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How Does CBT Help with Social Anxiety Disorder?

How Does CBT Help with Social Anxiety Disorder?

In Singapore alone, 10% of the population is plagued by anxiety disorders – one of which includes Social Anxiety Disorder, or SAD for short. And on a global scale, approximately 4.5% of the world’s population – 273 million people – are estimated to experience anxiety disorders as of 2010. Commonly misunderstood to be merely an over-exaggerated form of shyness, Social Anxiety Disorder is much more than that. Individuals with SAD experience symptoms of anxiety or fear under particular or all social situations, depending on the severity of their condition. For some, even doing the simplest day-to-day activities in front of others can cause extreme worry of being judged, humiliated or rejected. However, some research has also suggested that SAD may be especially manifested in individuals that have ongoing medical, physical conditions such as Parkinson’s Disease, obesity, facial or bodily disfigurement (including amputees), and any other sort of conditions that may cause one to look different from the norm.

What are the symptoms of SAD?

When people with Social Anxiety Disorder are surrounded by others or have to carry out a particular action around them, they may:

  1. Feel nauseous, experience an increase in heart rate, tremble, blush or sweat profusely.
  2. Be unable to make eye contact with others, move and act rigidly, or speak in an overly soft tone.
  3. Feel extremely self-conscious, as though others are judging their every move.
  4. Easily feel awkward, embarrassed and stressed out in social situations.
  5. Find it extremely difficult to be themselves around others, especially strangers.
  6. Have anxious thoughts such as, “I’m sure they won’t want to talk to me again,” or “Do I look plain stupid right now?”
  7. Apologise excessively, even when there is nothing to apologise for.
  8. Avoid conversations, such as by using their mobile devices or plugging in their headphones. 
  9. Avoiding situations where one might be placed at the centre of attention.

The list of symptoms above is not exhaustive, but we need to recognise that they may cause extreme distress to these individuals. For them, it can be tremendously helpful and relieving for them to seek treatment for their condition, more specifically through Cognitive Behavioural Therapy (CBT).

Cognitive Behavioural Therapy is a well-known form of therapy in the mental health profession. Considered to be a form of short-term therapy, CBT is usually delivered in a time-limited manner, often over the course of 8 to 12 sessions (although this may vary from person to person). Once the symptoms are reduced and the individual is well-equipped with the necessary skills to cope with anxiety triggers or social situations in general, treatment can be finalised. As it is not possible to change or alter emotions directly, CBT aims to tackle any maladaptive, limiting thoughts and behaviours that fuel or contribute towards agonising emotions. This, therefore, lowers the extent of anxiety that one goes through and instead, developing a sense of self-efficacy.

First off, CBT encourages individuals to open up and to be truthful regarding their automatic, instinctive (negative) thoughts so that they can work hand-in-hand with therapists to analyse the logic behind them. During the sessions, therapists will work to identify the assumptions (and their validity) that these people hold, which might be causing unnecessary anxiety or fear. Proper reasoning and clearing up of assumptions can be done by asking clients to do some self-assessment and to provide possible reasons as to why they maintain such assumptions. By doing so, therapists can then assess the situation and present evidence contrary to their beliefs. 

Another aspect of CBT includes ‘Decatastrophising’. One common thinking pattern found in people who suffer from anxiety issues is ‘Catastrophising’, which is the act of imagining the worst-case scenario and magnifying the bad in any given situation. CBT helps to counter such a mindset by helping these individuals prepare for the feared consequences, as well as to cope with their unhealthy ways of thinking. For example, therapists and clients will go through certain ‘Challenge Questions’, such as:

  • “Has anything this bad ever happened before? How likely is it to happen now?” 
  • “What makes you confident that your feared outcome will actually come true?”
  • “What is the best outcome that can happen in this situation?”

These are just a few examples of ‘Challenge Questions’, but they can certainly be beneficial in helping to ease feelings of anxiousness and to calm the individual. In some way, this can also decrease an individual’s inclination to avoid seemingly triggering social situations. 

Tying in with ‘Decatastrophising’, another technique introduced during CBT is ‘Reattribution’. ‘Reattribution’ is a method which challenges the negative assumptions held by the individual by considering the possible alternative causes of events. This is particularly advantageous for people who, in most situations, perceive themselves to be the cause of problem events. For example, this can mean having a discussion on the evidence which proves that the individual is/is not the cause of the problem. Eventually, this will help to tackle ‘Automatic Negative Thoughts’, excessive self-blame and worry.

