The Depths of Codependency

While that seems like an over-exaggeration to some, the feelings and behaviours exhibited by someone who is codependent are very real. There’s some pervasive sense of responsibility, especially if someone is going through hardship, to the point where personal needs or self-identity just doesn’t matter.

Its Twisted Roots
The strongest root lies in our childhood familial environment. Those of us who grew up in dysfunctional families, are more likely to develop codependency.

Some examples:

Ψ      A family member with chronic addiction or illness. A child is parentified, and grew accustomed to constantly sacrificing freedom, or interests, to care for their family member. “They won’t suffer if I give them my allowance. I’ll be fine.”

Ψ      Abuse. A child believes they are unworthy of love or deserve the punishment. “I need to do more, to get the love or care I wish for.”

Ψ      Domineering or controlling parents. High expectations and harsh punishments. “As long as the expectations are met, I can get approval, affection. Or I won’t be punished. It doesn’t matter what I feel!”

Its Warning Signs

Ψ      Purpose and self-image is tied to relationships with others

Ψ      Self-expression is difficult – needs, opinions, emotions

Ψ      Fear of separation, or abandonment

Ψ      Others’ opinions or approval is a need, not a “good to
have”

Ψ      “Their needs are more important, mine aren’t”

Ψ      “I’m doing all this to take care of them, to rescue them”
(cue need to control)  

The Battle Shields Against Codependency

Ψ      Knowledge: Ignorance is not bliss – recognising the signs and identifying it bears the foundation for everything else.

Ψ      Check: Thoughts, feelings, behaviours about yourself, and your relationship with others – have we lost ourselves in the process of giving away too much?

Ψ      Craft the blueprint: Think - how do we support others without losing ourselves? How much can we give without losing everything? What can we protect or enhance? Negotiate, but clarify what our loved ones need as well – it’s collaborative.

Ψ      Build the shield: It’s not going to be perfect and full-proof, and the first few times will always be rusty. But over time, we upgrade or learn how to do it better. Find what works for us, practice, fail, and learn again!

Humans are interdependent creatures. We can’t survive alone, but we don’t have to live for others as well. We each have our own needs and wants. Although interdependency is like a scale that can never be fully balanced or level, at the very least, it’s not all the rocks on one side.

Can ChatGPT Replace a Psychologist?

With its sophisticated responses and continual technological advancement, ChatGPT 4 has surpassed many previous versions of AI chatbots, raising the question of whether it could one day replace human experts.  

It's tempting to take the easy way out and simply say that ChatGPT can never replace human experts – something that ChatGPT seems to agree with. But as any trained psychologist will tell you, the answer isn't always so simple.

It all depends on your unique needs and circumstances. There are many factors that come into play when deciding whether a chatbot is sufficient. So, before you make a decision, consider the pros and cons and evaluate what's best for you. 

This article isn't going to cover everything, but we're going to highlight some key circumstances where an AI chatbot might be a viable option for your mental health difficulties.  

Ψ You are not yet ready to seek in-person psychological services. 

ChatGPT can serve as an easy introduction to seeking a psychological service. You can use it as your first line of defense, to learn about your symptoms or practice coping strategies. You could say anything you would like to ChatGPT without fear of judgment or reproach. It acts as a safe (virtual) space. 

Ψ You want quick access to information and you don’t know where to look. 

ChatGPT is a convenient way to quickly obtain information about a mental health disorder or symptom. It is also an easy way to read up about the types of psychological therapeutic modalities such as CBT, DBT, Schema, or ACT.  

A basic description of each modality usually accompanies the write up, and you can ask ChatGPT for exercises or examples of how to incorporate an exercise in your daily life. 

Here is one useful description: 

"CBT stands for Cognitive Behavioral Therapy, which is a type of psychotherapy that focuses on changing negative patterns of thinking and behavior to improve mental health and well-being. CBT is based on the idea that our thoughts, feelings, and behaviors are interconnected, and that negative thoughts can contribute to negative emotions and behaviors.” 

If these strategies prove insufficient, you may then be more inclined to consider seeking help from a psychologist.

Ψ You cannot access psychological services. 

If you're struggling to access psychological services in your community, ChatGPT may be a platform you have to consider. For example, if you live in an area with limited psychological services, or if you have financial difficulties.

