Coming for Psychotherapy
Why a Clinical Psychologist?
You wouldn’t call a plumber to fix your piano (although our plumber can - most plumbers have more than one set of skills), so why shouldn’t you see a clinical psychologist if you need psychotherapy?
But there is a lot of information (and disinformation) surrounding psychology.
The first thing you need to know is that psychology is an umbrella science containing multiple disciplines and specialisations.
Clinical Psychologists are the bunch who are specifically trained to conduct Psychological Assessments such as diagnostic interviewing, behavioural assessment, administration and interpretation of psychological test measures, and to provide Psychological Intervention to individuals and families at all levels.
Clinical Psychologists also receive advanced training (minimally a Master in Clinical Psychology) in diagnosing and treating intellectual, emotional, psychological, social and behavioural maladjustment issues ranging from daily stressors right up to severe clinical psychopathology.
In the same way an eye doctor will not (should not, really) operate on your knee, you must seek out the type of psychological help you need and ensure they have the necessary training and experience. For example, if you are seeking out services in Sport and Exercise Psychology, or Psychoanalytic Psychology, this is not the place for it - although we will be happy to introduce some of our friends to you.
Your first therapy session
(aka “Intake Assessment”)
Your first therapy session will comprise of an initial assessment by your psychologist. We call this an Intake Assessment or simply, Intake.
Intake is basically a session for your psychologist to understand you as a person and discuss the issues that have brought you into therapy. It is important that this takes place in a safe, private, and non-judgemental space. You may be asked to complete a form with your basic personal information prior to Intake.
Through guided conversation, your psychologist will begin to develop an understanding of your concerns and other underlying factors, and explore relevant background or history; for example, information about your family, social relationships, work history or any past counselling that you have done. With the gathered information, your psychologist will work with you to craft a collaborative and flexible plan for future therapy sessions. You may wish to bring a notepad to record these and other useful discussions that occur during your session.
Intake sessions typically run for 90 minutes. If the concerns or the issues you face are complex, your psychologist may request that you extend your Intake session or return on another day.
works best if you follow through!)
During intake and through the course of therapy, your psychologist and you will jointly formulate and refine your treatment plan based on the information you provide.
Therapy will be different for everyone. It is therefore important that you share information that you feel may be relevant to your concerns. This is because therapy is a collaborative treatment based on the relationship between your needs as an individual and your psychologist. We call this the Therapeutic Alliance. Grounded in dialogue, psychotherapy is at its most effective when you participate fully in your sessions. Your psychologist will provide a supportive environment for you to share thorny or difficult issues with someone who’s objective, neutral and non-judgemental. You and your psychologist will work together as a team to identify and change the thought and behaviour patterns that are keeping you from feeling your best.
You can be completely honest with your psychologist without concern that anyone else will know what you revealed.
The therapeutic relationship is a confidential one (subject to a few legal exceptions: for example, if you threaten to harm yourself or someone else, or by court order). At your request, information we collect about you can be shared with other medical or mental health professionals.
By the end of treatment, you may have learned new skills to an better cope not only with the problem that brought you in, but with whatever challenges that may arise in the future.
Therapy sessions typically run for 60 minutes.
How many sessions does it take for me to feel better?
This is a difficult question to answer. But we tell you some of the factors that affect the length of treatment. Typically, this depends on
Ψ the complexity of issues
Ψ how long you wait before seeking help
Ψ how frequent you turn up for session
Ψ whether you “complete your homework”
By way of example (and only as a guideline), persons who present with straightforward depression or anxiety typically take at least 10 to 15 sessions before they feel well enough to request for discharge. More complex issues such as Personality Disorders can take years.
Seeking psychological intervention*
(*basically, seeking professional help)
“What good does talking do?”
“That’s what friends are for?”
“What can a psychologist do? Isn’t psychotherapy just ‘talking’? I talk to my family about my problems”
These are familiar refrains among those with anti-therapy attitudes.
But don’t get us wrong.
Support from family and friends you trust is often your first line of defence. However, the “talking” therapy that you will have with your psychologist involves so much more. Clinical Psychologists have years of specialised education coupled with supervised training and workplace experiences that make them experts in understanding and treating complex issues with psychotherapy.
What is Psychotherapy
Think of your body, your bones and your flesh as your hardware. Important physiological tools for your very survival.
Your thoughts, emotions, and feelings: this is your software. Your software controls your hardware, dictates your mood, and is responsible for your well-being. It’s important stuff. But your software may not always work as well as you’d like it to. Software issues cannot be resolved by telling the problem to go away, the way you would give your old television an occasional knock. Life happens, and you may not always have the necessary tools to rough it out. Or you may simply need the occasional tune up. This is psychotherapy.
Psychotherapy is understanding and dealing with your inner thoughts and emotions in a productive way
In a completely honest environment. And research shows that psychotherapy is most effective and helpful when an honest dialogue takes place between you and your psychologist.
The techniques a Clinical Psychologist employs during psychotherapy are developed over decades of research and involve more than mere talking and listening. We assess, diagnose and treat individuals suffering from psychological distress and mental illness. We also perform psychometric testing such as IQ assessments for adults or kids.
Clinical Psychologists recognise behaviour or thought patterns objectively, more so than those closest to you, who may have stopped noticing, or perhaps not all. Your psychologist will be able to identify the next steps that you may face in your challenge, and offer coping strategies. Their observations may sound similar to what your family or friends may say, but an experienced psychologist bringing their clinical skills to the table will greatly assist the process.
If your difficulties have been ongoing for some time without significant improvement, or would like preventive work before your difficulty becomes insurmountable, now may be the time to seek help from a trained psychologist.
Psychology v Psychiatry
“What’s the difference?”
The fields of psychology and psychiatry share a common goal: helping people feel better. Both disciplines are essential in the research and development of treatment for improving mental and emotional health.
