Sibling rivalry is a conflict between brothers and sisters that go beyond simple disagreements between two or more parties because of individual differences and different opinions on a subject. Starting from as early as the birth of the second child, sibling rivalry usually involves jealousy and competition between siblings which can show up as fighting on a frequent or routine basis. It is usually frustrating and stressful for parents who do not understand human psychology or the basis behind relationship conflicts. They are often at a loss as to how to respond to the ongoing conflict between their children.
Since sibling rivalry often shows up from early childhood, the following forms of sibling rivalry behaviour are often displayed in response to each other:
challenging a belief,
simply looking at each other (with the intent of intimidation)
breaking something that belongs to the other one,
throwing something at the other one,
hiding something that is important to the other person.
Reasons for sibling rivalry:
Children may feel their relationship with their parents is threatened by the arrival of a new baby. They were the centre’ of their parents’ attention until the new baby arrived. Now the new arrival is seen as a competitor for the parent’s attention.
Children feel they are getting unequal amounts of a parent’s attention, discipline, and responsiveness. Their sense of value is measured based on their evaluation of their parent’s attention to them. So they compete to be favoured.
Children who struggle to differentiate and individuate as unique individuals do not yet recognize their personal power except through conflict and competition with each other. It shows up as a power struggle.
Children who are hungry, bored or tired are more likely to become frustrated and start fights.
Children may not know positive ways to get attention for a sibling or how to start playful activities, so they pick fights instead.
Children’s developmental stages affect how mature they are and how well they can share a parent’s attention and get along with one another. The less mature sibling may be more likely to want their parents’ attention as an all-or-nothing need focused on them and not their siblings. This immaturity is expressed as an either-or view instead of being able to adopt the view of both-and (ie., both being important). As such, their level of emotional maturity is showing in their attempts to resolve their attempts to negotiate with each other to resolve their conflict.
Each child feels the need to compete with each other to define who they are as an individual. As they discover who they are, they may uncover their own talents, activities, and interests. Sibling rivalry shows up as their struggle to separate, differentiate or individuate from their siblings while feeling inferior or superior along the way in contrast to their sibling.
Stress in children’s lives can shorten their fuses, and decrease their ability to tolerate frustration, leading to more conflict.
Stress in the parents’ lives can decrease the amount of time and attention parents can give the children and increase sibling rivalry.
Family dynamics play a role. For example, one child may remind a parent of a relative who was particularly difficult, and this resentment may subconsciously be projected on their child to influence how the parent treats that child so that the child is regarded as, eg. the ‘black sheep’ or ‘the problem child’ vs. the idealized. The problem-child view can be accepted by the other siblings from the parents and then be regarded accordingly. Similarly, if a parent simply has a favourite child among their children, maybe because the child is regarded as more socially, academically or physically attractive among the children, this can foster jealousy, resentment and competition between the children.
How parents treat their kids and react to conflict can make a big difference in how well siblings get along. Children often fight more in families where parents think aggression and fighting between siblings are normal and an acceptable way to resolve conflicts.
Not having time to share regular, enjoyable family time together (like family meals) can increase the chances of children engaging in conflict. The absence of an emotional bond between the children can increase the likelihood of conflict.
Other factors that influence sibling rivalry:
Birth order: for example, it is common that the oldest and youngest child often receive the most attention while the middle children often feel overlooked (eg. the oldest being celebrated by the parents or extended family as the first-born; the youngest being celebrated as the ‘baby’ of the family).
Spacing between the children: when spaced further apart, there is usually less competition; when spaced more closely, there tends to be more.
Temperamental differences: temperamentally easy babies tend to be liked more while more difficult ones are experienced as more annoying.
If parents choose as a favourite or respond differently to their children, this can also spur more jealousy and competition or intensify competition between them.
Gender: in some families, a child of one sex is preferred over the other.
Physical influences: children who share a room may argue more due to being in constant close proximity with each other; a child who received more attention due to an illness or physical disability may leave siblings feeling neglected or ignored.
Parenting style or approach: Children with very permissive and overly harsh parents tend to fight more –permissive parents may not operate with adequate rules so children feel they have to settle their conflicts by themselves without guidance; overly harsh parents who are strict or harsh tend to model aggression to their children to get their needs met. The best outcomes show up with parents who have acquired what has been described as the authoritative approach.
