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What Does Journeying with a Psychologist for My Mental Health Issue Look Like?

What Does Journeying with a Psychologist for My Mental Health Issue Look Like?

So you are going to see a psychologist for the first time – now what should we expect? The thought of having to step into a psychologist’s room for the first time can be nerve-racking, and understandably so. Oftentimes, individuals may be apprehensive and would wonder if talking to a complete stranger is really going to help, or if opening up your innermost thoughts to a stranger was too much of a risk to take. However, rest be assured that these mental health professionals are well-versed in psychotherapy methods to help you manage your issues as best as possible, and will work closely with you at a comfortable pace. Just like in the treatment of physical illnesses by physicians, patient privacy and confidentiality are also primary obligations for psychologists. In this article, we hope to give you a clearer idea of what you can expect from your visit to a psychologist, especially if it is your first session.  

 

First things first, it is important to understand that psychotherapy isn’t merely a one-off session. While the duration of treatment may vary from one person to another, the American Psychological Association (APA) reports that “recent research indicates that on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures.” The type and duration of treatment also heavily depend on the nature and severity of each client’s conditions, and it would simply be unfair to make an overgeneralised statement. Regardless, it would be beneficial to go in with an open mind, and to have an honest conversation with your psychologist. It really helps to trust that the process works, while acknowledging that it takes time. 

 

Meeting the psychologist

At the beginning, the first few sessions would aim to help one identify the most pertinent issue that needs to be dealt with. The psychologist will talk through with you gathering some information on your life history, your family’s mental health history, the problems you are dealing with, and analyse those details – no matter how insignificant they may seem at first – that could have possibly led to emotional distress or coping difficulties. For the psychologist, being able to get a good grasp of the situation and seeing the big picture is vital for formulating the treatment plan and treatment process, as it will help to determine the type of psychotherapy that is best suited for you. The psychologist is trained to listen and analyse your conditions in order to help you with your recovery. As such, it is equally important that you don’t hold yourself back from being fully honest with your psychologist. To a large extent, the patient’s participation in the therapy is an important determinant of the success of the outcome. 

 

Goal-setting

While we fully understand that it can be unnerving, these mental health professionals are trained to help you work through the challenges you face, and the therapy room is very much a safe, non-judgemental space. Goal-setting is one of the key aspects of psychotherapy, and it is exceptionally important to set goals from the start that you can use to track your progress. You may start by identifying personally meaningful broad motives, hopes and dreams – having a clear direction in mind will better steer future sessions towards alleviating symptoms of distress and tackling the root cause of one’s concerns. Don’t worry if you feel the need to change your goals or take a different approach halfway through the treatment process. Psychotherapy is a dynamic process after all, and increased self-discovery along the way can certainly give you a better sense of what needs to be changed.

 

Different approaches to psychotherapy

There are several approaches to psychotherapy that can be implemented in the following sessions. Not strictly limited to one or the other, psychologists may make use of psychoanalysis and psychodynamic therapies, cognitive-behavioural, interpersonal, and other types of talk therapy. They can help you focus on changing problematic behaviours, feelings, and thoughts to build on healthy habits, or teach you emotion-coping strategies to cope with your symptoms. Forms of treatment like cognitive-behavioural therapy also aim to help individuals recognise negative thought and behaviour patterns, thereby working towards a positive change. Each session is essentially a problem-solving session. By allowing yourself to talk to your psychologist about your most difficult moments, your feelings and the change you want to observe, the psychologist is then able to make use of his/her expertise to assist you.  Many mental health professionals don’t limit their treatment to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each patient’s needs.