Of course, in order for the treatment process to be carried out more effectively, some therapists do assign “homework” to their clients. This is to say that clients are encouraged to apply CBT principles in between sessions, and are tasked to self-monitor and focus on implementing tips and processes when dealing with actual situations. By monitoring their emotions and making a conscious effort to calm themselves through methods discussed during sessions, these individuals will eventually develop the much-needed skillsets to cope with emotionally-draining social environments.

 A combination of cognitive and behavioural therapeutic approaches, CBT has been proven to be an extremely effective treatment method for anxiety disorders, including SAD. In fact, the skills you learn in CBT are practical and highly applicable, and hence can be incorporated into everyday life to help you cope with future stresses more effectively.  As such, if you or a loved one is struggling with SAD, do seek treatment as it will ultimately benefit you in the best way possible. 

 


References: 

  1. https://www.mentalhealthacademy.co.uk/dashboard/catalogue/using-cbt-with-social-anxiety-disorder/chapters/1 (Accessed 3/11/2020)
  2. http://psychcentral.com/lib/social-anxiety-overview (Accessed 3/11/2020)
  3. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml (Accessed 3/11/2020)
  4. Photo by Luke Porter on Unsplash
Healing from being with a person with Narcissistic Personality Disorder

Healing from being with a person with Narcissistic Personality Disorder

Written by: Winifred Ling, Couples Therapist & Relationship Coach

Happily-ever-after is an ideal that many believe and pursue and numerous studies have suggested that the key to happiness lies in a thriving marriage. I am also convinced that when couples come together and decide to get married, they do not have the thought of a divorce on the horizon.  

To many, marriage is not a frivolous decision but one where he or she has deliberated and decided to entrust oneself to the other legally. Imagine the horror when shortly after the wedding bells, you discover that your spouse turned out to be someone that you don’t recognise and ends up hurting you so deeply that you wonder how you even got to this point: being romanced to being discarded. This is what it is like to be in a relationship with a narcissist. 

Let’s explore the traits of a narcissist. 

The following are the 9 official criteria for Narcissistic Personality Disorder (NPD):

  • grandiose sense of self-importance
  • preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • believes they’re special, unique and can only be understood by, or should associate with, other special or high-status people or institutions
  • need for excessive admiration
  • sense of entitlement
  • interpersonally exploitative behaviour
  • lack of empathy
  • envy of others or a belief that others are envious of them
  • demonstration of arrogant and haughty behaviours or attitudes

In essence, a narcissist has an excessive sense of self-importance over and above the needs of others. There is a sense of grandiosity and arrogance; and a lack of ability to empathise and experience reciprocity within intimate relationships. They are typically charming and charismatic. The early stages of the relationship are almost always exhilarating, romantic, powerful and intense. Love-bombing is a tactic where NPD makes you feel so special and loved that you can’t help but fall deeper in love with him or her. Most narcissists only reveal their true colours when they are in conflict. And when you no longer serve their needs, they discard you from their lives or make it a living hell for you. 

Imagine the adverse and trauma that one experiences when you wake up one day and realises that the love you’ve received is not real and permanent. 

The following are the lasting psychological and emotional impact of being in a relationship with a person with NPD: 

  1. “I don’t know what is real anymore.”
    Survivors of persons with NPD have the inability to trust their own judgment. Because gaslighting is a key feature in this toxic relationship, they lose touch with what is the reality. Gaslighting is defined as a form of manipulation, emotional and psychological abuse that results in a slow dismantling of a victim’s self-trust and judgment.
  2. “It is all my fault. Everything I do is wrong. I trigger him/her. I deserve his/her anger.”
    Because a person with NPD will never assume responsibility for anything (they believe they do no wrong), they turn it around and project their emotions on the survivor. The survivor is the one who is over-sensitive and would ask irritating questions that trigger them to react. The consequence of this is that the survivors feel powerless and start to blame themselves for not being good enough for their partner.
  3. “I am worthless and deserve nothing
    From the constant criticizing and undermining from a person with NPD, the survivors begin to accept the narrative that they are the problem and suffer from low self-esteem. They may start to withdraw from their family and friends who are concerned and question the relationship. They also hide their partner’s behaviour and lie about it.
  4. “I am going crazy”
    This is related to point #1. Because a person with NPD constantly lie and intentionally say things that make the survivors question their reality, they start to think that they are crazy for having those questions. They feel confused and lost all the time.
  5. “I don’t know. I can’t decide. It will be wrong anyway.”
    They have great difficulty in making decisions because they start to believe that they can’t do anything right. This is the message that is drummed into them persistently and this could extend into other aspects of life, such as in their work.

