adult self) will open the door for it to rage, cry, grieve, laugh and speak again. Whatever your inner child feels and tells you, you will not abandon, shame, reject and attack him/her. You can give your inner child the voice that their natural birthright deserved. You can be his/her new parent.

2. reconnect with yourself.

Ask yourself, “What do I feel, need and want?” Listen to your feelings and explore the underlying reasons behind them. For example, your exhaustion and resentment may be telling your that you need to also take care of yourself, and not just other people. Your anger may tell you that you are doing more than your fair share of work at home or at the office.

3. ask for what you need.

Start with some specific needs that others may be able to assist with. For example, you could say to your spouse, “I love to connect with you. At the same time, I often feel very tired as I struggle to manage the children and housework after a long day of work. Do you think you can help me out with the dishes?”

Remember that even if the other party is unable to assist you, you would have met your most important need – that of having a voice – when you speak up for yourself.

4. tolerate emotional backlash when you speak up for yourself

Most of us suppressed our voices because somewhere in us, we instinctively felt that our voice was a threat — a threat to receiving love, approval, affection and consequently, our self-worth. As a child, it was a no-brainer. Of course, we would surrender our voices if it meant losing our relational oxygen. Keep us in a cage and visit us with "love". Children would take that over running free and alone. 

But as we grew, the consequences of our cages became unbearable. To set ourselves free and speak up, we must be prepared that we will face the very monsters that we have spent our entire childhood running away from. Are you afraid of being called selfish? You will be called that. Are you afraid of guilt-trips? You will receive that. Why?

People who have not done their own healing work are spiritually blind in varying degrees. They will not be able to see you for all that you are. Their limited sight only allows them to view you as an object in relation to their own comfort and pleasure. To speak up would be to separate yourself from them. You would be saying, "I am not your object. I am an independent human being with my own opinions, values, needs, wants and goals." Asserting your independence would cause separation anxiety — the key is to tolerate this.

Remind your inner child that it is absolutely normal that he/she would feel terrified. Cry with your inner child for the times he/she contorted themselves to fit into cages just to be partially seen. Tell him/her that any difficult emotion you now experience is worth ending his/her captivity for. Over time, the anxiety, guilt, shame and self-doubt will reduce in intensity and frequency. New emotions of courage, self-love and self-gratitude will arise. This is the new world you will lead your inner child into. Your inner child will run freely here — this time, not alone, for you will be here.

If you find it difficult to stand up for yourself and speak up, please reach out for help with one of our psychologists or counsellors to support your healing. Your voice matters.  

TWO FUNDAMENTALS OF ANY HEALTHY RELATIONSHIP




As human beings, we are social beings. Romantic relationships, friendships and work relationships are all important to a life worth living. When these relationships are not healthy or strong, there may be adverse effects to our mental health. In fact, in my practice, I have noticed that many of the challenges that my clients face are related to relationships. Below, I have listed two fundamental ways to build, maintain and improve healthy relationships. I have also included a small exercise you can complete on your own to begin the path to healthy relationships.

1. Pay attention and interest

This is the most basic building block for every kind of relationship. Being present and showing interest in the other person is fundamental. This is not new information as we know this to be true at an intuitive level. In fact, I would go so far as to say that we already know how to do this and have done it at different points in our lives.

We have all paid attention and shown interest when we are consciously trying to build a relationship. Think about first dates or job interviews or when you are listening to your niece or nephew tell you about a character on Paw Patrol for the 10th time that day. All these scenarios have a few characteristics in common.

  • Facing the person and giving them appropriate eye contact
  • Nodding and changing facial expressions to suit the context
    • e.g. smile for positive statements and look concerned for something distressing
  • No multi-tasking
    • i.e. put down the phone
  • Verbally reflect to show that you understand
    • This could be in the form of “parroting” or repeating back what the person has said. Or being sensitive to non-verbal clues to understand what the person is not
  • Acting interested
    • This demonstrates respect for the other person and what they are trying to communicate, even if you may not be excited about the topic

Practice Makes Progress: This week, in one of your relationships, commit to facing the person and making appropriate eye contact when they speak. This might mean that you turn your chair away from your computer to face them, or put down your phone, or sit down to match their eye level when interacting with them.