 

‘Homework’

To make the most of the treatment process, “homework” may sometimes be assigned as between-session tasks to clients as part of your treatment. A variety of homework assignments exist – sometimes in the form of practising new skills, habits, and other coping mechanisms, or someone who is dealing with complicated emotions could be asked to record your negative thoughts in nightly journal entries. When you return for your next session, the psychologist would then check in on your progress, and address any issues that may have arisen while you were completing your tasks. For some clients the benefits of therapy can be achieved in a few sessions, while for other clients they might need more to improve. Empirical evidence supports the benefits of homework in promoting positive symptom change and increasing patient functioning, that is, the quality of a client’s participation in therapy through active application of what they learn will lead to improvements in their conditions.  

 

Was the psychologist right for you?

Often during the conversation with the psychotherapist, or after the session, you may feel a sense of relief, elation, or anxiety and exhaustion. However you feel, it is important to take note of those feelings. Did the psychologist put you at ease? Did he/she listen to you carefully and demonstrate compassion? Did he/she develop a plan to guide you with your goals and show expertise and confidence in working with issues that you have? For the treatment to be effective, you need to be able to ‘click’ with the psychologist, that is you are able to  build trust and a strong connection with your psychologist.

 

To end off, the first session with a psychologist is understandably a bit intimidating and overwhelming, but the first step in the journey to recovery is a critical step to regain your mental wellbeing.

 


 

References:

  1. https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment (Accessed 24/04/2021)
  2. https://www.apa.org/topics/psychotherapy/understanding Accessed 25/04/2021)
  3. https://www.self.com/story/how-to-tell-if-therapy-is-working (Accessed 25/04/2021)
  4. https://www.researchgate.net/publication/281642213_Homework_in_Psychotherapy

(Accessed 26/04/2021)

 

Types of Psychotherapy Methods (DBT vs ACT) Used To Treat Depression

Types of Psychotherapy Methods (DBT vs ACT) Used To Treat Depression

Many of us are absorbed in an endless, self-defeating rat race. The nature of modern society has instilled in us a “winner/loser” mindset, and its systems highly prioritise external rewards and punishments as measures of our personal success and social worth. This oftentimes forces us to shift our perception of self-worth from the satisfying efforts of personal endeavour, to the critical imperative of achieving yardsticks of success defined by the rest of society. When we are constantly striving to win a race while focusing on external factors largely beyond our design or control, we’re surely putting ourselves at a disadvantageous position.

The overwhelming pressure to conform to societal expectations, or to outrun others in the race of life, can make one particularly susceptible to depression if negative emotions are not managed well. As we aim for perfection – as most people would – we need to understand that total perfection is unattainable. The more we believe that we have failed to reach a certain state of “perfection”, the greater the extent to which we experience low self-esteem, self-hatred, and depression. Depression can be extremely debilitating to one’s mental health. Apart from the diminishing enthusiasm for life and self-esteem, depressed individuals may self-isolate and pull away from their social circles, making it all the more difficult for them to get the help they need. 

Perhaps one of the healthiest things we can do for ourselves is to accept who we are. Self-acceptance might just be the antidote to excessive self-resentment and discontentment. It is important that we fight against influences that force us to conform to certain standards rather than to accept ourselves.  Presented below are a couple of talk therapy methods that we use to guide you towards achieving that. 

What is ACT?

Acceptance and Commitment Therapy (ACT) is a form of talk therapy suitable for the treatment of individuals displaying symptoms of depression. As its name suggests, it’s core aims are to help individuals accept whatever is beyond their control, and to commit to actions or habits that will serve to enrich their quality of life. ACT helps us to clarify what is genuinely important to us (i.e our values), and thus assists us to set more meaningful and life-enriching goals. Along the way, it also guides us to practise useful emotion-coping strategies such as mindfulness in order to equip us with skills to handle negative emotions effectively and healthily. While the number of ACT sessions may differ for each individual, the benefits acquired by clients are largely similar:

  • Learning to be fully present in the “here-and-now”, and to stop obsessive worrying over the past or future
  • Become aware of what they are avoiding (be it consciously or subconsciously), and to increase self-awareness
  • Learning to enjoy greater balance and emotional stability, and to be less upset by unpleasant experiences
  • Learning to observe thoughts such that one does not feel held captive by them, and to develop openness
  • To develop self-acceptance and self-compassion
  • Clarifying one’s personal values and taking the appropriate action towards his goals.