 

One of the common frustrations that my clients, who have survived persons with NPD, have often expressed: ‘how is it possible that they missed the warning signs’. Because of the suffering that they have been through, they have asked for the warning signs to be shared so that more can be aware and watch out for them in their relationships. 

  1. Self-centeredness
    They believe that the world revolves around them. They are not able to empathise and therefore can only see from their point of view. When things do not go their way, they get very upset and may threaten to end the relationship. Everything is on their terms. For example, my client shared that when they were dating, the partner dictated when to meet according to his schedule. Not knowing better, she accommodated. That is a red flag. Also, when they no longer have use of the partner, they have no qualms to simply discard them by being emotionally unavailable, refusing to communicate and abandoning the partner.
  2. Frequent threats and emotional blackmail
    If you feel like you are perpetually walking on eggshells not knowing when your partner will explode on you, chances are he/she has NPD. Threats and emotional blackmail are their tools to control and get you to submit to their wants. E.g., Go ahead and leave, I never needed you anyway. I’ll tell everyone what a mean person you are.”
  3. They act entitled and rules don’t apply to them.
    They believe that their needs are more important than their partner’s. There will be no reciprocal gestures unless there is an ulterior motive to get what he or she wants. Because of the self-importance and arrogance, they believe that they can do as they please as long as they don’t get caught. They deserve special treatments.
  4. Obsessive focus on the external
    This applies to how they dress and carry themselves. Typically they are attractive, have material possessions and are of certain social status. They appear to be an excellent “catch”. They will go all out to inflate their status and standing. Another client told me that her husband, a covert narcissist, was charming and social. His real self only surfaced when they were on their own and when he felt threatened by her. This creates problems as people may not believe her when she tells her challenges.
  5. They are master manipulators and schemers.
    The key emotions that you feel when you’re with a narcissist are guilt, shame and confusion. The hallmark of a person with NPD is the inability and unwillingness to take responsibility for any action and word. Consequently, they project their emotions onto the survivors and make them feel guilty and responsible. They can also be verbally abusive and are good liars. They scheme and twist the words of the survivors to their advantage. They have no issue in making their partners the bad guy and spread rumours that paint themselves as the victim. The bottom line is this: they need to make themselves feel good at the expense of everything and everyone. When they don’t get what they want, they will withdraw either physically and /or emotionally from the partner. They may give the silent treatment, be passive-aggressive, stonewall and/or ignore the partner. At the end of it, the partner will accept the blame and promise to not upset them next time.
  6. They are hot, then cold.
    When they want something, they will go all out to get it. As such, in the early stages of the relationship or when they are on a mission to keep you under their control. They will pull out all the stops to make you feel wanted, admired and loved. One moment, you could be the most important person in their lives and in the next, when you don’t agree with them on something, it could be a trivial matter, you would become a worthless person that is undeserving of his/her respect and love. The switch from hot to cold is unnerving and they will make the survivors think that the problem lies with them.

 

In spite of the detrimental impacts of being in a relationship with a narcissist, the good news is that it is possible to heal from it. I have supported and seen my clients live a meaningful and flourishing life following the breakup with a narcissist. Though the journey may not be easy, if one is willing to work with a professional to go deeper and understand the pattern of relationships in their lives, they can find healing and freedom. 

What are the steps to heal? 

  1. Educate yourself on NPD and accept that it is a disorder. Know that you are not alone and you are not the problem. Raise awareness for it. The World Narcissistic Abuse Awareness Day is on 1 June. Get involved and when you are ready, share your story. You can empower and help others by sharing your experience courageously.
  2. Get professional help as dealing with trauma can be complicated. Learn to connect the past to the present; typically, the dynamics between the person with NPD and the survivor is one that the latter is familiar with. It is not uncommon that upon the realization that the partner has NPD, the survivor can see that a family member could be one as well. Those who persist in such toxic relationships are usually accustomed to such dynamics from childhood.
  3. Practice boundaries – physical and emotional. Have zero contact or keep it to a minimum should you share the care of the children. The survivors are usually empathic and attuned to the feelings of others. Be mindful not to take on feelings that are not yours. Have clarity on what is your responsibility and discard those that are not yours.
  4. Build a strong foundation – focus on one’s strengths and resilience, in ending the relationship and working through the issues. Find meaning in it by rewriting the narrative.
  5. Forgive and work on self-love. Self-compassion is a critical component in recovering. Learn to take good care of yourself – physical, emotional, psychological, spiritual, social.
  6. Pay attention to your body as trauma is stored in your body. Practice mindfulness to bring yourself to the present moment when you’re triggered by difficult memories. The triggers will still be there, and the healing process will be imperfect and a work-in-progress.