One key difference between the disciplines is that psychiatrists are medical doctors and will generally approach your issues from a pharmacological perspective, while clinical psychologists focus on psychotherapy; identifying and treating the underlying causes of your emotional and mental suffering through behavioural and thought modification. Psychologists are also responsible for conducting psychological and psychometric testing, which is critical in assessing a person’s mental state and determining the most effective course of treatment.
Simply put: psychologists and psychiatrists work as a team to make you feel better.
Because of the division of responsibilities between psychiatrists and psychologists, the frequency of your visits are also different – a follow-up visit to a psychiatrists typically takes place at intervals scheduled around medication while psychotherapy is beneficial only if you participate with regularity i.e. once a week or fortnight.
Fun fact: Psychiatrists are also trained to perform electro-convulsive therapy or ECT.
When should I seek help?
When should I seek psychological intervention?
Come talk to us if you feel that your problems have reduced your quality of life, your mental well-being has a disruptive impact on your daily routine (e.g. work, social life), your relationships and mood has been affected, or generally if you feel you are not living a meaningful life or not according to your values.
What are Personality Disorders?
Disorders of Personality: let’s unpack the two keywords. (or skip for the summary)
Personality is the combination of traits that makes you a unique individual.
Reduced to its essence, it’s the sum of thoughts, feelings, and behaviour, which makes you, well, YOU. Your personality is influenced by everything around you: your experiences, environment, circumstances.
Disorders require a somewhat lengthier explanation.
For many years, the term Disorders was deemed somewhat a misnomer. If your personality was uniquely you, how can your personality be a disorder! The first thing to understand is that Disorders do not mean that there is something wrong with you. But it does mean that the way you think, feel, or behave (i.e. your personality), causes you and those around you distress or problems.
There are three key criteria that a Clinical Psychologist will look for when diagnosing a Personality Disorder.
The first criteria is that there must be an impairment in self. This is simply a short hand for saying that there must be an issue with your identity or ability to self-direct. For example, ego-centrism, low self-esteem, lack of personal boundaries are issues that go to a person’s identity. On the other hand, the inability to adhere to lawful or normative behaviour, adapt to a new situation or circumstance, or unrealistic or incoherent personal goals, are some of the issues associated with a person’s ability to self-direct.
The second criteria is an impairment in the way you interact with others. There are two specific impairments that Clinical Psychologists look out for, and these are issues with empathy or intimacy. For example, issues with empathy include the complete lack of concern for others or the lack of remorse after causing hurt, or a preoccupation with and sensitivity to criticism or rejection by others. Intimacy problems include an inability to form close relationships, forming intense, unstable and conflicted relationships, or forming exploitative relationships as a primary means of relating to others.
The third criteria is the presence of one or more pathological personality trait domains or facets. There are 5 personality trait domains, each domain containing 3 trait facets. The domains are Negative Affect, Detachment, Antagonism, Disinhibition and Psychoticism. We’ll do a deeper dive into the trait domains and facets on a separate piece.
These impairments and personality traits and facets are usually persistent over a period of time and consistent across situations, and must not be due to any physiological effects of a substance or a general medical condition.
So, how many Personality Disorders are there?
By now you must have surmised that the term Personality Disorders refers to a grouping of different types of disorders relating to personality. 10 Personality Disorders to be precise. These are helpfully grouped into 3 clusters:
Cluster A (the "odd or eccentric" cluster)
Cluster B (the "dramatic, emotional, erratic" cluster)
Cluster C (the "anxious, fearful" cluster)
[TL;DR]Personality Disorders are persistent thought, emotional, or behavioural patterns that have caused significant difficulties in your daily life.
Living with a Personality Disorder
Most people who are suffering from a Personality Disorder may not even realise that the difficulties in his or her life are a result of that Personality Disorder.
A common indicator of a personality disorder is when a person’s way of thinking, feeling or behaving causes distress or affects his or her daily functioning, over a period of time. Seemingly common stresses and problems feel harder to resolve. Family and friends may start to observe patterns that occur across that person’s life; the same patterns that result in serious problems with relationships and work.
During a clinical assessment, a Clinical Psychologist will look for signs of the 4 traits, and ascertain whether you have significant and enduring difficulties in these areas before making a clinical diagnosis.
Obtaining a diagnosis isn’t a shameful thing. It just means now you know where to look to get better. And as with any other form of treatment, knowing what you are dealing is an enormous step in the right direction.
Borderline Personality Disorder
Now that we understand what is a Personality Disorder, let’s talk about a specific PD: Borderline Personality Disorder.
What is Borderline Personality Disorder?
Persons suffering from Borderline Personality Disorder are usually characterised by interpersonal difficulties as a result of how he or she interacts with others. Irrational fears of abandonment by loved ones or friends, a history of unstable friendships and relationships, and impulsive and self-destructive behaviours are some of the more common Borderline PD symptoms.
But why is it called “Borderline” Personality Disorder? What is this line, and where is the border? (hint: it is not found between the US and Mexico)
Well, conventional literature classified personality disorders into two categories: “Psychosis”, which basically refers to psychological disorders where the sufferer losses touch with reality (i.e. through hallucinations or delusions); and “Neurosis”, where the sufferer remains in contact with reality but nevertheless experiences chronic distress.
In Borderline Personality Disorders, these symptoms may manifest in the form of emotional instability, anxiousness, impulsive behaviour, distorted thoughts or perceptions, and intense but unstable relationships. Some may also be triggered by what are seemingly ordinary events - for example, a brief period of separation from a loved one. As you can see, depending on which symptoms arise, sufferers do not necessarily fit neatly into “Psychosis” or “Neurosis”.
For want of a better definition, as sufferers were thought to be in between the categories of Psychosis and Neurosis - i.e. somewhere along the border - the disorder was christened “Borderline” Personality Disorder.
What causes Borderline Personality Disorder?
There are several factors that indicate whether an individual may be predisposed to Borderline PD.
These factors are made up by a combination of genetic and environmental factors. Let’s take genetic factors first: Research has shown that abnormal developments or changes in certain regions of the brain responsible for mood regulation and aggression are indicators of Borderline PD. Malfunctioning neurotransmitters are also a key indicator of Borderline PD. Other research suggests that individuals with a biological parent or sibling suffering from Borderline PD are at higher risk of being diagnosed with Borderline PD.