2. Be respectful

It can be said that respect is the cornerstone of every healthy relationship. In Aretha Franklin’s famous song, it is all she asks for from her partner. Respect in any relationship refers to treating the other person as an equal, as a human being. If there is mutual respect, it allows for openness, validation, acceptance and trust. Respect in a healthy relationship looks like 

  • Valuing the other person’s opinions even if you might not agree with them
    • “Given who you are as a person, I understand where you are coming from”
  • Loyalty to your shared values and dreams
    • the opposite of this would be betrayal. In romantic relationships, this could be sexual in nature or siding one’s parents over your partner. In friendships or work relationships, this could look like passive aggressive behaviour, not putting in effort, or even sabotage.
  • Supporting the other person’s interests and goals
  • Honouring each other’s boundaries
    • This might mean giving space or not teasing them about something they are sensitive about.
  • Fighting “fair” (not trying to “one up” the other)
    • This refers to not doing something worse to demonstrate how hurt you are or to prove a point
  • Acknowledging the “kernel of truth” behind what the other person says or does
    • Seeing and understanding why they may say or do something.
  • Knowing when to make a point and when to keep mum
  • Build trust by doing what you say you’ll do

Practice Makes Progress: This week, do at least one thing that will build trust in a relationship. In any relationship, this could be offering to do something that would be meaningful to the other person and then doing it.

Keep these two fundamentals for healthy relationships at the back of your mind and put them into practice as often as you can. 

COPING WITH UNCERTAINTY



The recent outbreak of the new coronavirus, 2019-nCoV, has everyone on high alert. While we have faced pandemics such as the swine flu (H1N1) and the severe acute respiratory syndrome (SARS) before, this new coronavirus seems to have shaken the world as it is thought to be able to spread before symptoms show up in an infected individual. 

Not knowing what is going to happen is scary, and it can make us feel like we are being thrown into quicksand. As curious humans, we also often seek to understand and to control in order to feel safe. When we are hit with an unknown unexpectedly, our innate survival alarm bells start to ring.

Amid this outbreak, with uncertainty looming over us, it is almost inevitable that we feel in danger and this feeds our worry and anxiety. Yes, it is paramount to be vigilant at times like this, but we also need to be aware of a potential compulsion in us to wash our hands again and again every ten minutes just to make sure they are clean and that we are safe as this may put us at risk of being unable to deal with uncertainties that are very much part of life. When we are unable to cope with the unpredictability life throws at us, we are also more inclined to feel defeated and depressed. 

Considering the nature of all things, and all the seemingly impossible possibilities, nothing is 100% absolute, and in this case, there is no guarantee how this virus outbreak could pan out. 

“What can we do then?”

This question reminds me of a quote from one of my favourite books, Mitch Albom’s Tuesdays with Morrie:

“Don’t cling to things because everything is impermanent.”

Instead of clinging on to the feelings of helplessness during this difficult time, we need to trust the nature of ephemerality of such events. Just as we have endured previous plagues, this too shall pass.

Yes, it is hard not to give in to how we feel given that one of the main functions of our feelings is to help us detect danger and survive, but how we respond to fear plays an essential role in our mental health.  An inability to cope with the fear of the unknown can make us feel anxious and helpless, and before we become aware of it, we start catastrophising the situation with averse and unhelpful negative thoughts which constantly having a field day in our minds. It is even expounded that the fear of the unknown is the fundamental component of all anxiety disorders (Carleton, 2016). 

In cognitive behavioural therapy, we encourage clients to manage their intolerance to uncertainties by recognising and accepting that some things are just not in our area of control. While we cannot control the direction the wind is blowing and the evolution of the coronavirus, we could practise control and responsibility over our choices. We can choose to see a doctor when we are feeling unwell or have more servings of vegetables and fruits in our diet or we can watch comedies all day long and have a good laugh. 