  7. Focus on the good – that is in you; the work that you have put in to heal and maintain your well-being by learning new skills and maintaining good habits. Celebrate quick wins when you are able to enforce boundaries or not take on responsibility for how others are feeling.
  8. Embrace a healthy relationship. After being in a toxic relationship for a long time, being in a healthy relationship can feel weird and scary. You aren’t sure what to make of it. The lure to get back to what is familiar albeit negative for you is high. Be aware of it and put measures in place so that you can recalibrate when you feel threatened.

 

Let’s remember that significant relationships in our lives will impact our mental well-being. Even as we focus on the benefits of positive relationships and promote it, we also need to provide support for those who have been through traumatic and toxic relationships. The key is to remember that relationships should enhance your lives and motivate you to be a better version of yourself. When there are disempowerment and manipulation in the relationship, it is not healthy, and you can make the decision to get out of it. 

Healing comes with returning your focus to yourself, acknowledging your feelings and emotional experience and taking responsibility for yourself. Through the right help and therapy, you can learn new skills, to regulate your emotions, have better communication and understanding, and help yourself break the cycle of unhealthy patterns. Your resilience can be enhanced, and a flourishing life is once again within your reach. 


DSM-IV and DSM-5 Criteria for the Personality Disorders

 

Understanding Childhood Emotional Neglect 

Understanding Childhood Emotional Neglect 

As a child, how did adults around you react whenever you expressed your feelings? Did you grow up receiving that subtle message to wall up your emotions so they don’t get the better of you, or become anyone else’s burden? Childhood Emotional Neglect (CEN) is a topic often overlooked, and many fail to realise that it can eventually manifest into mood disorders or anxiety disorders if not dealt with appropriately. 

Childhood Emotional Neglect occurs when our caretakers or parental figures fail to respond to our affectional needs suitably during critical stages in our development. An individual who grows up experiencing emotional neglect may experience a pattern of having his or her emotions being disregarded, invalidated or downplayed by others. While many of us may wonder, “What kind of parent doesn’t pay attention to a child’s emotional needs?” In reality, some parents may not actually realise that they have been shutting their child(ren) out emotionally. In Asian societies in particular, some parents are commonly labelled as “authoritarian” or “tiger parents”. These people may in fact perceive themselves to be giving the absolute best to their child, enforcing strict discipline and ensuring that their offsprings are well-equipped with the best skills to succeed in life. However, young children and teenagers may instead be overwhelmed by such demands, and feel as if their feelings were never considered or understood. Whilst we mentioned its prevalence in Asian societies, it is key to note that it is not merely limited to these children – many worldwide experience it too, making it an exceptionally important subject. With emotional neglect being a common feature in the childhood of many, it can become an undesirable shadow that follows us throughout our lives – eventually leading to undermined happiness and the lack of an authentic sense of self.  

Delving into the matter at hand, Childhood Emotional Neglect (CEN) can come in two forms – active and passive CEN. Active CEN is when parents or caregivers actively act in a way that dismisses or denies the child’s emotions. For instance, a boy is sent to his room for crying over the death of his pet fish, and his parents complain of having an overly-dramatic son. When the child is being denied of his sadness and is receiving the message that his behaviour is unreasonable, this forces the child to grow up hiding his feelings, and at times struggling with fear and shame of his own emotions. On the other hand, passive CEN occurs when parents show a lack of care or validation regarding the child’s emotional needs. When parents fail to notice when the child is angry, upset, hurt or anxious, this gives off a subliminal message to the child that his feelings are irrelevant or not worthy of note. In any case, both forms of CEN are clearly detrimental towards one’s mental health. 

Albeit not having a test or questionnaire that can help with a diagnosis for CEN, there are certain “symptoms” of CEN that may surface, be it in the later parts of one’s teenage years or adulthood.\

For one, individuals who have experienced CEN may find it difficult to prioritise their wants and needs, even if it’s something that would bring them great joy. It is innate for us to have desires and to just be aware of what we want and need. However, for someone who grows up having his feelings invalidated and cast aside, it could become a natural thing for him to keep his desires to himself. As such, even if opportunities do come along, these people would often fall through the cracks, most probably due to their inability to request for it upfront, or by allowing others to seize it instead. 

CEN also causes one to start projecting any feelings inward, regardless of whether they are negative or positive ones. People who have experienced CEN are particularly predisposed to turning feelings of anger inwards, as they never learnt how to be comfortable with their emotions, nor how to handle them in a healthy manner. It is often said that nothing good comes from bottled-up feelings, and that is absolutely true. 