Turning to environment factors, childhood or other trauma experienced later in life have been linked to the development of Borderline PD (abuse or sexual assault, physical or emotional neglect etc.).
Treatment for Borderline Personality Disorder
Psychotherapy remains the primary means of treating persons with Borderline Personality Disorder, although this is usually combined with psycho-pharmacological therapy (i.e. medication) to reduce particular symptoms. We work with psychiatrists specialising in Borderline Personality Disorder (and other Personality Disorders) regularly to provide holistic treatment.
Paranoid Personality Disorder
Is Paranoia a personality issue?
As any good lawyer will tell you - that depends (and that’ll be $5,000 thanks).
What we call paranoia, shorthand for suspicion and mistrust, is a huge part of the disorder. But for it to be a clinically recognised disorder, the focus is whether your paranoia is irrational or excessive (unless you are the President of the United States, then it is of course Fake News).
How Paranoid must I be?
It is normal (and human) to have had moments where we were more cautious or mistrustful; after all, we are constantly learning from experience.
But these moments of paranoia may suggest the presence of a disorder if the mistrust persists and turns into something uglier like believing others have bad motives and doubting their intentions “for no reason”.
Before a diagnosis may be made, Clinical Psychologists will look out for these symptoms:
Ψ Suspecting that others are manipulating, harming or deceiving him/her without sufficient basis
Ψ Preoccupied with unjustified doubts about loyalty or trustworthiness of your peers
Ψ Unwilling to confide in others because of unwarranted fear that information will be used maliciously
Ψ Finds hidden demeaning threats or meanings in benign or neutral remarks
Ψ Persistently bears grudges and unforgiving of others
Ψ Perceives attacks on his/her character or reputation
Ψ Recurrent suspicions, without justification, regarding fidelity of spouse/sexual partner
(you can see the trend now can’t you)
You may have noticed by now that the underlying issue is the lack of justification for your paranoia.
Justification, in and of itself, is also highly subjective. This is because individuals with paranoia frequently disregard concrete evidence that contradict their beliefs and views. Some might even go to the lengths of alleging the presence of trickery or arguing that the evidence itself is untrustworthy or doctored (Fake News again anyone?).
As a result, a major consequence of Paranoid Personality Disorder (Paranoid PD) is the toll it takes on interpersonal relationships, due to the sufferer’s inability to look pass omnipresent doubt. Sufferers rarely confide in or fully “open up” to others, even to close friends and family.
Schizophrenia vs Paranoid Personality Disorder
People often associate Paranoid PD with Schizophrenia because persons suffering from either disorder seemingly exhibit similar psychotic symptoms (e.g. loss of contact with reality, delusions, hallucinations).
One difference is that often, individuals with Paranoid PD are in contact with reality, except that the symptoms usually manifest when the individual is under high levels of stress, and such episodes typically last only from a few minutes to a few hours. By contrast, persons suffering from schizophrenia experience a persistent and much deeper disconnect from reality lasting for significantly longer periods of time.
People with Paranoid PD rarely seek psychological help due to the high levels of mistrust with those who do not agree with them (the list is usually long). Those who seek preliminary treatment often discontinue regular therapy or consultations.
However, anecdotal evidence suggests that persons suffering from Paranoid PD are likely to consult a psychologist from time to time. This is a good starting point, even if therapy is irregular. The focus of these infrequent consultations will centre on first equipping them with skills to cope and function in their daily lives. These concerns usually revolve around challenges in interpersonal relationships. Your clinical psychologist will use these sessions to build trust and rapport (remember the Therapeutic Alliance with your psychologist?) to allow you to eventually address and work through the Paranoid PD.
Generalised Anxiety Disorder
First of all, yes, anxiety is a normal human response to challenging events. Challenging events range from the very mild (where did I leave my keys) to really problematic challenges (like building a wall, stretching 3,145 km, without congressional funding).
When feelings of anxiety affect other aspects of your everyday life and spirals out of control, it may signal the beginning of a maladaptive form of anxiety known as General Anxiety Disorder (GAD). A 2012 Singapore study revealed that GAD affected 0.9% of the local Singaporean population, depending on which figures you believe (6.9 million anyone?), means that the number of persons suffering from GAD is not an insignificant number.
Persons who suffer from GAD experience symptoms such as:
Ψ Feeling nervous, irritable or on edge
Ψ Having a sense of impending danger, panic or doom
Ψ Having an increased heart rate or heart palpitations
Ψ Breathing rapidly (hyperventilation), sweating, and/or trembling
Ψ Muscle tension
Ψ Feeling weak or tired
Ψ Difficulty concentrating
Ψ Having trouble sleeping or maintaining sleep
Individuals often say that these symptoms are hard to control and once experienced, they affect other aspects of their life. They usually seek medical attention only when GAD symptoms like sleeplessness and headaches become harder to ignore.
At the same time, it is important to remember that a diagnosis of GAD is not automatically given even if one experiences most or all of the symptoms listed. GAD is a clinical diagnosis that must be made by a trained clinical psychologist or psychiatrist. Additionally, some symptoms must be present for more days than not over the past 6 months. Symptoms typically worsen during periods of stress.
In severe cases, individuals with GAD may find it difficult to carry out daily tasks. This is compounded by the lack of drive or motivation to even get out of bed to face the day’s tasks and challenges, especially when it comes to going to work or school. Research indicates that women are more vulnerable to GAD, and the disorder tends to rear its ugly head from middle adulthood.
Fortunately, GAD responds well to treatment, especially if there is early intervention. Psychotherapy (Cognitive Behavioural Therapy (CBT) and exposure and response prevention therapies) has been found to be very effective in treating GAD. CBT aids the individual to recognise triggers that would set off an anxiety episode, and at the same time, allows the individual to use imparted healthy coping mechanisms and relaxation techniques to deal with these triggers and the resulting reactions.