ChatGPT is affordable, convenient, stigma-free, and can be accessed anytime, anywhere, but it is essential to remember that ChatGPT is not a trained psychologist or counsellor and cannot replace one. 

Remember that there are many free and low-cost public and community resources available in Singapore. Here are some examples:  

• Community Psychology Hub

• Changi General Hospital

• Family Service Centres 

• Shan You Counselling

• Singapore Association for Mental Health

Yet… There are several circumstances when it is highly recommended you speak to a psychologist or any mental health professional instead of an AI chatbot. 

Ψ You have, or are experiencing, severe or complex mental health struggles. 

If you are experiencing a severe mental health crisis that poses a risk of harm to yourself or others, please seek immediate attention and intervention from a qualified professional.  

While ChatGPT can be a helpful resource for understanding symptoms of mental health concerns, it is not designed or equipped to handle such emergencies.  

On the other hand, mental health professionals go through years of rigorous training and supervision to be able to appropriately handle such situations. 

Ψ You find ChatGPT’s resources ineffective or insufficient. 

Complex or severe mental health conditions typically result in a significant impairment in the ability to function in daily life. Things like concentrating, being productive, socialising, can seem difficult. 

Comprehensive and often intensive therapeutic approaches may be required to effectively improve functioning. ChatGPT would not have the ability to provide such in-depth intervention. This is when connecting with a qualified mental health professional can provide you the necessary care and support.

Ψ You find ChatGPT impersonal. 

The resources offered by ChatGPT are likely to be broad-based and will not provide the level of depth and personalization that you might need to effectively implement strategies in your life. You may need more specific guidance and details that it cannot provide.  

Moreover, ChatGPT's understanding of the human condition, including context, morals, and spirituality, is limited to available data and research, which means it might not fully comprehend the unique needs and circumstances of each individual user.  

In contrast, a psychologist has focused training and understanding of how social and cultural values differ per person; how responsibilities can influence intervention strategies; how some individuals lack a supportive home environment to foster good mental health. A psychologist takes these diverse factors into account and designs a personalized therapy plan that caters to the individual's needs.

AI and language processing models are rapidly advancing, creating the potential for chatbots to "replace" or supplement certain microinterventions that do not require a lot of therapist contact or empathizing. While this is subject to legal, data, and privacy concerns, ChatGPT can be a useful resource for microinterventions such as goal-setting, progress tracking, and psychoeducation.

However, chatbots still struggle with understanding context, family background, trauma, biopsychosocial factors, and individual differences - essential factors that psychologists study for years to holistically assess mental health struggles from different perspectives. 

All in all, chatbots lack the human connection and understanding that many users desire. However, they present unique benefits in mental health education that should not be dismissed. Combining chatbots with traditional modalities can result in effective intervention. While clinical research is ongoing in adapting psychotherapy techniques into different modalities, psychologists have already started using digital platforms for psychotherapy. As technology continues to evolve, it will be fascinating to observe how chatbots can be further integrated into mental health care. 

Perinatal OCD: When Intrusive Thoughts Feel Scary

What if I harm my baby?

What is Perinatal Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterised by obsessive thoughts, and behavioural compulsions.

Ψ Obsessions are intrusive, unwanted and persistent thoughts and mental images.

Ψ Compulsions are repetitive acts, including avoidant behaviours, that aim to reduce the distress associated with the obsessive thoughts. They could look like cleaning rituals, repeated checks, counting, saying a particular word or phrase, or avoiding certain places or activities.

Perinatal OCD occurs during pregnancy or a year after childbirth. It could be another manifestation of existing OCD or a sudden onset of a new condition.

Find out more about Obsessive-compulsive disorder

Symptoms of the condition often centre around the baby. They are associated with fears that the baby would be harmed, such as through contamination, inappropriate handling, etc. While individuals with perinatal OCD probably recognise that their obsessive thoughts and compulsive behaviours are irrational, they feel consumed by those thoughts and unable to break free from the rituals.

Often Undetected and Unspoken

Having a baby is stressful and overwhelming. As parents, it’s normal to feel anxious about caring for a young child, and worried that they will harm the child. This anxiety, at manageable level, could actually be helpful in ensuring that you avoid potential risks to your pregnancy and child. 