Having pent-up feelings also mean that these individuals are not likely to seek help or lean into their support systems whenever things get tough, making them feel all the more isolated and vulnerable. Even at times when they are feeling deeply challenged by certain life events, they find themselves trying to cope all on their own, leading to unhealthy stress levels and anxiety. Unsurprisingly, the constant feelings of shame and inability to get in touch with one’s emotions will eventually lead to one losing sight of his or her strengths as well. As a result, poor self-esteem is sometimes a consequence of CEN.

While many individuals, including adults, fail to recognise the impacts of childhood emotional neglect on their lives due to its subtle nature, it is important that they get themselves back on track – to regain true happiness and greater self-esteem. You might have grown up devoid of your own emotions, but you need to recognise that facing them head-on will ultimately help you to cope with life events and for you to regain your sense of self. 

Learn to start getting in touch with and embracing what you feel – both the good and bad. Identifying what you feel in certain situations will be a good step towards helping yourself cope with your environment and daily life. When challenges seem overwhelming, don’t feel afraid or ashamed of reaching out to your friends and family for help either. Even more so, if you ever feel like you’re losing control of your life and are derailing emotionally, seek professional help as soon as possible. While not everyone who grows up with emotional neglect ends up with mood disorders such as depression or anxiety disorders, there are certainly people who do. Don’t deny yourself of your emotions any longer, therapy might just be the solution to helping you learn the vital life-coping skills you never learnt as a child.  

 


References: 

https://www.straitstimes.com/singapore/how-emotional-neglect-during-childhood-affects-ones-mental-health (Accessed 07/10)

https://blogs.psychcentral.com/childhood-neglect/2018/09/the-2-types-of-childhood-emotional-neglect-active-and-passive/  (Accessed 07/10)

Photo by Isai Ramos on Unsplash

 

Evidence-Based Mental Health Disorder Diagnosis: How It’s Done from a Clinical Perspective

Evidence-Based Mental Health Disorder Diagnosis: How It’s Done from a Clinical Perspective

For individuals that are taking the first step to seek help from mental health professionals, it is natural that they may be concerned with the possibility of a misdiagnosis, or perhaps an overdiagnosis. With the pre-existing stigmatisation of mental health disorders, clients would have needed to pluck up their courage to seek treatment in the first place. A misdiagnosis could not only hinder them from receiving the appropriate treatment for their affliction, but also allows for their distress to grow unchecked as their hope for recovery diminishes. In other words, accuracy in evidence-based mental health diagnosis is crucial, and this article aims to help you better understand how the diagnostic process works.

As the term “Evidence-Based Diagnosis” implies, psychiatrists or clinical psychologists take extra care to ensure that any diagnosis made is accurate, objective, and not subject to any form of personal bias. In some sense, this also means allowing for a safe, non-judgemental and compassionate environment. Primarily, clinicians would have to understand the client’s suffering and situation, before thinking about how that might relate to a possible mental disorder. Perhaps you may be unaware of this – clinicians do not simply jump straight into tying the client down with a specific diagnosis of a mental disorder. Before all else, clinicians have to consider if the client’s symptoms meet the definitions of a mental disorder in the first place. As per the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the definition of a mental disorder considers these five factors:

  1. A behavioral or psychological syndrome or pattern that occurs in an individual
  2. Reflects an underlying psychobiological dysfunction
  3. The consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)
  4. Must not be merely an expected response to common stressors and losses (i.e.. the loss of a loved one) or a culturally sanctioned response to a particular event (i.e. trance states in religious rituals)
  5. Primarily a result of social deviance or conflicts with society

With reference to the definition of a mental disorder, it is particularly important to note that the consequences of a mental disorder is clinically significant, and causes a weighty amount of disruption to one’s lifestyle and day-to-day activities. For example, it is completely natural for one to feel upset over certain situations, and this does not necessarily mean that you have a case of depression. However, you might need to get it checked out if you find yourself unable to cope with prolonged feelings of sadness which start to interfere with your daily activities, or are causing you to have suicidal thoughts.  

Of course, clinicians then assess the syndrome one displays. By “syndrome”, we mean a collection of signs or observable aspects of the client’s suffering (i.e outward expression or behaviour). The main point of this is to identify if the syndrome is clustered in an identifiable pattern that is noted to be severe or pervasive. During the assessment phase, clinicians also try to understand the internal experiences of the client. Besides their outward display of distress, their thoughts and feelings are also important information which counts towards the diagnosis of certain disorders. Upon identifying that the client is indeed suffering from a mental condition, clinicians then try “assigning” the client to a particular category. You can think of it as, “can the syndrome be broadly identified?” There are certain broad categories of disorders, such as anxiety disorders, or psychotic disorders. Needless to say, clinicians have to consider which category the client best fits in.