Exposure therapy, as the name suggests, involves individuals exposing themselves (get your mind out of the gutter) and confronting their fears and anxiety in a safe and controlled environment. Through repetition and regulating the intensity of exposure, the aim of this therapy is to reduce the emotional intensity of these reactions to a manageable level, allowing individuals to rationalise and cope with their anxiety.
Medication may also be necessary in some instances, and we work together with our friends over in psychiatry to provide you with holistic care.
Abuse and Trauma
There are many types of abuse. A common misconception is abuse is limited to merely physical or verbal abuse. That’s not entirely true.
Let’s talk about four common forms of abuse:
Physical Abuse: if you experience any kind of physical abuse or violence, you should seek immediate help from the police. Call the Police Emergency hotline 999 if you are in immediate danger.
Sexual Abuse: may also occur with physical abuse, if you experience any kind of sexual abuse, coercion or intimidation, seek immediate help from the police. Find out more information on violence against women from aware Singapore. Men, contrary to popular (and incorrect) belief, are also susceptible to sexual abuse. If you are a victim of sexual abuse, reach out for help.
Verbal Abuse: occurs when a person (or persons) uses words to criticise, insult or belittle you, with the intent to cause you hurt and distress. Verbal abuse over a prolonged or intense period of time may cause significant psychological distress.
Psychological Abuse: is also known as mental abuse, emotional abuse, or psychological violence. But depending on who you ask, the precise type of action involved is different depending on who the victim is. Psychological abuse is the systematic use of manipulation to intentionally inflict mental anguish on the victim. Psychological abuse can occur by itself or together with other forms of abuse.
Regardless of how it is carried out, abuse causes psychological distress in individuals who experience it. Abuse over a prolonged and sustained period of time is generally considered to be a traumatic event. In Psychology, trauma is used to describe a major psychological impact or damage on a person who experiences a traumatic event.
Abuse and Trauma related Mental Disorder(s)
While it is possible to completely recover from abuse and trauma, many sufferers do not or may not have timely access to help or psychological intervention. In some instances, sufferers develop mental disorder(s) as a result of the abuse or trauma.
This group of disorders, known as trauma- or stressor- related disorders, develop as a result of the direct psychological impact of the event(s). There is also the possibility of triggering the development of other mental disorder(s), either from certain characteristics of the traumatic event, or other factors that make the individual vulnerable.
Potential disorders include (but not limited to):
Trauma and Stress related Disorders:
Ψ Acute Stress Disorder
Ψ Post-Traumatic Stress Disorder (PTSD)
Ψ Panic Disorder
Ψ Agoraphobia (fear of open or crowded places or situations which might cause you to panic or feel trapped, helpless or embarrassed)
Ψ Generalised Anxiety Disorder
It is possible you may suffer from more than one mental disorder at any given point in time.
When should you seek treatment for abuse or trauma?
If your emotions become distressing or disabling, and become too much for you to handle, seek help from a mental health professional.
(hint: there is more than 1 type of depression)
Major Depressive Disorder
Did you know that roughly 1 in 16 people in Singapore (or 6.3% of Singapore’s adult population) has suffered from Major Depressive Disorder (MDD), also known as major depression, at some point in their lives?
MDD is the most common disorder in Singapore of which people have suffered from at some point in their lives, compared to other common disorders like bipolar disorder, generalized anxiety disorder, obsessive compulsive disorder and alcohol use disorders. MDD is not as uncommon as previously thought, and this could evolve into a much bigger concern for our society if the figures continue to grow.
But wait, what really is ‘depression’? If I feel depressed, does it mean that I suffer from depression?
There are actually many different types of depression, just like how you may feel more happy in certain situations and less in others , depression can range from being mild to severe as well. Some types of depression are triggered specifically by certain life changes, like giving birth.
Ψ depressed mood (feeling sad, empty, hopeless)
Ψ loss of interest or pleasure in activities
Ψ significant weight loss/gain due to changes in appetite
Ψ difficulty sleeping or sleeping too much
Ψ loss of energy or increased fatigued
Ψ feelings of worthlessness or excessive guilt
Ψ difficulty concentrating or indecisiveness
Ψ increase in purposeless physical activity (like pacing), or slowed movements and speech which can be observed by others
Ψ thoughts of death or suicide
A diagnosis of MDD requires a person to experience at least five of the above symptoms to persist for at least two weeks and symptoms must be present for most of the duration. Symptoms must also include depressed mood or loss of interest.
Persistent Depressive Disorder (PDD)
What is even harder to detect is what is sometimes known as “High Functioning Depression”, or as its clinically known, Persistent Depressive Disorder (PDD). It is more difficult to recognise PDD; although the symptoms of are similar to that of clinical depression, many who are suffering from High Functioning Depression might not even know it because the symptoms are often not as severe as those experienced in MDD.
The main characteristic of PDD is a depressed mood for most of the day, and for more days than not, for a period of at least 2 years. Persons suffering from PDD experience milder symptoms such as poor appetite or control, sleep issues, low energy or fatigue, low self-esteem, poor concentration or general feelings of hopelessness.
A diagnosis of PDD only requires the presence of at least two out of the six symptoms listed above (as contrasted to MDD which requires at least five out of nine) but requires the individual to have experienced symptoms for a minimum of two years rather than two weeks.
It is also possible for individuals to experience both disorders at the same time. They may be moderately depressed for a long time (resulting in diagnosis of PDD), but undergo more serious problems occasionally (which warrants the diagnosis of MDD).
Perinatal or Postpartum Depression
Perinatal depression refers to depression occurring during pregnancy or after immediately after childbirth, while postpartum depression refers mainly to depression following childbirth. Perinatal depression may be an initial indicator for the development of depressive disorders later in life, and also increases the chance of developing postnatal depression.
You might be also surprised to know that men can also suffer from perinatal depression! Yes, men have been reported to have suffered from perinatal or postpartum depression as well, although the focus may be more on the increased responsibility or changes in lifestyle which comes with parenting.