While many parents have that fear, people who suffer from perinatal OCD give undue importance to those thoughts, and believe that they are capable of causing harm.

These parents may be reluctant to disclose their anxious thoughts for fear that they may be regarded as the potentially dangerous and harmful parent.

Parents may also not be aware of the condition or recognise it as an illness. They may see themselves as an unreliable and unfit parent, or attribute their fears as “going crazy”. 

Failure to detect and address perinatal OCD can result in persistence of the distressing thoughts, and affect the relationship the parent has with the child and their family members. New fathers and mothers (or even those without children) with perinatal OCD may struggle to enjoy moments and bond with the child.

Depending on the severity of your condition, it can also impact your confidence in caregiving and overall quality of life as you spend the day worrying about your child being harmed.

How can I Cope with Perinatal OCD?

Ψ Learn more about OCD

Find out more about the condition. Understand that it is not your fault, and that you are not going mad.

It is often comforting to find an explanation for what you are going through. With better understanding of the condition, you could also make sense of the consuming thoughts and compulsions that you have.

Ψ Learn about your symptoms

Everyone’s triggers and symptoms would look different. It is always a good idea to note how your symptoms present and when they present. This give yourself and ideally your therapist a clearer idea of your presenting difficulties and how to manage them.

Ψ Talk to someone

Reach out to a loved one and share with them what you are going through. It can be relieving just to tell someone your feelings. It could be helpful to first write down your thoughts and feelings before you bring this up with someone.

It can be also reassuring to hear that similar anxious and distressing thoughts are experienced by other people too. Connect with support groups online or in your local community (e.g, OCDNetwork) to receive the emotional support much required in this journey.

Ψ Get practical support

Your anxiety may make you unavailable to care for your child for the time being. Reach out to your family and friends to help with the caregiving tasks.

Let them know how they can help (e.g., could you help to change the baby’s nappy)

Ψ Seek professional help

OCD can be managed with psychological therapy, and sometimes with the additional help of medication. Typically, Exposure and Response Prevention Therapy (ERP) and Acceptance and Commitment Therapy (ACT) are used to help individuals with OCD. They involve exposure to anxiety-provoking situations and accepting the intrusive thoughts while engaging in value-aligned behaviours respectively.

Your therapist will work with you to develop a management plan that best supports you. Things would get better, however overwhelming they seem now.

Supporting a Loved One Who is Struggling with Perinatal OCD

Many individuals who experience perinatal OCD worry that they get ostracized when others find out. Do not criticise their compulsions. Assure them that you are there to support them if they ever need it. 

Learn about the condition. With greater understanding of the condition, it may be easier for you to see why your loved one is acting the way they do. You would also realise that providing assurance (e.g., “I’ve sterilized the milk bottle”, “the baby is still breathing”) might not be the best form of support for them – counterintuitively it may sound. Instead consider staying by their side as they experience the discomfort rather than reinforce their rituals.

If you are concerned that you or someone you know is struggling with perinatal OCD, seek professional help. Feel free to reach out to us for support with coping with OCD.

How to Deal with Passive Aggressive Colleagues

But what exactly is passive aggressiveness? 

Passive aggressiveness occurs when a person harbors negative feelings towards an individual and expresses those feelings in an indirectly harmful manner.

A person may feel negative feelings such as anger or jealousy, but instead of communicating honestly, they mask their emotions through indirect hostility.

These are some examples of displays of passive aggressiveness at the workplace: 

• The silent treatment 

• Chronically procrastinating on tasks 

• Intentionally neglecting their share of the workload or shirking responsibilities as a form of “retaliation” 

• Withholding information 

• Disguised insults and non-compliments 

• Downplaying or ignoring other people’s achievements 

• Sarcasm 

• Spreading rumors 

• Being silent, sulky, sullen and resentful to get attention or sympathy 

Passive aggressive behaviors are usually not immediately recognizable as “aggression”. After all, it is easier to notice aggression when people lash out at you. However, in the workplace, such behaviors create a toxic workplace environment, which comes along with a host of negative consequences such as burnout and lowered morale. Considering all these negative consequences, it is therefore important for passive aggressiveness to be carefully and effectively dealt with.

How should I respond to a passive aggressive colleague?