You may be wondering, does it really work? The good news is that ACT is considered to be an empirically validated treatment by the American Psychological Association (APA). Through program evaluation data, research has also shown that Veterans who completed ACT treatment phases displayed a significant decrease in depression in addition to improved self-awareness and a better quality of life.

 

What is DBT?

Apart from ACT, another alternative for the treatment of depression is Dialectical Behaviour Therapy (DBT). While originally used for the treatment of Borderline Personality Disorder, DBT has since been adapted to treat other mental health conditions including depression, anxiety, and post-traumatic stress disorder. A type of cognitive behavioural therapy, DBT aims to help individuals who struggle with emotional-regulation and are exhibiting maladaptive or self-destructing behaviours. It is not an uncommon sight for persons with depression to engage in substance-abuse or self-harm. As such, DBT helps to build on distress tolerance, such that people who struggle with these are able to handle negative life-circumstances better and to avoid falling back on such devastating coping methods.

DBT can be considered a holistic approach to depression treatment. Apart from tackling maladaptive behaviours, it encourages a shift in the clients’ perspective on life, for it equips them with the necessary skills to cope with intense emotions. In short, it empowers you to cope with them with a positive outlook. DBT also recognises that interpersonal effectiveness is key, and hence it strives to help these troubled individuals to reconnect and enhance their relationships with others. 

 

ACT Versus DBT

ACT and DBT are both highly effective methods of treatment for depression. Both forms of psychotherapy allow for individuals to tackle the notion of suffering head-on, and to avoid suppressing undesirable or uncomfortable feelings. Both promote psychological flexibility, and encourage people to behave in a conscious or effective way towards their life-choosing directions. The practice of mindfulness is also a commonality between both therapy methods, and it plays a crucial role in ensuring that persons are well aware of their values, goals and emotions.

However, overlaps between the two are considerably limited too. The main differences between ACT and DBT would be that DBT leans towards a more educative approach while ACT emphasises an experiential one. Perspective wise, DBT adopts a biosocial perspective on behaviour while that of ACT is contextual. Moreover, the underlying philosophy behind each form of therapy also differs. DBT philosophy is dialectical (i.e using logical reasoning and analysis), while the philosophy behind ACT is functional contextualism. With that said, the analysis of clients’ experiences, the use of languages as well as experiential exercises will be different for each type of therapy.

Seeking professional help can be rather daunting, but we need to recognise that psychotherapy is called for if one struggles to accept himself. Don’t deal with depression alone, lean into your support systems and mental health professionals when you need to – your future self will thank you.

 


References:

  1. Richard Hill, The Rise and Rise of Depression in a Competitive Winner/Loser World, video recording, Mental Health Academy

<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/the-rise-and-rise-of-depression-in-a-competitive-winner-loser-world/video> (Accessed 13/02/2021)

  1. https://www.mentalhealth.va.gov/depression/act-d.asp  (Accessed 13/02/2021)
  2. https://behavior-behavior.org/act-fap-dbt/ (Accessed 13/02/2021)
Breaking Free from the Tentacles of Addiction as a Family Unit

Breaking Free from the Tentacles of Addiction as a Family Unit

Written by: Julianna Pang

Confronting the problem of addiction is almost always daunting and exhausting. The layers of complexities increase tenfold when the family system is also trying to preserve its stability and normal functioning despite the disruptions that addiction brings.

Family members are often exasperated that the usual admonishments of “how could you do this to…?”, “why can’t you see that you are hurting…?” or “how long do you think you can keep doing this…?” seem to bounce off the walls.  No amount of shaming, guilt-laying or threats seems to wake the affected person up to see the realities of the wreckage that has been inflicted on the family.

What is Addiction?