Age of the children: as children mature and reach later developmental stages, sibling rivalry tends to decrease.
Transitional times: sibling rivalry tends to intensify when there are changes in the family, eg. the birth of a new baby, when a baby becomes mobile, when a sibling goes off to school, when a sibling leaves the family for college or marriage, if there is a divorce or a remarriage.
How to respond as parents?
With this knowledge already outlined, parents can lookout for ways to parent more intentionally. Firstly, they have to desire for their children to get along or be positive or loving with each other in the family. Interventions can then be planned for. They can be preventative or when conflicts occur, facilitate to address the identified need or help resolve the conflict between the children. For example, understanding how the birth order could raise the possibility of jealousy between siblings, or the prospect of one child being favoured over another, the importance for each child to be valued and appreciated as unique is an important practice. Also, parents need to watch how they manage their own conflicts as their children view them as role models for life learning. At the same time, they can remain optimistic when they realize that some sibling rivalry is inevitable and that as children mature and learn ways to handle conflicts, the rivalry will usually subside. The younger they are, the more parents are called on to be a referee. Probably the most help needed to be directive with the children is 4 years or younger. Here are some useful strategies to help children manage their conflicts:
Communicate the basic message that includes:
Acknowledgement that they both want their way by arguing with each other rather than to cooperate.
Hitting each other, calling each other names or bullying is not going to work.
They both have needs in the situation and they have to find out how they can both be acknowledged and met but without fighting.
Find out how to do this by themselves of you will decide on their behalf in a way they may not like.
Establish rules for managing the conflict.
Having rules in place is a way of communicating your family values. So the parent needs to decide what behaviours are important and what they wish to enforce. This is an effective preventive strategy.
Handling conflicts and anger “No hitting, use words to say what you are upset about.”
Family Values/morals “We treat each other with respect.”
Parents’ role when there is conflict “If I get involved, I will determine the outcome.”
Hurt or property is damaged “Whoever caused the hurt or damage must make amends.”
Personal possessions and boundaries “We don’t take someone else’s things without asking first.”
Complaining “No complaining to get someone in trouble; you can “tell” to get someone out of trouble.” For example, a child telling his mother that his sibling just entered his room without permission.
Cooperation “Work it out between you two or if I get involved, neither of you might like what I decide.”
Conflict Resolution Sibling rivalry highlights the need for children to be taught the skill of conflict resolution. When they are young, the parent will have to walk them through the whole process after each conflict. In time, they will be able to resolve their conflicts with their siblings and others on their own. In summary, this process involves each child learning to express his point of view and listening to the other child’s point of view, generating a number of possible solutions that work for each of them, choosing one solution, and trying it. It encourages listening for and the expression of feelings to understand each other to discern what they both need. In this practice, it fosters the development of the sense of mutuality, and promotes the practice of collaboration and cooperation. This skill helps your children to navigate current and future relationships with their peers. It is useful throughout their life. It can equip them to be emotionally and relationally competent and capable as they see that they can come up with solutions to problems in relationships without fighting. But in order to engage in a problem exploration process, the children must be calm enough to dialogue. Time out may be called until both are calm enough to proceed. The parent also has to model for their children when it comes to handling conflict. The lesson is obviously more powerful when the parents practise this themselves. Use “fair fight” rules yourself.
Use cool off times to calm down first; then re-enter the situation.
Give second chances and opportunities to make amends.
Listening well: seek first to understand, then to be understood. In order to seek to understand, we must first learn to listen (Stephen Covey’s 5th habit of highly effective people).
Attitudes and additional strategies that help to encourage health sibling relationships:
Expect many episodes of sibling rivalry.
Treat your children as the unique individuals they are.
Do not show favouritism.
Stay calm and objective.
Recognizing the need is important in discussing ‘fairness.’
Don’t look for someone to blame or punish. Take personal responsibility to communicate well with each other.
Don’t get in long discussions about what happened (it can act as a reward for their arguments)
Establish basic relational rules: encourage communication, listening and understanding of feelings with empathy, taking turns.
Reinforce and remind them of a list of basic rules: “You can express your feelings to communicate clearly without having to be hurtful;” ”Use your words and not your fists;” “Speak to them in the way you would like to be spoken to.”