The last step of the diagnosis process concerns the further narrowing and identification of the specific disorder – branching out from the broader, generalised category and into the specific details. For example, a client could be diagnosed with Obsessive-Compulsive Disorder (OCD), a form of an anxiety disorder. Ideally, a specific disorder is identified during the diagnosis process for various reasons – for the sake of the clients themselves, but also for clearer communication with other mental health professionals (in the case of continuity of care), and even for legal or court matters. Under rare circumstances, some clinicians are able to identify the broad category of the mental disorder, yet are unable to specify the exact condition that the client is suffering from. In cases like these, their disorders will be labelled as “unspecified”, as per the 10th version of the International Classification of Diseases. 

As mentioned, evidence-based mental disorder diagnosis is all about diagnosing clients accurately and objectively. To enhance objectivity, some clinicians go the extra mile, stopping to consider if the diagnosis given was biased, or influenced by his or her own culture and history. “Is the syndrome maladaptive?”, “Did I take cultural variables into account?” An objective diagnosis will certainly go a long way in ensuring that the client receives the most appropriate treatment, which will in turn enhance his or her recovery journey. 

Overall, it is safe to say that it takes two hands to clap in every treatment process. Clients and clinicians should try as much as possible to work together, be it in the assessment or treatment phase. For an effective treatment, clinicians will do their best to assess the severity and pervasiveness of any syndrome using understandable language such that clients are well aware of their condition. However, clients also need to understand that transparency on their side is pivotal and that it will drastically impact the treatment process, for better or for worse, depending on their cooperativity and how much they choose to reveal. 

 


References:

Dr Robert Shwartz, Ph.D., PCC-S, Evidence-Based Mental Disorder Diagnosis: How to Increase Accountability, Efficiency and Objectivity, video recording, Mental Health Academy

<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/evidence-based-mental-disorder-diagnosis-how-to-increase-accountability-efficiency-and-objectivity> (Accessed 11/09/2020)

My partner may be a Porn Addict – What should I do?

My partner may be a Porn Addict – What should I do?

Written by: Andrew da Roza, Addictions Therapist, Sex Addiction Specialist

With the introduction of the fast speed Internet, a new addiction was born – Internet porn addiction. 

One client who has fallen down the “Rabbit Hole” of porn addiction reports: 

“I saw porn in Manga mags and comics when I was in my early teens and occasionally saw a porn mag. 

It wasn’t until the fast speed Internet came in and I could stream videos on my mobile phone and iPad, that I started to watch it regularly. After a year or so, I started to watch it every day at home, when I was alone. 

Later on, I started watching it in the bathroom of the office; then at my desk, and finally, in public places and on public transport – I am amazed I wasn’t caught by someone!”

Some clients come to therapy to kick the porn habit because they recognize that they have a problem. They have been “caught” multiple times by their partner – always promising to stop. 

Or they may have inadvertently left sites open on the family computer. Some even get called in by HR at work and asked to explain the hundreds of times they have logged into porn sites, which the IT department has uncovered.   

Others don’t see they have a problem – even when their experiencing porn-related erectile dysfunction, anejaculation, or loss of libido and intimacy with their partners and spouses. 

They may simply consider this distressing, though natural, change in their relationship – a product of familiarity and boredom.  

As it turns out – they may be quite wrong – because there is nothing “natural” about porn. It’s toxic and it can effectively hijack intimate relationships, which could otherwise have been healthy and fulfilling.

Clients with porn use compulsivity often say:

“I wouldn’t have come to therapy unless my partner had given me an ultimatum – “get help or we break up!”.

And it’s also common to hear: 

“At first I thought I would just see a therapist once or twice to appease her, and let her know I want us to stay together”. 

However, after discussing in therapy how long a client has been using porn, how frequently they were using it, where they were using it – and the type of porn they have digressed to watching – they often realize all the risks they are taking with their relationships, marriage, families, and their jobs or their studies.

One client reports:
“the therapists gave me a detailed questionnaire. I was staggered by the report that came out. Seeing my behaviour over the last few years, what motivated me to do it, and how it changed me and my relationships, I became really worried.”

“I hadn’t realized that because of porn, I was losing interest in sex with her, I wasn’t present for my family, and I was getting irritated, restless and discontent at home and at work.

I thought that my problem with my sex drive and erections was our relationship – not the porn.”