Fundamentally, this approach does not work due to a miscomprehension of what addiction is. Addiction is neither a moral issue nor is it a flawed character problem which can be corrected.

According to the American Society of Addiction Medicine:

“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviours that become compulsive and often continue despite harmful consequences.”

Addiction is a disease.  As a family member, it is important to recognise that “you did not cause the disease, you cannot cure it and you cannot control the outcome of the disease”.   The person affected needs to learn to manage their own recovery and family members need to learn effective responses towards the affected person to support the recovery of the family system.

Recovery is a life-long process that may and often include a series of relapses both on the part of the individual and on the family system.

How Does One Know When Addiction Strikes?

Symptoms of addiction are manifested by:

  • Compulsion – an absolute and overpowering urge towards substance use or behaviour.
  • Craving – an increase in usage and/or frequency to a point of necessity for survival.
  • Control – loss of ability to manage manner of use, to reduce or to stop.
  • Consequences – the use or behaviour continues despite relationship, work, school, legal and money problems.
How can Family Members get the Affected Person into Treatment?

The first step to bringing the affected person towards professional help can either motivate or unsettle the recovery process.

As professional therapists working in this field, we witnessed many instances where one of the first steps by family members would be to call the authorities.  This is a painful first step that often inflicts hurt on both the affected person and the family member.  The outcome could turn out to be a sharp wedge between family members which may take a long time for repair and reconciliation. Many a time, the affected person may attempt to run and hide, taking them even further away from the treatment help that they need.

The next most common first step is an intervention. This is a meeting convened to confront the person affected and interventionists may include family members, close friends and/or religious leaders.  Each member shares with the person about their observations of specific negative behaviours and how these behaviours have affected them.  The group then presents options to the target person and encourage the entry into rehab immediately.

An intervention is a double-edged sword. When done well, members expressed their love and care for the target person, while maintaining an uncompromising position about the person’s problem with addiction and need for treatment.  When executed poorly, the target person receives a shock and feels a deep sense of betrayal from the group. The feelings of bitterness and resentment towards the whole intervention experience wipe out the initial good intentions. This, in turn, makes for poor motivation to accept and adhere to treatment. Trust towards the family system is broken which would likely take a long time to mend.

A 3rd strategy is known as CRAFT – which advocates for positive communication, positive reinforcement and allowing for natural consequences to happen. This approach takes a longer time to implement and focus on identifying actions by the affected person which are helpful towards recovery, expressing empathy towards the person’s suffering and offering to work with the person to find a solution.  An example of positive reinforcement could be to engage the person in activities within the family system that the person still values. The 3rd aspect is counter-intuitive; to allow the person to bear the natural consequences of their actions, instead of covering up for them or trying to make everything “all right”.  In so doing, the realities of the consequences of the addiction is experienced fully by the affected person which can create the turning point to seek treatment.

Is the Family’s Job Done When They Ship Off the Affected Person?

Addiction is a life-long recovery process and parallel to the individual’s recovery is the family system’s rebalancing process.

In broad terms, the individual’s stages of recovery are as follows:

  • Withdrawal – Detoxing
  • Honeymoon – Addiction Stops
  • The Wall – Protracted Abstinence
  • Adjustment – Working through Underlying Issues
  • Resolution – Acceptance of lifelong Abstinence
What is the Parallel Journey for the Family System?
Pre-treatment and Withdrawal

At the initial stage, the affected person will test the limits of the system by engineering and re-engineering their way to get to their addiction.  A person in active addiction is usually not rational, nor are they conscious of the effect of their actions on others.  There may be many false promises made in order to get to the addiction or manipulation of family system dynamics to garner support for their continued addiction.