Encourage the children to solve their problems: be creative to find out “What would work for you both?”
Be aware of developmental stages: very young children find it hard to share as they need to have a sense of possession before they can share.
Don’t referee a fight if you don’t know what happened.
Do not allow your children to pit one parent against the other. Discuss privately and directly between parents if they disagree with a parenting decision made by the other.
Do not bemoan to the children that they “fight all the time” (or they will live up to this pronouncement).
Reward them verbally for their efforts at collaboration to promote a loving or positive connection between themselves. Valuing them verbally models for them to value each other. This also promotes both their self-esteem.
These attitudes are commonly practised by parents who embrace an authoritative approach to parenting. But when the conflicts get out of control and do not stop, get professional help. The relational skills children learn in childhood is what they practice with as adults. The ability to be effective in relationships is crucial to personal success later when children grow up to marry, have families of their own or at work.
Dr Deirde Barrett, assistant professor of psychology at Harvard Medical’s department of psychiatry, who has studied the dreams of survivors of the Sept 11 attacks, said people tend to have an increase of bizarre, emotional and vivid dreams after crises (such as Covid-19). Can you share your thoughts on why you think this happens?
Some people dream about sanitisers, face masks and toilet paper. Why such particular items?
What exactly is happening in our subconscious (when we sleep) during periods of stress? How does that manifest in our dreams?
Will such dreams affect the quality of one’s sleep? Why or why not?
Answers: Nearly all trauma survivors experience some type of trouble sleeping such as insomnia. But for anywhere from half to three-quarters of people, it is vivid dreams that make it difficult to sleep soundly. Having flashbacks to traumatic events, also called re-experiencing, is a hallmark symptom of post-traumatic stress syndrome (PTSD). For half of PTSD patients, those flashbacks occur at night while sleeping. Some people have nightmares that are exact replays of the trauma that they experienced, and these are called “replicative nightmares.” Others have nightmares that are related to the trauma indirectly or symbolically. Trauma and stress can disrupt your sleep in many ways. It can set off your body’s fight-or-flight response, and ramp up production of neurotransmitters that keep you awake and vigilant when it is time to sleep.
The items sanitizers, face masks or toilet paper may be dreamt about because they represent perceived solutions to address the threat of being harmed by Covid-19. Our psyche (our human mind or soul where we deliberate consciously and unconsciously –judge, think, feel– in relation to our sense of self and our sense of reality) is highly concerned about safety and security and therefore, when a threat is perceived, we consciously and unconsciously move in search for items or avenues that promote and restore our sense of safety.
There are several theories about the role of dreams in our sleep. In the event of stress, it suggests that our unconscious is working overtime in search for safety or to be settled with what may be traumatic, distressing or are reasons for anxiety. Stress is a disruption to our equilibrium and is communicated as an emotional and physiological alert. Because our psyche does not like to be unsettled or be disturbed, we tend to work consciously and unconsciously to settle what may be threatening or disturbing towards safety.
Yes. Trauma and stress can disrupt your sleep in many ways. It can set off your body’s fight-or-flight response, and ramp up production of neurotransmitters that keep you awake and vigilant when it is time to sleep.
Dr Rose Gibson, a research officer at the Sleep/Wake Research Centre at Massey University in New Zealand, said that while some dreams can be confusing or distressing, dreaming is normal and considered helpful in processing our waking situation. Can you comment on this?
Answer: Dr. Gibson is correct. Dreams are a normal part of our sleep. Dreams have been described as hallucinations (defined by Oxford as “an experience involving the apparent perception of something not present”) during certain stages of sleep. They are strongest during REM (rapid-eye-movement) sleep, one of the four stages of sleep. But dreams are thought to have other functions as well:
Dreams are sometimes engaged in settling what is unsettling or disturbing as already mentioned,
Since the psyche is particularly concerned about safety and security in the daytime, dreams can represent an unconscious search to address the threat in overtime when sleep is intended. One of the areas of the brain that is most active during dreaming is the amygdala. The amygdala is the part of the brain associated with the survival instinct and the fight-or-flight response. Because the logical part of the brain is less in play in contrast to the emotional during dreaming. Nightmares may reflect attempts to address our fears or to prepare to deal with anticipated threats in waking life.