Responding to a passive aggressive colleague is tough and a great deal of patience is usually needed. This often comes with a hefty amount of stress and anxiety on your end too. However, equipping yourself with these skills goes a long way in making you a more confident and effective person!

Ψ Remove the reward

With many kinds of behaviors, a person will be more likely to engage in an action again if it is met with reinforcement. In the context of workplace passive aggressiveness, if you respond to a colleague’s behavior by going tit for tat, your response may actually end up reinforcing that colleague’s behavior such that it becomes even more likely for them to engage in passive aggressive behaviors again.

It can be difficult to resist the urge to respond to provocations by similarly being sarcastic or saying “it’s fine” when it actually is not. However, doing so is unlikely to get you anywhere and may even further escalate the conflict by perpetuating the person’s bad behavior. Instead, try to focus on keeping cool so you will remain composed and not act impulsively. The best way to achieve this is by giving the person objective, emotionally neutral responses whenever appropriate. For example, instead of using “you”, use first-person pronouns such as “I”, “we”, and “our”.

Ψ Ensure that expectations and deadlines are clearly and explicitly set at the start of any task or project

This is a good habit to carry out regardless of whether you have a passive-aggressive colleague or not. After all, communication is key! Ensure that you communicate diligently and set crystal clear expectations on the scope, expectations, and deadlines of any given project. To do this, confirm any discussions that you have about deadlines and actions in writing, send follow-up emails after meetings, or draft a performance agreement.

When this occurs, reasons such as “I did not know” become less plausible and it increases behavioral accountability. By ensuring that all communication is clear and understood by everyone, a passive-aggressive colleague will have to take responsibility for their own actions and have fewer opportunities to blame others for their mistakes.

Ψ Try to adopt an empathetic approach and understand the reasons behind their actions  

Why is your colleague acting this way? Do they derive happiness from making others feel manipulated? It might be easy to simply write off their behaviors as being due to a nasty personality or intentionally being difficult. However, studies have found that passive aggressive behavior is often driven by deep seated fears of being rejected, a lack of self-esteem, as well as insecurity or as a maladaptive way of handling conflicts. When we take on an empathetic approach, this enables us to better understand why people act the way that they do, and to select a more appropriate means of responding.

Ψ Create a Safe Environment

Finally, foster an environment where your colleagues know that it is safe for them to raise concerns and issues with you in an open, direct, and constructive manner, rather than in covert ways. Let your colleagues know that they can always approach you if they are facing any problems rather than letting them bubble beneath the surface. 

Of course, you will have to walk the talk too! You can create an encouraging and supportive workplace culture by fostering genuine, positive relationships with your colleagues.

Should you have any concerns about the well-being of your work team or wish to further support your employees, our Employee Assistance Program (EAP) aims to help employees in Singapore, from staff to managers, manage work- and personal-related issues that may otherwise result in a negative impact on their emotional well-being and job performance.

12 Tips To Cope with a Cancer Diagnosis and Treatment

Learning that you have cancer is a difficult experience. After being diagnosed, it’s natural to feel anxious, numb or angry and wonder how you can live with the long and at times painful days ahead.

These are normal reactions to an abnormal, or otherwise, unexpected situation.

Furthermore, it can be hard to deal with the pain resulting from the symptoms or the side effects from cancer treatment, such as medication or chemotherapy.

Cancer treatments can bring about many changes in your body, altering the way you look and how you feel about yourself and your body. The demands of treatment could also influence your personal relationships, making it challenging to navigate your daily life and usual routines. Fortunately, remember that these are obstacles you do not have to face alone.

Here are some tips to help you cope with the diagnosis: 

Ψ Learn as much as you can about your cancer diagnosis

Try to obtain as much basic, useful information about your condition as you need to make informed decisions about your medical care. Information can help you to know what to expect. Taking in information can feel difficult and overwhelming, especially when you have just been diagnosed. Make a list of questions you’d like to ask before you visit the doctor. Consider bringing a family member or friend with you to your appointments to help remind you your questions or to remember what you hear.

Remember that you don’t have to sort everything out at once. It could take some time to deal with each aspect of your condition. Ask for help if you require it.