Here are a few pointers that family members can keep in mind at this stage:

  • Get an Accurate Understanding of Addiction.
  • Create Unison in the Family Approach.
  • Relinquish Control of Outcome of Addiction.
  • Self-Care and Emotional Coping for Shame, Anger and Blame.
  • Learn How to set and Communicate Boundaries.
  • Find Family Support Groups to Brainstorm Strategies – Link to Visions Programme.
Honeymoon

During this stage, the affected person would have stopped the active addiction. The person reverts to their pre-addiction persona that the family was used to and readily embraced.  There is a delusion that all is victorious, and the person is cured.  Some people would even deny that there was ever an addiction in the first place.  Family members and individual alike start to make wonderful plans for a new future, unaware of the undercurrent of the recovering person’s vulnerabilities to triggers, anxieties, and relapses.

Here are a few pointers that family members can keep in mind at this stage:

  • Maintain Boundaries.
  • Adjust Family Life to Reduce Triggers.
  • Rebuild Trust and Learn To Discern Through Observations.
  • Learn About Adjustment Process and Strategies with Other Families – Link to Visions Programme.
The Wall

By the time the recovering person reaches this stage, his/her body is trying very hard to stabilise and find its new baseline. The struggle without their past go-to coping mechanism manifests in depression, irritability, and inability to find pleasure in the usual activities.   Family members may take things personally when their overtures to reintegrate the person into their lives are rejected. Some family members may start to prefer the “happy” person who was previously addicted or start being highly suspicious that the person has relapsed.

Here are a few pointers that family members can keep in mind at this stage:

  • Maintain Unison in The Family Approach.
  • Learn Emotional Coping to Rejection, Anxieties and Tolerance for Uncertainty.
  • Share and Validate Family Experiences with Other Families – Link to Visions Programme.
Adjustment

When the recovery process reaches this stage, both the individual and the family have crossed some major milestones (It is typical that some 6 months would have passed from the start of journey.).  The most daunting challenges are now bubbling up in the horizon.  Family relationships, lifestyles and values may be examined at a fundamental level and permanent changes may need to be made for recovery to be sustainable over the long haul.  Past hurt and traumatic experiences would need to be resolved for both individual and family to move forward to a new way of interaction.

Here are a few pointers that family members can keep in mind at this stage:

  • Commit to Family Approach Without Complacency.
  • Address the Emotional Well-Being of Other Neglected Members.
  • Learn Emotional Coping on Forgiveness, Grieving, Acceptance and Letting Go.
  • Learn Goal Setting and Strategies to Create a New Family Life Experience with Other Families – Link to Visions Programme.
Resolution

The last stage is not a phase per-se but a continual process for the lifetime of the individual and for the family system that has learnt and grown alongside him/her.  The individual is practicing commitment to his/her sober life free from addiction every single day.  The family system has likely been permanently transformed by the recovery process and is now reintegrating the member into its new dynamics.

Here are a few pointers that family members can keep in mind at this stage:

  • Embrace the New Family System, Lifestyle, Values and Norms.
  • Celebrate Successes and All Learning Experiences as A Family Unit.
  • Offer to Be a Supportive Family System to Other Families – Link to Visions Programme.
Visions of Recovery

This article is not intended to be exhaustive in addressing all aspects of family system disruptions when addiction strikes.  Working with professional therapists at any point along the recovery pathway helps manage the diverse challenges and provide a sounding board to create more effective strategies.  The emotional and structural resilience of the family system and its members ultimately creates the critical strength to sustain all members in this marathon towards sobriety.

Write to visions@promises.com.sg to get in touch with an addictions specialist or for more resources and information, click on the relevant links:

 


  1. Asam.org. 2021. ASAM Definition of Addiction. Available at: https://www.asam.org/Quality-Science/definition-of-addiction
  2. Brown, R., Brown, M. and Brown, P., 2014. Families and addiction. Create Space Independent Publishing Platform. USA.

  3. This is notwithstanding a citizen’s duty to alert authorities in times of criminal activity. It is a consideration of how the process can be better executed.

  4. Hilary S. Connery. and Thomas F. Harrison., n.d. The Complete Family Guide to Addiction: Everything You Need to Know Now to Help Your Loved One and Yourself. The Guilford Press. London.