Symptoms include fatigue, feeling sad/hopeless/worthless, difficulty sleeping or sleeping too much, changes in appetite, difficulty concentrating, lack of interest in baby/not feeling bonded/feeling very anxious about baby, feelings of being a bad mother, fear of harming the baby or oneself, or a loss of interest or pleasure in life.
While it may seem common to experience some form of “baby blues” after childbirth, never hesitate to approach a medical or mental health professional just to clarify any doubts you may have. This is especially so if you have experienced the symptoms for more than two weeks, had suicidal thoughts or thoughts of harming your child, worsening of depressed mood, or having trouble with daily functioning or even taking care of your baby.
Common treatments of depressive disorders are usually psychotherapy and antidepressants, sometimes one without the other or both in the most severe of cases.
Examples of psychotherapy that prove to be effective are interpersonal psychotherapy, acceptance and commitment therapy (ACT), and cognitive-behavioural therapy (CBT).
If appropriate, interpersonal therapy is done to improve interpersonal relationships and social functioning to relieve distress. This is done in a variety of ways from improving social skills or to dealing with family disputes, past grievances or major life changes.
Cognitive-behavioural therapy focuses on unhealthy emotions, thought processes or coping behaviors. The aim is to stop you from engaging in unhelpful thinking patterns, negative thoughts or poor coping behaviors when dealing with stress as they often do not help to relieve stress, but rather, prevent individuals from actually engaging in effective ways to relieve stress.
Acceptance and commitment therapy focuses on accepting inner emotions and thoughts as appropriate responses to certain situations, and how to stop avoiding or suppressing these emotions and thoughts. Acts of avoidance merely make it harder for people to move forward with their lives as these acts often cause more distress. However, by promoting acceptance and understanding towards personal emotions, thoughts and responses, this helps to increase understanding towards oneself, focusing more attention to personal principles and can help commit individuals to make changes to their behavior.
A special note about the treatment of perinatal or postpartum depression: it is common for mothers to shy away from seeking a diagnosis, or become fearful of getting help due to the fear of what others may think, or about the effects of the medications prescribed.
Antidepressants are only prescribed if the depression is severe, and there are medications that are safe for use in pregnancy for both the mother and bubs. Always check with your psychiatrist. The point is to never hesitate to seek help from a medical or mental health professional; avoiding treatment does not make the problem go away.
Post-Traumatic Stress Disorder
(or as you know it, PTSD)
What is Post-Traumatic Stress Disorder ?
It is not uncommon to experience flashbacks or nightmares after witnessing a shocking, scary or dangerous event: natural disasters, a catastrophic accident, the death of a loved one, grievous assault - the list is endless. Everyone will, quite naturally, experience a range of emotions as a result of such trauma, and most will eventually recover from the ordeal. However, there are those who continue to suffer from the impact over a prolonged period of time. This is known as Post-Traumatic Stress Disorder (PTSD).
PTSD is a major psychological disorder that can be debilitating for those experiencing it. Symptoms include:
Ψ Recurring, intrusive thoughts: re-experiencing the events involuntarily, in the form of recollections, dreams, nightmares, and triggered flashbacks.
Ψ Hyper-arousal: this includes anxiety, irritability, quickness to anger and a sense of feeling exhausted from being continuously alert.
Ψ Intense psychological distress when exposed to cues that resemble aspects of the traumatic event.
Ψ Avoidance of cues associated with the traumatic event.
Ψ Negative emotions and thoughts: a sense of numbness and emotional distancing from others (diminished involvement in activities), alienation, or self-blame.
Symptoms typically begin shortly after the traumatic event. Occasionally, this may take a longer time, even years after the event. Symptoms last for at least a month and are sufficiently severe so as to interfere with your work or relationships. Some recover within 6 months while others may experience it on a more chronic level.
But don’t wait for a month to pass before seeking help! Our natural stress response to traumatic events may be immediate and in some cases, persistent. Even after the traumatic event has passed. Persons showing symptoms of PTSD for more than 2 days may be diagnosed with Acute Stress Disorder instead.
Why do some people suffer from PTSD and others do not?
Why do some people seemingly have it all, and others, none?
That’s because there are many factors that increase a person’s likelihood of developing PTSD. For example, women are more likely than men to develop PTSD. Certain genetic factors also make some people more likely than others to develop the condition. Here are a few other factors:
Ψ Experiencing dangerous events and traumas (rape, serious injury, childhood trauma etc.)
Ψ Witnessing hurt on another person, a killing or a dead body
Ψ Having little or no social support after the event
Ψ Dealing with unrelated stressors after the event, such as loss of a loved one, pain and injury, or loss of a job or home
Ψ A history of mental illness or substance abuse (alcohol, drugs etc.)
Just as there are factors that increase risk for PTSD, there are also factors that reduce it. These are known as resilience factors and a few of them are shown below:
Ψ Seeking out support from other people, such as friends and family, or support groups
Ψ Helping others process trauma as part of your healing process
Ψ Learning positive coping strategies
PTSD affects everyone in different ways and so there is no standard treatment. However, two concurrent treatment modes are usually prescribed: medication and psychotherapy.
Antidepressants may be prescribed, which may help control PTSD symptoms including sadness, anxiety, anger and feeling numb inside. Medication is sometimes prescribed alongside psychotherapy.
You know by now that Psychotherapy involves guided talk therapy with a trained mental health professional. It can occur one-on-one or in a group. PTSD specific therapy usually involves education about symptoms, and equipping you with skills to identify the triggers as well as techniques to manage the symptoms.
There are two main forms of therapy typically used to treat PTSD:
Ψ Exposure therapy. This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened.
Ψ Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault.
There are other types of treatment as well (Acceptance and Commitment Therapy). For example, Trauma-Focused Cognitive Behavioural Therapy (or TF-CBT for short — scroll below to read more) is primarily used for treating trauma and traumatic grief in children and adolescents.
People suffering from PTSD should discuss potential treatment options with their clinical psychologists.
What is Trauma Focused-CBT (TF-CBT)?