Ψ Anticipate possible physical changes that you may experience  

Plan for changes in advance. You can prepare yourself now so that you will be better equipped to cope later. Check with your doctor what changes you should anticipate. For instance, if the drugs can cause hair loss, you can seek advice and help from image experts about wigs, clothing, or hairpieces to make you feel more comfortable.

In addition, consider how treatment may impact your daily activities. Ask your doctor whether you can expect to continue with your normal routine in case you may need to spend more time in the hospital or have frequent medical appointments.

Ψ Try to maintain your normal lifestyle as much as possible

Maintain your usual routines but be open to modifying them as necessary. Take one day at a time. It’s easy to overlook this simple strategy when you are distressed. When the future is uncertain, organising and planning may suddenly seem overwhelming. 

Ψ Adopt a healthy lifestyle

This can improve your energy level. Choose a healthy diet consisting of a variety of foods and get enough rest to help you navigate the stress and fatigue of breast/ovarian cancer and its treatment. Engaging in physical exercise during treatment can also be helpful!

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Ψ Review your goals, priorities and values 

Determine what is important to you in your life. Find some time to engage in the activities that are most meaningful and fulfilling to you.

Spend 3-5 minutes practicing the 60th Birthday Exercise to help you identify what is important to you and how you want to live your life.

Ψ Share your feelings.  

Talking about your emotions can be hard, but it can also bring comfort to you and the people who care about you. When you tell your loved ones what you are feeling, you give that person a chance to support you. You also give your relationship with that person a chance to grow. 

Cancer may affect your relationships. Communication can help reduce the anxiety and fear that cancer can cause.  

Ψ Be specific. 

When reaching out to others, be specific and clear about the kind of support you need. For example, saying something like, “Could you help me shop for groceries this week?” or “Could you help to drive me to my next doctor’s appointment?” gives a clear indication to your loved ones how to best support you.  

Being specific can also cut down frustration and reassure your family and friends that they are being helpful.  

Ψ Take steps to look and feel your best. 

Many women might feel uncomfortable with their appearance after having surgery or chemotherapy.  

If you had breast surgery or are experiencing hair loss, learn about some of the options available, such as breast prostheses and hair wigs. Give yourself time to adjust to changes and try different solutions until you find what makes you feel most comfortable! 

Ψ Let yourself feel loved and cared for. 

After a breast removal surgery or chemotherapy, you may find that regular activities such as dressing, undressing, bathing or being intimate with your partner or spouse, can give rise to complex emotions.  

You might feel so different that you stop taking care of your emotional and physical needs. This might cause you to even distance yourself emotionally from your partner. However, you can always make other choices, such as choosing to remain close to your partner or spouse. You deserve to feel loved and cared for.  

Ψ Talk to your spouse or partner about the physical closeness you need. 

Share how you feel about your body and talk about what you think or worry that your partner is feeling.  

Whatever your needs are – whether you have a need for physical affection, or if you are not yet interested in being physically intimate – let your partner know. He/she is most likely waiting for your signal to know what to do, how to act and what you need in order to best support you. 

Ψ Join support groups and talk to other people with cancer. 

Sometimes it will feel as though people who haven’t experienced a cancer diagnosis can’t fully understand how you are feeling. It might help to talk to others who have been in your situation. Other cancer survivors can share their personal experiences and shed some insight into what you can expect during treatment.

You may have a friend or family member who has had cancer. If not, you can also connect with other cancer survivors through local support groups in your area.

Ψ Develop your own coping strategies and practise self-compassion. 

Just as each person’s cancer treatment is likely individualised, so can your coping strategy!  

Here are some self-care ideas you can try out: 

• Practise relaxation and mindfulness techniques (e.g., progressive muscle relaxation, breath focus, guided imagery, or loving-kindness meditation) 

• These methods help cultivate a softer, more spacious and kinder mind, while fostering self-compassion and letting go of inner judgement and hostility towards oneself. 

• Keep your own personal journal to help organise your thoughts 

• Finding a source of spiritual support (e.g., from your religion) 

• Set aside time to be alone each day 

• Remain engaged with work and leisure activities as much as you can.
  

Seeking professional help

Even with various support groups and loved ones, the cancer journey may still feel incredibly lonely. You may wish to speak to a psychologist for support and to help you process complex emotions that may arise. Know that you are not alone, and that there is great strength in asking for help.