  5. Hilary S. Connery. and Thomas F. Harrison., n.d. The Complete Family Guide to Addiction: Everything You Need to Know Now to Help Your Loved One and Yourself. The Guilford Press. London.

  6. The exception to the rule is where the person is unsafe or at risk of seriously hurting themselves.

  7. Brown, R., Brown, M. and Brown, P., 2014. Families and addiction. Create Space Independent Publishing Platform. USA.

Suicide Risks for Persons with Addictions

Suicide Risks for Persons with Addictions

Written by: Juliana Pang, Therapist

Caregivers with a family member affected by addiction problems are often exhausted, drained dry of their empathy and compassionate capacities.

They recount countless cycles of suspended hope followed by just as many broken promises as they watch the affected person return time and again to their compulsive addiction despite a seemingly obvious trail of destruction behind them.

Caregivers learn to cope with the endless demands on their energies by blending the words uttered by the affected persons as a cocktail of lies, manipulation and attention-seeking antics to get what they want.  In time, the cries for help from the affected person turn into cries for help by the boy who cried wolf and eventually fading into indistinguishable white noise.

Professor Lisa Firestone of the Glendon Association observes that there is a natural tendency for caregivers to minimise any suicide expressions in general.  Responses such as, “Well, his past attempts weren’t serious.” or “He is just manipulating to get something.” are commonly observed.  There is also a general tendency to not want the expressions to be true.  In the case of addicts, words such as “I want to die” or “I am going to end my life” no longer convey the same meaning or gravity of their sense of desperation.

Why should we want to pay attention to an addict’s cry for help?

In Singapore, we lose 1.1 lives every day to suicide.  It is still the leading cause of death for youths aged 10 to 29.  While direct correlation evidence is still being researched on, studies in America have shown that more than 90% of people who kill themselves suffer from depression have a substance abuse disorder or both. Suicidality and addiction share a high concordance relationship.

When we overlay the statistics with a physiological lens, we note that both groups of persons have been observed in studies to have a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis which essentially controls our body’s response to stress.

In a person with a normal functioning HPA axis, on the reception of a stressor, the hypothalamus in our brain instructs the secretion of the corticotropin-releasing factor (CRF) and vasopressin to stimulate our pituitary glands to produce the adrenocorticotropic hormone (ACTH).  The ACTH, in turn, stimulates glucocorticoid synthesis and release (commonly referred to as cortisol) from the adrenal glands.  This chain reaction provides a person the increased energy to handle the stress event and to do so without suffering from the pain and fatigue.  When the stress event is gone, the body produces a negative feedback loop which then brings the body system back to homeostasis.

In a person exposed to a persistent or extreme level of stress, or in a person who frequently activates the HPA axis through substance use, the body starts to blunt the sensitivity of the HPA axis and blunt cell receptivity to cortisol in its efforts to return to and maintain homeostasis.  This alteration to the sensitivity of the HPA axis affects our ability to tolerate physical and mental stresses and creates a need for a much bigger stimulus to activate the HPA axis (which may mean higher dosage of substance use); and when the HPA axis does react, produces a much bigger and exaggerated response (which may translate to more aggressive behaviours).

What Does This Mean In Practical Terms?

Many suicidal persons described having a voice in their head which is constantly there; telling them how much they need to seek fulfilment and comfort by reaching for the desired stimulus, whether it be a substance or a behaviour, of which one is killing themselves.  Their mind starts to command them to constantly plan, to seek out and to take actions to soothe the unbearable lack that they are feeling.  Eventually, the voice in the head goes from coaxing and persuading to being more intensive and aggressive towards the self to take immediate drastic actions.

The relief of death, a final refuge, becomes alluring and pleasurable and the fear of dying eventually transforms into the fear of not dying and becoming the loser, disappointment, and burden that they already believe themselves to be to their caregivers.  This dual push towards drastic action and the need for an ever-increasing amount of substance in addicts leads to an increase in the risk level of suicidality.