Dreaming may reflect our muse as it facilitates our creative tendencies. A person can be awakened by great ideas for a movie or song that has been deliberated on during awake hours. The awake period could also involve psychological defenses at play such as denial or suppression that prevent certain ideas from emerging. In dreaming, these filters are not as active so that suppressed ideas or fears often emerge then.
Besides sorting through complicated and unresolved events or anticipated fears, dreams are also suspected in aiding the storage of important memories and getting rid of unimportant memories as a part of our need to process information triggered during the awake period. Learning new information and being able to sleep on it facilitates recall of lessons learned.
Do you think extra sleep, or lack of sleep, might contribute to vivid dreams related to Covid-19?
Answer: Dreams can also be affected by certain health conditions that result in sleep deprivation. Sleeping issues that cause a lack of sleep, such as insomnia and narcolepsy, can increase one’s risk of experiencing vivid dreams. Changes to your sleep schedule, such as flying overseas (and going to sleep at a different time) or getting less sleep than usual, can also increase this risk. Those who are sleep-deprived can lead to parts of the brain being much more active so when they finally slip into REM sleep they are likely to have more vivid dreams. They are also more likely to recall their dreams too.
It seems that people are having better memory of their dreams now (An ongoing study at the Lyon Neuroscience Research Center in France found that “the coronavirus pandemic has caused a 35 per cent increase in dream recall among participants, with respondents reporting 15 per cent more negative dreams than usual). Why are people having a better memory of their dreams?
Answer: The brain during sleep is involved in information processing where unnecessary information is eliminated and important short-term memories are moved into our long-term memories, and dreams occur during this process. As such, some people may recall dreams with a difference in their ability to memorize things in general. Also, memory is affected by recall. Memories that are repeated as perhaps a sign of preoccupation or paranoia are more accessible.
Have you noticed any of your patients having problems with sleeping specifically related to Covid-19? For example, if they are worried about the number of community cases the next day and this worry keeps them up at night, they fear for their jobs, etc?
Answer: Difficulty sleeping because of Covid-19 concerns is not a common complaint among my patients. This may be suggested by them not feeling threatened by the risk of infection, or that they feel they are coping with this threat, or that they are not in jobs or situations that are being threatened by the pandemic.
Have any of your patients experienced any dreams related to coronavirus and such fears? If so, can you share what some of such dreams are?
Answer: None of my patients have reported dreams related to the coronavirus to me. Those who are more likely to be reactive to the coronavirus are probably those who are vulnerable to anxiety such as those who are obsessive-compulsive in nature.
Answer: The hallmark symptoms of PTSD are exposure to a traumatic event; re-experiencing the event or intrusive symptoms (flashbacks); avoidance of people, places, or things that serve as a reminder of the trauma; negative mood and thoughts associated with the trauma; and hyper-vigilance. Trauma is experienced when the perceived threat is overwhelming or life-threatening that leaves a victim feeling numb, helpless, disconnected and having difficulty trusting. Since this article in question is reported by researchers from a particular country (Italian), one has to question the scope of the study. Is the study about the traumatic response to the lockdown found across different countries or is it reported specific to a particular region or town in Italy? It is unclear if the reported trauma is in response to the lockdown itself (which is usually activated as a preventive measure to protect against infection), or that the attempt at lockdown is seen as inadequate because the infection rate is already at such high numbers so that the lockdown is perceived as irrelevant or ineffective. As such, there may be the existence of an extraneous variable to explain how those in lockdown could have experienced this action alone as traumatic. At the same time, once the specific group is defined in the study, the results of the study may be explained by a high and pre-existing inter-dependency on this community to cope together as the norm such that restricting communal support disrupts their coping. Subsequently, imposing personal isolation, which is otherwise highly unusual, is therefore experienced as traumatic. The people in this community feel cut off from a regular method of coping which relies on their dependence on each other.
Is there anything people can do to try to control what they dream about? If so, what?