If you feel that you need support and a listening ear, please feel free to contact us at Admin@Elephant.com.sg 

 2nd February 2020

TIPS ON HOW TO TACKLE PROCRASTINATION

By: Adriana

How many times have we heard ourselves or other people say things like: “I haven’t got time”, or: “I am too busy”, or: “Oh… I am just lazy”, or “I have got plenty time!” or: “this assignment is just too difficult”? We can easily find the most creative and brilliant excuses when it comes to avoiding certain tasks. Such an avoidance is what, in jargon, we, psychologists, call procrastination.

What is procrastination?

Procrastination is a coping behaviour characterised by the action of delaying or postponing emotionally triggering tasks, despite their relevance or burning deadlines. Its function is to avoid uncomfortable feelings underpinned by negative core beliefs.

In other words, people procrastinate due to their inability to regulate negative feelings around a – triggering – task (Fuschia, 2016), therefore effectively delaying the time to deal with uncomfortable feelings – such as shame, fear of failure, boredom, fear of being punished for being “imperfect”, fear of exposing oneself and being “found out” as a fraud/impostor – all driven by underpinning learned beliefs about oneself and/or trapped memories formed within the context of past experiences and conditioning.

Taking our inspiration from the start of the Lunar New Year and new decade, let us make sense of this disempowering pattern of behaviour in greater detail and see how we can understand, tackle and transform it, with the goal of thriving and flourishing in our lives (Recommended reading: Procrastination, health and wellbeing by M. S. Fuschia).

The other face of perfectionism?

When we feel we can’t meet our internal – perhaps unrelenting or unrealistic – standards and expectations (generally an internal expectation to deliver perfection linked to some form of ideal self, possibly underpinned by shame of the real self thus the consequent drive to atone, fix and perfect oneself) we may avoid and procrastinate. In so doing, anxiety increases progressively and opportunities are often lost. This is why procrastination has also been understood as a self-harming behaviour in literature (Steel, 2012). 

The perfectionistic part can be reduced through self-compassion, self-acceptance, increased leisure time and activities, as well as by accepting that there is no such thing as perfection (Recommended reading: The Gifts of Imperfection, Brene Brown).

Impulsiveness and lack of discipline

Procrastination could be underpinned by the inability to tolerate discomfort and frustration, to delay immediate or short-term gratification, to persevere and tolerate the boredom of undertaking mundane tasks. Such a habit can also lead to significant lost opportunities in life and may result from lack of competent guidance, limit setting, structure, holding and boundaries growing up or from the internalisation of maladaptive coping behaviours displayed by relevant others (e.g. parents/caregivers) during the developmental age.

The lack of a regular, gentle routine and compassionate self-discipline, paired with a lack of tolerance to frustration and/or a wish for immediate gratification is a habit that can be transformed with perseverance and commitment by responding to one’s needs, in this case, the need for limit setting and progressive increases in one’s tolerance of discomfort and frustration (Recommended reading: Do/breathe/calm your mind. Find focus. Get stuff done by Michael Townsend Williams).

Fear of success?

A more hidden aspect underpinning procrastination may be an unconscious fear of success and the fear of other’s retaliation, or may be driven by an invisible loyalty to one – or more – relevant other/s (e.g. a parent/s or caregiver/s). If this is your case, be mindful and try to break through these invisible forces (tips below).

Transforming to thrive

Here are some helpful tips to tackle procrastination, whether driven by perfectionism, lack of self-discipline, low tolerance to frustration or other forces. Just choose the tips that you find helpful in your particular circumstances:

  1. Be a curious explorer of the negative feelings triggered by the task
  2. Remember these uncomfortable feelings will pass like clouds in the sky. Indeed they contain relevant information for you to know what is happening to you and assess what you actually need in the present moment
  3. Do the tasks you hate first – literally first thing in the morning – and get them out of the way
  4. Learn to tolerate discomfort and meet your challenges with total acceptance and kindness towards yourself
  5. Remind yourself it’s ok to make mistakes as from them, you can learn and grow 
  6. Remember you only have to produce work that’s good enough. It doesn’t have to be perfect!
  7. Reassure yourself that you are OK and lovable, regardless of your performance
  8. Remind yourself that your worthiness does not depend on your achievements
  9. Learn to discriminate between constructive and destructive criticism
  10. Be open to – and learn from – constructive criticism whilst not letting destructive criticism in
  11. Explore whether your fear is stemming from past experiences (e.g. being scolded or disapproved for a low grade) and, if so, do some tapping combined with positive affirmation (e.g. TFT Tapping http://tfttapping.com)
  12. Place 100% of your attention and effort on performing a given task, being fully absorbed. Each time you catch yourself drifting away, take a deep breath and gently bring your attention back to the task in hand fully absorbed. Repeat this again and again, as many times as you find yourself drifting away. This is a practice and it will get better through repetition and perseverance (albeit you will never be perfect!)
  13. By doing the task, you will soon discover it’s not as difficult or dreadful as you thought (what’s dreadful is the anxiety that progressively increases, whether consciously aware or not, as a result of procrastination itself, and the consequent guilt and lack of control/failure to achieve) so you will actually feel empowered
  14. If you slip (and procrastinate) – and you can indeed, as this is all new – forgive yourself and carry on. Keep going. When forging new habits, every baby step counts so don’t give up! 

Adriana Giotta is the founder of Elephant Therapy & Training and a senior Clinical Psychologist, integrative psychotherapist, executive in-depth and peak performance coach, writer and researcher. Sign up for Elephant’s weekly free tips emailing: Admin@Elephant.com.sg  

27th January 2020

COPING WITH TRAILING SPOUSE SYNDROME


Since entering expat life in Singapore I have become more aware of ‘Trailing Spouse Syndrome’. 
A ‘trailing spouse’ is someone who has moved abroad with their spouse so the spouse can take up employment abroad.  The idea of a ‘trailing’ spouse is that this individual has followed their spouse for the spouse’s career and in effect has left behind their family, friends, social network and any other attachments to the home they have moved away from.  The affect of such a move, particularly for previous dual income or dual career couples, can be significant.  Some may already have been ambivalent about such a move but even for those who are enticed by the allure of adventure and excitement associated with living abroad, can often find the realities of expat life to be more challenging than anticipated.

Trailing Spouse Syndrome refers to someone experiencing feelings such as loneliness, isolation, loss of direction, loss of identity, being ‘homesick’, lack of worth and purpose.  This can be particularly daunting for individuals for whom such feelings are completely new, and they may find themselves seriously doubting whether expat life is worth it.  This can place pressure on relationships and family dynamics when children are involved, which in turn can also further exacerbate or add to trailing spouse symptoms.

There is a risk that a spouse struggling with this syndrome and who is feeling isolated without a support network of their own, may adopt less helpful ways to cope for example turning to alcohol and drinking too much, self-medicating, excessive spending beyond means or withdrawing and disengaging.  Such coping mechanisms can be a road towards depression.

If you are experiencing any symptoms of trailing spouse syndrome, it is important to know that 1) You are NOT ALONE! and 2) Many have gone through this and SURVIVED!  There are ways to move through this experience and come out the other side enjoying life abroad.  If you are experiencing any of the many symptoms associated with trailing spouse syndrome, here are some ideas and tips for coping:

  1. Joining a club or group of interest: It may be helpful to focus on finding groups or clubs that match your interests. While trying to settle in a new place finding connection with people who share your interests and/or who are like-minded may be comforting. Common interest may naturally lead to companionship and friendship evolving comfortably.
  2. Exercise: Exercise can be good for physical health and can also help counteract any possible weight gain that can come with lower mood and changing diet. Importantly, exercise also means that your body will release chemicals that can help improve mood and our mental health. Joining a gym or exercise class may also be a way of meeting new people and getting out into the community. Exercise need not feel daunting and can be as simple as going for a walk.  As well as the benefits noted above, this can be a way of exploring your new environment and finding new places of interest.
  3. Engaging social media: There are many forums on Facebook and other social sites where information is shared daily, or on which you can ask for recommendations, about every day things one needs to know when you move to a foreign country. From where to get a hair cut to best places to live and go out.  It can be hugely informative!  Social groups often have their own sites or forums advertised or referenced and may help you find a group to join.  Many expats have found meaningful friendship by being brave and joining one or more of the many groups or activities frequently advertised.  If you are looking for something in particular and ask, you may very well get some helpful recommendations or feedback.
  4. Finding time to be a couple: If you are a parent and have moved abroad with your spouse you may find yourself at a loss without practical childcare support from family and friends. You may miss going out together and ironically through times of such big change, it can be very important for your relationship, to have time together as a couple to reconnect.  If you do not employ full time help, there are numerous websites advertising childcare services and if you shop around it is possible to find someone you feel comfortable trusting with your child/ren.  You can ask neighbors for recommendations or there may also be expat teenagers around who could be enlisted for babysitting.
  5. Learning the language: If you are keen to ‘acclimatise’ and immerse yourself in your new environment, you may find going to a relevant foreign language course rather stimulating. Not only will it get you out, you will get to meet new people and feel intellectually stimulated which can help with confidence and developing a sense of purpose.  Learning the language may also improve job prospects as well as enable you to engage more with local people within the community, learn about local culture and feel more a part of the community. 
  6. Volunteering: Those struggling with symptoms of Trailing Spouse Syndrome often feel a lack of direction or purpose, which can affect self-worth and confidence. If you have the time and altruistic interest, becoming a volunteer can be a very positive use of your time. This can be a win-win situation as there are always charities and organisations in need of volunteers and your help can be hugely beneficial to them whilst the experience can also be stimulating, purposeful and enjoyable for you. 
  7. Self-awareness and seeking help: Times of significant change can be a trigger for feeling unsettled and unstable. Being aware of your own wellbeing and trying to recognise the signs of not being well can help you realise when you may need to try and make changes to have a happier life abroad.  If trying out tips or ideas such as the ones listed above does not prove helpful and you, your partner or you both as a couple; need further help to process the struggles and problems that come with Trailing Spouse Syndrome, please know that help is out there.  Depression or other problems affecting ability to cope is common within the expat community and seeking counselling can be of great support to get through such times. 

If you are experiencing symptoms of Trailing Spouse Syndrome and the struggle to cope feels beyond your emotional capacity, Elephant Therapy and Training have a range of therapists who can support individuals or couples struggling with Trailing Spouse Syndrome.  Please feel free to contact us for more information or consultation if this could benefit you.  I hope the ideas above may come as some sort of help for you in your journey. 

20th January 2020

HOW TO ENJOY SINFUL SNACKS DURING CNY?

 by: Joy

Christmas and New Year is just over, Chinese New Year is around the corner. What first comes to your mind when you think about CNY? Besides visiting relatives and receiving (or giving) Ang Pao, what you can’t miss is the food. With all the sinful snacks…Bak Kua, pineapple tarts, mini spring rolls, and now comes popular salted egg fish skin and chips…how can you resist temptation to eat more? How to enjoy your favourite snacks without guilt? The secret is mindful eating.

Here are some tips for mindful eating:

1. Pause

If you are watching TV or talking to relatives, and realise your hand has automatically reached out to the food, or the food has almost reached your mouth, remember to pause and take a moment (a few seconds) to turn attention towards the snack, look at it mindfully, asking yourself: “is this what I really want to eat?”

Once you interrupt your automatic tendency to eat mindlessly, expand your awareness to glance at the whole range of snacks in front of you (I am sure there will be many), and see what options are available.

2. Exercise your power of choice

Exercise your power of choice by taking a slow breath, tuning into your body, and asking yourself: “which food is calling you right now?”, “what does my body feel like eating now?”, “sweet or savory?”. Pick the snack that is most appealing to you.