TF-CBT is a type of Cognitive Behaviour Therapy (CBT) that is specifically designed to treat children and adolescents suffering from PTSD (between 3 and 18 years of age). In short, CBT combines elements of behavioural therapy and cognitive therapy into a useful and targeted form of therapy.
The goal of TF-CBT is to educate the child and caregivers on PTSD and equip them with skills to identify and cope with emotions, thoughts, and behaviors that have developed after a traumatic event. TF-CBT achieves this by:
Ψ Developing and teaching coping strategies to deal with traumatic stress reactions.
Ψ Reduce symptoms of depression, anxiety, or acting-out behavior common in children exposed to trauma.
Treatment is typically done over 12 to 18 sessions and include individual sessions for the child and their caregivers, and also joint sessions with the child and caregivers. Specific interventions include:
Ψ Psychoeducation. Learning about traumatic stress together with the child and caregivers: typical reactions and why they happen; about the systems that may be involved (medical personnel, social workers, police, prosecutors etc.) that may invoke various reactions; the connection between thoughts, feelings and behavior; and what is involved in therapy.
Most children will recover from PTSD if effective treatment is regularly administered.
Ψ Emotion regulation and correcting maladaptive beliefs. Learning to recognise typical trauma-related emotions such as fear or anxiety, sadness or grief, anger, or shame and learn specific skills to handle these difficult emotions in constructive ways. Identifying typical but unhelpful beliefs such as self-blame, that no one can be trusted, or that the world is dangerous all of the time. Children and caregivers will be exposed to helpful and more accurate ways to process the trauma.
Ψ Trauma narrative. Encouraging the child to remember and recount the traumatic incident without becoming upset, avoiding certain memories, handling cues and triggers that might remind your child of the trauma. The child and caregivers must work together to reframe the traumatic experience so it does not affect his or her present life. This is the main part of TF-CBT.
Ψ Positive parenting. This component teaches caregivers the skills to help them handle behaviours that are difficult or that interfere with family relationships.
Major Neurocognitive Disorder
(or commonly known as “Dementia”)
Dementia is an umbrella used term to describe a range of neurological conditions, all of which result in a decline in brain function due to physical changes in the brain. Alzheimer's Disease and Vascular Dementia are the two most common types of dementia.
It was once thought that dementia only affected “old people” who had taken leave of their minds. Others thought that dementia was Alzheimer’s disease. In a bid to move away from these stigmatisations, there was a move to recognise dementia for what is was: a major neurocognitive disorder (NCD).
The term “major NCD” more accurately reflects the many different causes and manifestations of significant cognitive impairment that can affect people at any age.
Diagnosing Major NCD (Dementia)
Alzheimer's and other types of dementia are clinically diagnosed (which means it is a clinical decision rather than simply taking a laboratory test). A diagnosis is based on your medical history, brain imaging scans and blood test screens, and psychological assessments to study changes in characteristics or thinking, daily functioning and behaviours. A clinical diagnosis can be made with a high degree of certainty. But it's harder to determine the exact type of dementia because the symptoms and brain changes of different dementias may overlap. In some cases it may be necessary to see a specialist such as a neurologist or neuropsychologist.
In summary, there is no one symptom or test to determine if someone has dementia.
He Ain’t heavy; but is he my brother?
Behavioural and personality changes often accompany major NCD. These changes occur because of brain cell death. The types of behaviour changes observed are dependent on which part of the brain is losing cells.
For example, the frontal lobes in the brain control our ability to focus, pay attention, plan ahead, problem-solve and manage our impulses (late night shopping anyone). When cells in the frontal lobes of the brain are lost, it comes harder to stay focused or control their impulses.
Depending on which parts of the brain are affected, you family member or loved one may not behave as he or she did in the past. You may not recognise the behaviours and mannerisms, but he or she is still very much the person you know and love.
Caring for your loved one
An important concern for many is how one may provide appropriate care for persons suffering from dementia. One effective model is termed the “person-centred care” approach, where the sufferer’s characteristics as a unique person is recognised and his or her preferences emphasised, instead of focusing on the person’s “lost” abilities and attributes. Person-centred care recognises that a person should not be defined by their condition and that underneath the diagnosis and condition, there is (still) a person. This approach has been found to reduce the sense of helplessness in sufferers and lower the incidence of depression.
The key principle behind person-centred care is that it looks at behaviours as a way for the person with dementia to communicate his needs. It focuses on identifying which unmet need causes the behaviour. It is like communicating with a person who doesn’t share your language or culture. Person-centred care requires that medical and mental health professionals, and caregivers, shift their mental model of care by acknowledging that persons with dementia retain their personal beliefs, life experiences and relationships: things that make up who they are as a person. We just need to find a way to understand and communicate with them.
Most importantly, person-centred care ensures their quality of life and dignity is maintained through the course of their condition.
Don’t forget the caregivers…
The benefits of a person-centred approach also flow through to caregivers, empowering them with the confidence to continue providing high-quality care to their loved ones. More importantly, health care professionals delivering person-centred care in nursing homes found that this approach improved job satisfaction, reduced emotional exhaustion and increased the sense of accomplishment among professionals.
It easy to see why it is important to ensure that caregivers receive ample support.
6 years. Its a long time.
But that is the statistical duration of time that would have lapsed before most couples in need will seek therapy. And by the time things become truly intractable, the negativity between the partners would have become overwhelming.
Which is why it is important to identify teething issues that don’t go away and seek intervention at an early stage. Together with your significant other.
Dr Annabelle is trained in and has completed Level 2 Training in Gottman Method Couples Therapy and utilises the Gottman Method Couples Therapy in her couple therapy work. The Gottman Method Couples Therapy identifies “nine principles” that the couple must work through together in order to nourish and maintain their association, and the “four horsemen” responsible for the destruction in a relationship and which are found much less frequently in healthy relationships.
Find out more at the Gottman Institute.
A note on group therapy sessions we conduct
Our groups are conducted in a safe and open environment - no participant should feel ridiculed or threatened by any other participant at any time. We will not hesitate to ask an offending participant to leave our group sessions.