Answer: This depends on whether they view these dreams as distressing. If trauma is indicated or they could represent disturbing experiences in their past or their present, or difficulties at coping at their anticipated future, I would suggest they seek professional help from those familiar with psychodynamic psychotherapy. Dreams are problematic usually only if they are associated with nightmares or sleep disruption. To sleep better and avoid nightmares or sleep that is not restful, the above factors should be reviewed. In particular: (a) ensure that there is adequate sleep scheduled to avoid sleep deprivation, (b) observe their diet since some studies have found that meals high in sugar, spicy foods, or high in starch, too much alcohol, eating excessively and late are associated with higher reports of nightmares, (c) address reasons for anxiety, (d) address unsettled emotional issues such as trauma or abuse, and (e) develop good sleep hygiene practices. Additional steps can include practising mental relaxation before sleep, recording their anxieties somewhere so that they can resume the next day to avoid rumination of what is worrying when sleep is planned or plan for guidance or support to address the worrying on the next day so they can relax at present.
There are some people who have difficulty sleeping due to anxiety about the economy, they worry about losing their jobs and the future. How common can this be, and what can people do to relax their mind before they sleep? Now that people are working from home, some are taking naps in the day. Should this be encouraged? Why or why not? Does this make it harder for them to sleep at night?
Answer: For those who tend to have difficulty sleeping because of worries about employment or their future, insomnia is a common occurrence. Some even have chronic insomnia. Various studies worldwide have shown the prevalence of insomnia in 10%–30% of the population, some even as high as 50%–60%. It is common in older adults, females, and people with medical and mental ill health. The consequences of insomnia are significant, such as depression, impaired work performance, work-related/motor vehicle accidents, and overall poor quality of life. The reasons behind insomnia are varied. If the problem of sleep is persistent, they should consult psychiatrists or clinical psychologists. If they are anxious, sleep disruption is a common symptom of poor coping. As such, they should see a mental health professional. But if the question is how to promote good sleep for the average person where the sleeping problem is only recent, consider developing good sleep hygiene practices as a start. The following practices are recommended by the Sleep Foundation:
Limit daytime naps to 30 minutes.
Avoid stimulants such as caffeine and nicotine close to bedtime.
Exercise to promote good quality sleep.
Steer clear of food that can be disruptive right before sleep.
Ensure adequate exposure to natural light.
Establish a regular relaxing bedtime routine.
Make sure that the sleep environment is pleasant.
Since more people are working from home, they should limit their nap time. Their difficulty sleeping at night may be indicative that if they had naps during the day, their nap times may have become excessive. The objectives of those working at home should ensure that they maintain a healthy work-life balance. It is important at this time of disruption and uncertainty over a pandemic that we establish goals to maintain good physical and mental health consistent with building our resilience to cope with the unrelenting demands of living effectively in the present and in the future.
Is there a reason why these virtual meetings are so exhausting? How is video calling different from face-to-face meetings in terms of mental load?
There have been many changes placed on us as a result of the government’s attempts to create social distancing between one another in response to the threat of COVID-19 in Singapore. For the employed, perhaps the most significant change involves having to work at home instead of working out of our regular workplaces away from home. Accordingly, the necessary attempts to communicate at work have now to be moved online since face-to-face meetings at work have been prevented. The result of having to conduct our regular conversations and discussions previously in the workplace to the online format means that facing the laptop to attend to vocational as well as social in one location becomes the common practice instead. There are certain characteristics of this practice which leaves users of video-conferencing fatigued:
(a) Previously at a regular meeting often at a conference site, the meetings carry a bigger social bearing. At a virtual meeting, this social bearing is reduced to what is visible only on a screen. Instead of the opportunity to scan the room previously which allows our eyes to adjust and therefore cope with eye strain, virtual meetings mean our gaze is now focused only on what is confined within this screen. We have to stare at this screen and then process everything we hear or see often over a protracted period within a certain frame. As a result, there can be visual overload and mental strain.
(b) Virtual meetings also require more effort than face-to-face meetings. We have to work harder to process non-verbal cues such as facial expressions, the tone and pitch of the voice, and body language. In contrast to face-to-face encounters, virtual meetings require more effort to assess social and personal meaning because of the context. According to Dr Gianpiero Petriglieri, an associate professor of Organizational Behavior at INSEAD, there is a dissonance that emerges during virtual meetings because during this interaction between participants in this format, “our minds are together when our bodies feel we’re not.” This dissonance or disconnection causes people to have conflicting feelings which add to the fatigue. This makes it difficult for people to relax into the conversation naturally.