These revelations, and many more, may be tough for a person with porn compulsion but at least they may be motived to take recovery actions. 

But what about the partner or spouse? They may be feeling frustrated, angry, fearful and ashamed. They may be devastated. 

They may be confused when friends, relatives and the community at large believe that porn is the “new norm” and that “boys will be boys”. 

What can they do? 

While relationships are all as different and unique as the people in them, there may be some common actions that spouses and partners may wish to consider. 

These include:

  • Attend therapy with the person who has porn use compulsivity – and learn about Internet porn addiction. How it arises; what it looks like; is the behaviour compulsive – or is it a moral issue, a lack of discipline, selfishness – or have they just stopped loving or desiring me?
    In a couples’ session, you can also learn what the recovery actions are, what it takes to succeed in recovery, and how you will know that he is in recovery – and will he ever do it again?

 

  • Read about porn addiction and how porn changes the brain. There are many good websites with excellent information. Fight the “New Drug”, “NoFap”, and “Your Brain on Porn” are but a few sites with good articles and videos. Robert Weiss, Paula Hall and Stephanie Carnes also have helpful YouTube videos.   

 

  • Insist that your partner initiates a regularly weekly couples’ check-in session; in which he shares: what actions he taken in his recovery that week and what he has learned; what actions he hasn’t done and why; what he will do next week; and what help he needs from you – and you always have the right to say “no”, or “yes, but…”. 

 

  • Judge his recovery only by his actions – not by his promises, intentions, desires or apologies. What he says is important – but what he actually does, is definitive.    

 

  • Create physical, emotional, spiritual and sexual boundaries with him – and have consequences that you apply – without fail – whenever those boundaries are breached. 

   

  • Stay connected with others about how you are doing and don’t isolate – but be cautious who you tell about his porn compulsion; only choose a few trustworthy friends or relations. Do not talk to everyone, including your children, when you are angry, in a rage, frustrated – or to retaliate – you are very likely to regret it later.

    If you think an age-appropriate disclosure is beneficial for the children, work on a script together; and allow the person with the porn compulsion to deliver it. It is their responsibility to hold themselves accountable for their actions.

 

  • Take really good care of yourself. Treat yourself kindly and compassionately.  Eat three healthy meals a day; sleep seven to eight hours; exercise regularly; take up yoga, Tai Chi and meditation. There are a wealth of Apps and YouTube videos out there – Calm, HeadSpace and Insight Timer are popular meditation Apps. Spend time with friends and family; take up new interests and hobbies – seek to relax and allow joy into your life. 

 

  • Porn blocking software administration. If you are open to it, you may be asked to be the security administrator for the porn blocking software that will prevent porn from being seen on his devices and the family computer. Consider carefully whether this would cause you more distress – or whether you wish to support him by ensuring that the security blocking software is in place.  

 

  • Consider seeing your own therapist – sometimes porn and deceit can be felt as profoundly as a relationship betrayal. It takes time and help to get through the trauma.

    Some partners feel shame, and some question whether they are the cause of the porn compulsion. Some partners are confused and devastated by all the lies and deceit. They don’t know what is real anymore. Talking to a supportive therapist can help you through this.

 


Photo by Grzegorz Walczak on Unsplash

How Do You Find The Right Therapist For You

How Do You Find The Right Therapist For You

For many individuals, therapy is a rather intense and personal topic, and it could have taken them a lot of courage to finally seek the help that they need. Keeping this in mind, it is exceptionally crucial that one finds the right therapist, for there’s a pre-existing implicit clinical belief that the level of treatment effectiveness is greatly dependent on the therapist-client fit. Of course, every client would love to be able to – ideally – find that one therapist whom they can fully open up to from the very beginning, but in reality, that may not be the case. At times, it is necessary to assess your relationship with your therapist and evaluate if there’s the good rapport you need for your sessions to be a success. Ultimately, it boils down to whether you feel a steady, reliable and safe connection with the therapist, and whether you are making the progress you hope for. 

To give you some background, studies over the years have shown that the more similar the therapist and the client, the higher the rate of recovery. As an example, an assessment instrument entitled the “Structural Profile Inventory(SPI)”, which measures seven “independent yet interactive” variables (behaviours, affects, sensory imagery, cognition, interpersonal, drugs/biological factors or BASIC-ID), showed that client-therapist similarity on the SPI predicted a better psychotherapy outcome for the client as measured by differences pre- and post-treatment on the Brief Symptom Inventory. Moreover, the demographic similarity between therapist and client facilitates positive perceptions of the relationship in the beginning stages of treatment, enhances commitment to remaining in treatment, and at times can accelerate the amount of improvement experienced by clients. More precisely, it can be said that age, ethnicity, and gender similarity have been associated with positive client perceptions of the treatment relationship. With gender and cultural similarities appearing the most strongly preferred among clients, these domains generally enhance clients’ perceptions of their therapists’ level of understanding and empathy, and as a result, sessions are judged to be more advantageous and worthwhile. However, besides these, there are also other means to assess your “fit” with your therapist, and we’re here to discuss just that.