Dialectical Behaviour Therapy (DBT) group skills trainingDialectical behavior therapy (DBT) treatment utilises a cognitive-behavioral approach, emphasizing the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels. It is a cognitive-based, support-oriented, and higly collaborative type of psychotherapy.
Join our next DBT group skills training session, every Saturday from 2 to 5pm.
Caregiver Support Groups for Borderline Personality Disorders (BPD)Coming soon.
Mindfulness-based stress reduction (MBSR)Mindfulness is a mental state of awareness that involves one paying attention to the present moment with curiosity and openness. Through guided experiential meditation and a hands-on approach, this 5 week group workshop goes beyond introductory concepts and is intended to equip individuals with the powerful psychological tool of mindfulness. The program is guided by the principles of the Mindfulness Based Stress Reduction (MBSR) program, developed by Jon Kabat-Zinn.
Anxiety ManagementPersons suffering from anxiety go about their daily lives experiencing various levels of debilitation. High levels of anxiety may even affect critical decision-making processes and impair judgement.
Our anxiety group therapy focuses on equipping you with the tools to identify anxiety in its early stages and impart techniques to allow you to effectively manage anxiety through achieveable steps. We will also go through the psychology of anxiety and decision-making, and how you can maintain an open mind while copying with anxiety.
Join us for an evening of exploration and instruction on the "Twin-Tools" to manage anxiety: Mindfulness and Meditation. We will also explore common issues associated with anxiety disorders, including Generalised Anxiety Disorder, Social Anxiety Disorder, and specific phobias. We encourage participants to attend our sessions together with a person who has been giving you care or supporting you.
Caregiver Support Groups for Persons with Dementia (PWD)Providing care to a spouse, elderly parent or family member who is suffering long term illness or dementia can be very rewarding but it also can be a distressing experience. The caregiver has to endure high levels of stress, lowered sense of well-being and a host of negative emotions. Caregiver stress can be particularly damaging, since it is typically a chronic, long-term challenge. Without adequate help and support, the stress of caregiving leaves you vulnerable to a wide range of physical and emotional problems, ranging from heart disease to depression. When caregiver stress and burnout puts your own health at risk, it affects your ability to provide care. The key point is that caregivers need care too. Managing the stress levels in your life is just as important as making sure your family member gets to his doctor's appointment or takes her medication on time. The practice of mindfulness has been found to be helpful in enabling caregivers to be more reflective thereby allowing them to tap into a wider range of coping skills. Mindfulness based exercises leads to the individual being less reactive and judgmental about upsetting thoughts and emotions. This can be combined with a cognitive-behavioural approach to enhance problem solving abilities, challenge their negative thoughts and assumptions and reengage in positive aspects of life.
Writings and Muses
The Authentic Self
You've seen glamorous pictures of their cars, watches, and handbags (and other things from www.uncrate.com - which by the way is an excellent site to while away the time).
Or perhaps watched the latest 'stories' of linen-clad ‘frienemies’ traversing the Moroccan plains atop a camel. Maybe nothing too rich, just a good-looking former colleague armed with her silky-haired squad hitting the clubs every weekend, and you look at yourself, slumped on the couch with a bag of potato chips watching Netflix (or worse, endlessly scrolling through for something to watch).
Yep. We've all seen these pictures and most of us are guilty of it.
Social media platforms such as Facebook and Instagram inadvertently foster comparisons with your peers. You think, “Why can’t my life be as fun and exciting?” And you start to make plans to skip lunches to save up for a holiday to take twice as many photos, with your new skinny body of course. Or you blow your bonus on that much-vaunted 2.55 alligator bag in gold.
But still we constantly scroll through our feeds looking at the polished pictures of our peers. The cycle (and the feed) is endless.
Like Thanos, we want to reshape reality. We want to convince our friends and family that we are a certain person whether or not that might be true. We might even believe that we are the image that we create for ourselves. In a world of smartphones and selfies, where our identities are equated with our social media profiles, who’s to know what we are or aren’t?
But are we truly living happy lives?
A study conducted in 2015 found a strong correlation between authenticity and self-esteem. People felt better about themselves if they believed they were living authentic lives. People felt better about themselves if they thought they were true about themselves.
What is an authentic life? One philosopher thought an authentic life involved making choices based on your own values, rather than in accordance with the values of anyone else.
But almost every photograph on Facebook or Instagram is a filtered version of reality – there literally are dozens of filters to choose from to edit a photograph. They are also filtered because people only want the positive on display. Perhaps what wasn’t shown to you was how disastrously smelly that Moroccan camel was, how many times she puked along Jiak Kim Street after Mambo Night, or how many installments are left on that BMW. Our quest to emulate the lives of these people becomes meaningless because the very thing we seek to recreate is not real.
We would all be a lot happier (and richer) if we stopped trying to live like the people we follow on social media. Live life on our own terms, simply and without reference to others (said no professor ever).
In the wise words of Heidegger the philosopher, “The path we follow is always of our own choosing. We should never allow our fears or the expectations of others to set the frontiers of our destiny.”
Women and Mental Health
Among the UN nations, only 11 nations had a female head of state while 12 nations had a female head of government (we suspect most of these nations are headed by - deep breath - Her Majesty The Queen Elizabeth the Second, by the Grace of God, of the United Kingdom of Great Britain and Northern Ireland and of her other realms and territories Queen, Head of the Commonwealth, Defender of the Faith; by contrast, the head of government in a commonwealth country will usually be the Prime Minister - to continue the analogy, this would be The Right Honourable Theresa May MP, Prime Minister).
In Parliament (including the Singapore Parliament), women parliamentarians constitute approximately 20% of the parliament. Within the workforce, women account for less than a quarter of senior roles globally and the gender pay gap persists around the world.
There’s no denying it. Gender bias permeates through every aspect of our lives: at home and at the work place. Even in medical settings, especially when clinical judgment is involved.
For example, depression is one of the most common mental illnesses in the world, but it is almost twice as common in women than men. Women are also the single largest group of people affected by Post-Traumatic Stress Disorder (PTSD).