3. Eat mindfully

Even you’re busy watching TV or talking to relatives, you can still choose to spend a few moments with the food you’ve chosen and eat it mindfully with your five senses. You can choose to pay attention to all senses, or just some of the senses (if you got to quickly divert your attention to others during CNY gatherings):

  • See the food, investigating its shape, size, and color with curiosity, as if you are seeing it for the first time
  • Touch the food, feeling its texture (with hands and tongue)
  • Smell the food, fully enjoying the fragrance of the snack
  • Taste the food, taking small bits and chewing it slowly, and swallowing the food only when you’ve extracted every single flavor from the food, obvious or subtle.
  • Hear the food, paying attention to the sound when you eat or slowly chew the snack, e.g., crispy sound when you eat chips, and chewy sound when you eat Bah Kua.

4. Savour the experience

After you finish eating the first piece, take some time to savor the whole experience of eating that one piece of snack. Notice the aftertaste in the mouth, how satisfied your stomach and the whole body feels after taking in this small piece of your favorite snack. Also take some time to appreciate and express gratitude to whoever made the snack available to you.

5. Repeat steps 1-4 for your next bite (second piece of snack).

You may choose the same snack, or a different snack, and notice how it is same or different from your first bite (first piece of snack). Soon you may realise you reach peak satisfaction much faster than you expected, with much smaller amount of snacks. Your wisdom will also tell you when to stop, as with conscious awareness and power of choice, you are no longer munching food mindlessly.

Try this mindful eating exercise, discover the wisdom of “Eat Less, Enjoy More”.

Book recommendation:

<The Joy of Half a Cookie – using mindfulness to lose weight and end the struggle with food> by Jean Kristeller, PhD with Alisa Bowman

13th January 2020

SURVIVING CHINESE NEW YEAR

Tips for those who dread this occasion!

 

Chinese New Year (CNY) is one of the biggest cultural celebrations in our country. Some people view it as a precious occasion to get together with people they care about. They consider it a time to bless the young and elderly with monetary blessing (“red packets”). They love the CNY decorations and communal festive atmosphere shared by most people in the country.

At the same time, there are also many who dread CNY. They feel forced to meet relatives that they do not have a personal relationship with. They find it meaningless to sit in front of a television and consume a wide range of CNY snacks, just so that they are present. They do not find the family motto of “showing face” personally inspiring. Underneath their dread, they desire deeper connection and meaningful conversations, which these annual meet-ups do not often provide. It is especially difficult when they also feel that they need to hide parts of themselves that may be less acceptable to their family culture. These include hiding their irritation when asked about their relationship status, children’s grades, etc. Donning a “smiling mask”, they censor their emotional responses. They are physically present, but feel incredibly disconnected with others and themselves.

If this describes your experience of CNY, Dr. Jean offers 4 suggestions that may help below:

Tip 1: Show up for visits in whatever way you wish to, while keeping your inner child/inner self in mind.
This means that you may wear a mask because that make you feel safe at the moment, or remove that mask because being authentic is your way of feeling even safer with yourself (even if not with the other). Either way, tell your inner child (i.e., the part of you that desires authenticity and connection) that you see him/her and they are important to you. Tell them that you value who they are and that YOU see them. Keep him/her in mind and speak to them privately to reassure them of their worth.

Tip 2: Excuse yourself from conversations that you do not wish to engage in.

This includes gossips, unkind discriminatory talk, complaints, etc. You are not obliged to listen to anything that you do not wish to. Give yourself permission to excuse yourself from anything that is not aligned with your values.

Tip 3: Decide which gatherings are important to attend and which you can practice saying no to.

Some people manage their parents’ expectations by going overseas. Another way of managing parental expectations is having a chat beforehand on who is a priority to visit (for your parents and yourself). Then, personally make your own decision on who you will visit and not visit this year. Communicate this clearly, calmly, and non-apologetically. For example, you could say, “I will only visit so and so this year. I know that this is not our usual family visiting schedule. This year, this will be my schedule to balance both the family values and my personal needs”. Remind yourself (i.e., your inner child) that you are worth protecting and bearing others’ possible displeasure for. Others are free to have an emotional reaction – you are not responsible for orchestrating the most comfortable emotional experience for them.