First and foremost, consider if you are seeking help in the right place. Does the therapist you are looking at specialise in the area you are seeking help for? Before we can even touch on the topic of interpersonal therapist-client fit, it is important for you to take the time to do some research on various therapists’ profiles – in other words, to sift through and read up on their respective areas of expertise. Typically, therapists would have their area(s) of specialisation up on their online profile directories. It would be clearly indicated if they specialise in areas such as substance abuse, family therapy, or even anger management. It goes without saying that, for example, it would be inappropriate to consult a psychologist who specialises in child psychology when you’re clearly looking for someone who can help you with your substance-use addiction. With that said, it is to no one’s benefit for you to rush into therapy blindly. 

Once you have chosen the potential therapist that you are most likely to want to have see you through your road to recovery, another essential question you should ask yourself is whether you are comfortable with their suggested mode of therapy. During consultations, you will have the opportunity to enquire about their recommended techniques or treatment methods that will be explored during your subsequent sessions. If you are uncomfortable with any particular process, giving honest feedback and exploring other methods is always an option. However, at any point, you also have the right to seek other therapists who may be able to help you in other ways that don’t put you in a tight spot. After all, therapy is all about having a safe and comfortable space for you to sort out your difficulties. 

When assessing your interpersonal connection with your therapist, make sure to trust your gut. This way, you’ll also be able to track your progress better and to seek alternative help if required. Some questions you can ask yourself are:

  1. Am I satisfied with the current balance of talking and listening with my therapist?
  2. Is my overall therapy experience safe, warm, and validating? 
  3. Am I fully assured that I’m in a non-judgemental space where I can be fully honest?
  4. How much has the therapist helped me to gain greater insight into my own behaviour and thoughts so far? 
  5. Am I becoming more capable of coping (independently) with stressful or triggering situations over time?
  6. Am I noticing more positive changes in myself, as compared to when I first started therapy?

As mentioned, a major deciding factor should also be on whether you find yourself noticing positive changes in your thought cycles and behaviour after a couple of sessions. At the end of the day, therapy should be about working towards achieving your desired outcome, and should definitely not be limited to weekly venting sessions. Although venting and letting out hard feelings can provide temporary relief, it fosters a client’s dependence on the therapist over time and further reinforces the client’s problems. Therapy should instead help you to feel more confident that you’ve developed the relevant skill sets in order to cope with whatever emotional challenges that brought you to seek therapy in the first place.

Naturally, there’s no guarantee that we will find chemistry with the first therapist we meet. The chemistry between people varies, and sometimes it’s just not possible for us to force it. Thus, it is important to remember that a lack of fit between therapist and client is no one’s fault. However, remember that the ball is in our court, and it is within our control to start looking in the right place for the sake of our own well-being.


 1 Herman, S.M. (1998). The relationship between therapist-client modality similarity and psychotherapy outcome. Journal of Psychotherapy Practice and Research, 1998 Winter; 7(1): 56-64.

2 Luborksky, L., Crits-Christoph, P., Alexander, L., Margolis, M., & Cohen, M. (1983). Two Helping alliance methods for predicting outcomes of psychotherapy: A counting signs vs. a global rating method. Journal of Nervous and Mental Disease, 171, 480-491.

3 Jones, E. E., (1978). Effects of race on psychotherapy process and outcome: An exploratory investigation. Psychotherapy: Theory, Research and Practice, 15, 226-236.

4 Blase, J. J. (1979). A study of the effects of sec of the client and sex of the therapist on clients’ satisfaction with psychotherapy. Dissertation Abstracts International, 39, 6107B-6108B.

Beutler, L.E., Clarkin, J., Crago, M. and Bergan, J., 1991. Client-therapist matching. Pergamon general psychology series, 162, pp.699-716. (Accessed 30/08/2020)

https://www.counsellingconnection.com/index.php/2019/12/03/assessing-therapist-client-fit/ (Accessed 30/08/2020)

https://www.nytimes.com/roomfordebate/2013/02/14/think-like-a-pope-knowing-when-to-quit/when-to-quit-therapy (Accessed 30/08/2020)

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