Reasons for this gender disparity may include gender-based risk factors, such as domestic violence, socio-economic disadvantages, income disparities or inequalities, differences in social standing or empathy for others, all disproportionately affect women. Of course, other factors such as how symptoms are differently perceived and diagnosed in women and men also come into play.
Can we reduce the risk of developing mental illness in women?
Yes. Research shows that there are 3 main factors that are highly protective against the development of mental disorders (in men or women) arising from severe or traumatic events:
Ψ Having sufficient autonomy to exercise control over your actions after the event
Ψ Resources to allow the making of informed choices
Ψ Support from family, friends, and psychological support from mental health professionals
More is needed to reduce the risk of women developing mental illnesses such as depression. Changes are needed as a society to ensure that women have autonomy and equal access to resources and essential services; basically, we must improve the protective factors against the development of mental illnesses in women.
As persons – employers, co-workers, friends, or family members – we must all do our part to address personal biases, acknowledge and respect “the other half” of humanity.
After an Attempt
Surviving a suicide attempt
A suicide attempt is extremely traumatic.
Survivors feel disorientated and lost, not knowing where and how to go from here on. Others may feel intense waves of fear, sadness or anger. Some, after experiencing these waves, become seemingly emotionless. Numb. It is natural to have such feelings and thoughts.
Here is a list of steps that individuals should immediately take following a suicide attempt:
and call a loved one or friend right away.
Our ability to actively care for ourselves are greatly affected by the circumstances that give rise to the attempt in the first place. Having survived the attempt, this ability is further compromised. Which means that you are going to need support. Reach out immediately.
Then go to the nearest hospital or medical clinic to seek medical attention. Even if the attempt does not result in you suffering from any physical injury however minor, you should still seek medical attention.
What to do at the Hospital or Clinic
Knowing what to expect greatly reduces the anxiety that comes with waiting in a busy medical facility.
Firstly, emergency staff are trained to assess and manage any injuries that require immediate medical attention. This is known as triage. After treating these injuries, they will then arrange for a mental health professional to meet and have a chat with you about your mental health status. This may include questions on your mood, the presence of recent major stressors, and any concerns with your daily functioning. This is really just a shorthand to assess your mental state and look for any further risks that you may be facing.
Occasionally, the hospital may require a detailed review by doctors with different specialisations. Depending whether such doctor(s) are on hand, you may be warded for further observation or admitted into a ward.
Reaching out to your Tribe (my what?)
We often do not realise how many members of our tribe (your family, friends, colleagues, peers - anyone who is a part of your larger network) actually do care about our safety and well-being. Even if you don’t ordinarily consider them to be part of your support network.
It’s common for people to worry over what to say to others following the attempt. You may want to start a conversation only after you feel comfortable enough to share about your experience, and even then, you can control the extent to which you are comfortable with sharing. Confiding in a support group that you trust and feel connected to is a healthy way to process the experience and suicidal thoughts or make these thoughts easier to manage if they return.
Moving forward, you may find it helpful to write down thoughts and helpful tips to make your transition period easier (“journalling”, for example). These include things like knowing what you can do to make it easier to cope with things in the days following your discharge from the hospital, knowing who in your social support network you can reach out to, and most importantly, having a plan for dealing with suicidal thoughts should they come up again.
Things can change for the better if you allow it to.
Most importantly, seek support from a mental health or counselling professional if you feel suicidal. They will work together with you to create a safety plan or finding ways to cope. Things can change for the better if you allow it to.
A Brief Note on Grief
Grief is a natural response to loss
Grieving is a completely normal reaction to loss. Grief is experienced usually with the passing of a loved one, but is used also to describe reactions to the loss of a relationship, physical ability, or even an opportunity or aspiration.
Healing from grief will take time, and everyone’s healing process is different. There are different theories on the various stages or trajectories of grief a person may go through. Regardless of which some common emotions that typically make up the grieving process such as:
Shock, numbness, disbelief: The passing of a loved one can sometimes happen unexpectedly so feelings of shock and disbelief are normal.
Sadness: The sadness of grief is often deep. Sometimes, people feel a sense of emptiness and many people tend to withdraw from others.
Fear: Fear and anxiety are also normal emotional reactions to loss. Questions such as “How will I get through this?” or “What if someone else dies too?” may fan the flames of the ever-present anxiety that tends to accompany grief.
Guilt: After losing a loved one, many people reflect on their relationship with the person they have lost. Some people recall things that they may have said or done to their loved one that they regret, and the resultant feelings of guilt sometimes seem unavoidable.
All these intense emotions can certainly be overwhelming. Here is some advice on coping with grief:
Ψ Allow yourself to feel all the emotions you may be experiencing. Don’t let anyone tell you that it’s not okay to feel sadness, fear, shock or any other emotion you may be experiencing.
Ψ Take care of yourself – remember to exercise and eat well.
Ψ Be gentle with yourself. Forgive yourself for things you may have said or done.
Ψ Talk to people who have also experienced loss and get support from them.
When should you seek professional help? It may be a good idea to seek treatment or therapy from a professional if any of the following apply to you:
Ψ The intense emotions aren’t subsiding
Ψ You don’t feel capable of coping with the overwhelming emotions on a day-to-day basis
Ψ You have trouble sleeping
Ψ Your relationships are being strained
Ψ You have symptoms of depression or anxiety
Therapy centred on coping with grief may involve encouraging clients to accept and express the emotions they are feeling. The therapist may also work towards helping clients achieve self-forgiveness if they are experiencing strong feelings of guilt. Stress management and relaxation techniques may be taught to help cope with feelings of anxiety. For example, clients may be asked to think about how certain needs, such as love and belonging, were met before the loss, how these needs have been compromised since experiencing the loss, and how new steps can be taken to meet these needs in the near future.
There are, of course, large individual differences in the grieving process so therapeutic techniques used may vary from person to person. What is consistent, however, is that grief therapy is very much a collaborative effort between therapist and client.