(c) Dr Marissa Shuffler, an associate professor of industrial/organizational psychology also describes the fatigue that can come from being watched because the camera is physically and constantly focused on us. In natural social settings, this does not happen. During virtual meetings, people can feel they are on stage and therefore, they feel the social pressure and are expected to perform. The larger the group, the stronger the pressure.
(d) There is also the stress that comes from delays on phone or conferencing systems or when the screen freezes. Glitches in the application of technology put pressure for the participants to ensure that relevant or significant information is not missed out, or to avoid misunderstanding information from what has been communicated. This becomes harder to slow down to clarify when there is a group meeting out of concern that questions could be seen as interference within a tenuous electronic connection.
(e) Visual overload and fatigue that comes from constant online viewing occur not only if meetings are long or frequent with its inherent stresses. The restriction to home has also placed reliance on engaging other activities online, eg. taking classes, ordering food, maintaining social connections outside the immediate family. If there is a practice of over-reliance on the computer screen to attend to other interests, the physical effort to position ourselves at a prolonged period in front of this screen can also create fatigue.
(f) The strain that comes from virtual meetings can be accumulative when meetings are arranged close to one another. Since the worker is already confined at home, virtual meetings can easily be scheduled one after another. The meetings can appear to be executed efficiently. But there may not be any mental breaks in between.
(g) Dr Petriglieri also noted that meeting online creates stress from being reminded that the familiar context has been disrupted by the pandemic. We are all coping within a crisis that has taken the lives of the elderly and the vulnerable in society and endangers our well-being. It is also stressful in the fact that we are used to separating different relationships such as family, friends or colleagues. But now they are all happening within the same space. The self-complexity theory posits that individuals have multiple aspects about themselves –context-dependent social roles, relationships, activities and goals–and we find this healthy. When we find this variety reduced, we become disoriented and become more vulnerable to negative feelings. Over a prolonged period of the self-quarantine, he notes the effect: “We are confined in our own space, in the context of a very anxiety-provoking crisis, and our only space for interaction is a computer window.”
How do you alleviate the exhaustion that comes with virtual meetings? Are you able to share a few tips or suggestions?
In light of the stresses and strains of increased virtual meetings as outlined, I would suggest the following:
(a) limit the video calls to only what is necessary; this implies that it is important to take breaks from electronic devices, in general, to avoid over-reliance on them and the subsequent emotional effects from excessive use,
(b) allow for the option to turn off cameras on yourself to be involved and/or face the screen off to one side so that you can concentrate without feeling the pressure to be on camera,
(c) plan breaks in between virtual meetings so that the body and mind have a chance for a break, eg. getting the body to move and stretch increases blood flow and reduce mental fatigue,
(d) if virtual meetings are unavoidable and long, learn to practice the 20-20-20 rule: every 20 minutes, takes 20 seconds to look at something 20 feet away. Remember that the electronic devices are our tools and not our master.
What can bosses or organizers of these meetings do to facilitate these meetings so people don’t leave the meetings feeling exhausted? (While taking into consideration, the time spent on these meetings, or the feelings of the attendees)
It may help to start the meeting by quickly checking in to each other’s well-being. Being ready to acknowledge that the virtual meetings are unusual and that working at home means having to accommodate other family members inconvenienced by the pandemic invites everyone to be mindful about coping collectively with the current disruption. Secondly, consider if virtual meetings are the best way to work. To prevent information overload, would sharing files be more effective? Or the use of the phone to communicate may be a better device in many cases if there is only simple information to share. Thirdly, it may help if the meeting agenda is clearly defined and the end of the meeting is outlined at the start to reduce mental fatigue. Can the meetings be brief knowing that other meetings may be required? If meetings are prolonged, plan for breaks.
What can attendees/employees do to reduce the number of hours spent on video calls? (for example, what they can say to their bosses, or to keep track of the time so everyone is on track)
There needs to be increased education all around related to this topic of fatigue that comes from increased video-conferencing. It is a condition exacerbated by changes at work because of the pandemic. Employees should know their limits. If they recognize when fatigue sets in from excessive computer use, they should limit themselves from relying on their electronic gadgets throughout the day. Research has already shown that excessive computer use is correlated with depression. With more apps available online, there is an increased potential to become more dependent on electronic devices already. During this pandemic, the pressure to depend on the computer through increased virtual meetings is intensified. It is times like this when the wise among us would learn to separate the benefits of computer use from its downsides.