What Can We Look Out For?

How then does the caregiver separate the wheat from the chaff amid the chaos that addiction has already wrought onto the family system to detect the risks of suicidality?

Below are some, though not exclusive, common markers to look out for. It is particularly useful to note changes in the content of the affected person’s expressions and any escalation or sudden extinction of intensity.

  • Mood
    • Intense Emotional Outbursts
    • Extreme Isolation or Withdrawal
    • The feeling of Being a Misfit in Every Way
  • Speech
    • Hopelessness
    • Helplessness
    • Worthlessness
  • Behaviour
    • Researching or Procuring Means of Suicide.
    • Self-Harm, Including Risky Substance Use or Behaviours.
    • Planning of Affairs.
  • Presence of Trigger Events
    • Loss of Primary Relationship.
    • Physical or Mental Health Conditions That Debilitate.
    • Abuse or Trauma Events.
What Can Caregivers Do On Observing The Signs?

Ask the Suicide Questions:

  • In the past few weeks, have you ever wished that you were dead?
  • In the past few weeks, have you felt that you or your family would be better off if you were dead?
  • In the past week, have you made plans about killing yourself?
  • Have you tried to kill yourself?

If the answers are yes to any or to all the questions, caregivers are encouraged to take the following first steps:

  • Be empathetic towards the suicidal wish.
    • The objective is not to agree with the act of suicide but to understand what has happened to lead the affected person to the conclusion that suicide is the only solution.
  • Find a genuine connection with the affected person.
    • However difficult that person might have been in your life, express what this person means to you personally and how the loss of this person would affect you.
  • Make a safety plan.
    • Ask the affected person to agree to not take or delay any action to harm themselves until they get to or you get them to professional help.

In these situations, working with professional therapists can help the affected person build up their sense of self, adjust unhelpful beliefs towards the whole life experience, reignite their sense of being a valued part of humanity and community, develop skills to cope with life’s stresses and build a treatment and recovery plan for any inter-connected problems such as their addiction problems.

Professor Lisa Firestone observes that suicidal persons are generally ambivalent: a part of them wants to die but a part of them wants to live as well.  There is often a process of the dividing up of the self within the person, between an aspect which is life affirming and engaging with the outer world; and the anti-self, which is self-critical, self-hating and ultimately suicidal.  The key to recovery is to connect with and help strengthen that part of them that wants to keep on living.


1 Glendon.org. 2021. Understanding & Preventing Suicide – DVD « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/understanding-preventing-suicide-dvd0/

2 Sos.org.sg. 2021. Suicide Facts and Figures | Samaritans of Singapore (SOS). [online] Available at: https://www.sos.org.sg/learn-about-suicide/quick-facts

3 Addiction Center. 2021. Addiction and Suicide – Addiction Center. [online] Available at: https://www.addictioncenter.com/addiction/addiction-and-suicide/

4 Goeders, N., 2003. The impact of stress on addiction. European Neuropsychopharmacology, 13.

5 Glendon.org. 2021. Understanding & Preventing Suicide – DVD « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/understanding-preventing-suicide-dvd0/

6 Dazzi, T., Gribble, R., Wessely, S., & Fear, N. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. doi:10.1017/S0033291714001299

7 Glendon.org. 2021. Dynamics of Suicide: An Interview with Dr. Israel Orbach « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/dynamics-of-suicide-an-interview-with-israel-orbach/

8 Glendon.org. 2021. Understanding & Preventing Suicide – DVD « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/understanding-preventing-suicide-dvd0/

9 Glendon.org. 2021. Firestone, R.W. – The “inner voice” and suicide « The Glendon Association. [online] Available at: https://www.glendon.org/resource/firestone-r-w-the-inner-voice-and-suicide/

Photo by Francisco Moreno on Unsplash

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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