Tip 4: Create a new CNY tradition you find meaningful or enjoy for yourself.
This may include factoring in time for rest (e.g., a nap), for a hobby (e.g., recreational activity), and for meaningful connection (e.g., meeting someone you feel safe to be yourself with for a coffee).

As children we were powerless in needing to follow our parents to every relative’s home. But as adults, we don’t have to live with the same default powerlessness regarding CNY. If you’re finding it difficult to set some boundaries in order to protect your emotional health, consider seeking a professional clinical psychologist’s help to do so. Your wellbeing matters.

Finally, here are some books that Dr. Jean recommends as helpful for learning to speak to your inner child and setting boundaries:

  • Homecoming: Reclaiming and healing your inner child. (by John Bradshaw)
  • Affirmations for the Inner Child (by Rokelle Lerner)
  • Boundaries: When to say yes, how to say no to take control of your life (by Henry Cloud)

6th January 2020

3 WAYS TO SECRETLY MANAGE YOUR ANGER

Push Pause on the "React" to get to the "Respond"


You feel your neck and ears get hot, you notice a change in your breathing and feel an urge to attack (verbally or physically). You are experiencing anger, frustration, indignation, annoyance, fury or even vengefulness. You or someone you are about may have been threatened or attacked or disrespected. An important goal may gave been blocked. Something may not have gone your way.

There are many reasons why we may frustrated or angry, however, we may not always be in a context to express it effectively. For example, at a work meeting or at a family gathering. The challenge in these contexts is that you may feel a rise in anger that is valid but your urge to react not be appropriate for the setting. Verbally attacking your boss or insensitive family member or spouse will feel good in the moment but will not be effective in the long-run. So, how do we Pause the React to get to the Respond? 

Here are three ways:

  1. Willing Hands

Willing Hands is a deceptively simple way to bring down feelings of anger. It is a Dialectical Behaviour Therapy skill with Eastern philosophical roots. The technique’s premise is simple: change your body to change your emotions.

How:

  • Face your palms up
  • Relax your fingers
  • Place your open hands on your lap or facing forwards by your side
  • Hold the position until you begin to notice a change in your emotions

The open position of your hands signals your mind to bring the anger down. It is simple yet works extremely effectively.

Dr Kavitha’s tip: Practice this skill with minor irritations when out and about so you are primed to use it when bigger feelings of anger arise.

  1. Dragon Breathing

Breathing techniques are very useful in managing emotions and distress. This particular technique can be helpful to quell the rage and “fire” within us when we feel like we might explode.

How:

  • Sit up straight
  • Breathe in through your nose (feel your chest expand)
  • Breathe out very slowly through your mouth while imagining fire or smoke being released (if appropriate, whisper a roar)
  • repeat 3-5 times

Dr Kavitha’s tip: Commit to a long exhale. This will activate the parasympathetic nervous system to trigger relaxation.

  1. Distract Yourself

You have probably used this skill many times when feeling distressed. For example, turning on some music, scrolling through social media or calling a friend. When we engage in a distraction, we disengage from the emotion. However, in a world where with many distractions, it is a skill to harness it effectively.

How:

  • Pick something appropriately distracting for the context you are in. For example, consciously doodling on a notepad when you are in a meeting; turning to a cousin to ask about their weekend plans when at a family gathering; flicking through social media if you are a passenger in a car.
  • Engage in the activity completely and mindfully.
  • Continue until you notice the physical feelings of anger begin to subside.

Dr Kavitha’s tip: Keep bringing your mind back to the activity if you notice it wandering back to the incident that made you angry. Full and complete engagement in the activity is the most effective.

The three skills listed above are effective in Pausing the React to help you Respond effectively. Remember, these skills are not designed to cease the anger. They are used to bring down the feelings of anger and manage the urges to do something you may later regret. Once you have hit Pause on the React, use your problem-solving and effective communication skills to Respond appropriately and effectively.