In light of this knowledge, employees can be more proactive to define the perimeters in which they would like to have virtual meetings conducted. If they recognize when fatigue will set in because of prolonged virtual meetings, they can ask to clarify (or specify) to their managers how long the meetings will take to monitor their mental and physical strain. In cases when prolonged virtual meetings are unavoidable, they can clarify if permission can be given to practice adjustments such as moving around as a way of coping with eye strain or from limited mobility experienced during the meetings, avoid the direct exposure to the camera, mute the calls to focus on listening or take breaks after every hour. At times, a person may have to prepare for any interference from young children who find it hard to ignore the presence of the parent at home.
How do we instil positivity in our working lives, when the line between work and home is so blurred right now?
The pandemic and the subsequent quarantine is experienced as a period of adversity to some people. The emotional distress that comes from being quarantined has been recognized as common during this period. Common symptoms of this distress include fear, sadness, numbness, insomnia, confusion, anger, stress, irritability, post-traumatic stress symptoms, depressive symptoms, low mood, emotional exhaustion and emotional disturbance (eg. paranoia, anxiety). More specifically, people are faced with the disruption to the routines they have set up to cope with their stressors before the imposition of the quarantine. Distress is experienced because of the effect of the disruption on their autonomy, their sense of competence (being in charge of their lives to cope with their lives), their connectedness and their sense of security. It is a test on our resilience and ability to cope.
At the same time, the very challenge of this situation also provides us with the opportunity to develop our resilience. The first step is to understand and remember that these circumstances are temporary and not permanent. Pandemics happen but they are not frequent in history. Secondly, realize that there is a way to cope with the circumstances. As such, coping with this current situation is priority. I would suggest the following:
(a) Establish a routine for yourself (and that of your children). By creating a structure to attend to work and recreation, you start to organize and occupy yourself with addressing your daily needs as well as that of your family.
(b) Be as active as possible to maintain a fitness level physically, mentally and relationally for yourself and with your family. This also helps to battle against boredom. There are exercise videos online which you and your children can participate together to exercise as well as bond together. Also, for a personal project, you can ask yourself, “What will it take for me to become physically and mentally and relationally stronger as a result of this crisis?” Be curious about how to grow your resilience and to nurture the best version of yourself. Or as a parent, create a project to help your child develop resilience in their own lives and ask, “How can I help my children become physically, mentally or relationally stronger as a result of this crisis?”
(c) Deal with boredom by creating projects that self-nurture, eg. start a hobby or clean out your closet. Competing personal tasks provide a sense of purpose and maintain a sense of competency despite the external circumstances. Creating plans daily offer a focus on accomplishing what is important to your well-being.
(d) Communicate more to avoid isolation as well as cope with boredom. This can be an opportunity to nurture relationships if you are in quarantine with family and to strengthen social bonds with them, or with your support group. Remember that kids may be stressed too from this experience. More time together can provide opportunities for increased play to increase bonding. Games are useful means to bring fun into your relationships and to develop socially besides your entertainment. It can also become a reminder that the family is safe and coping together.
(e) Be informed without being overwhelmed to cope with the anxiety that comes from the unknown. The Straits Times newspaper provide a useful daily update so that you can monitor the threat of the virus rather than obtaining information from cable news. There is much information on the virus today locally and globally so be careful not to become obsessed with the topic.
(f) If you find that your distress is becoming more intense, consider support for your mental health. Your mental health is very important for your daily and long-term functioning. Different places may offer telehealth support where you can consult a therapist or mental health professional. Some services are available online and they can be reached through email, phone calls, texts or video calls.
Written by: Dr Mark Toh, Consultant Clinical Psychologist
It is a reality that we can choose our friends. If at times we find them annoying, we can always choose to make adjustments or even terminate the friendship if needed. But unfortunately, we cannot choose our family members. As such, it can be a challenging and sometimes very difficult situation when family members are emotionally unhealthy and they have not sought help to address their own difficulties.
Instead, by having to live with them as members of the same family, they become a regular source of mental distress. This can pose a particular burden for minors, or those still dependent on the difficult member as the financial source of living, or during the current coronavirus lock-down imposed by the government when family members are confined together. In some cases, especially when violence and harm is a possibility, these unhealthy members can become damaging or dangerous and more drastic action may need to be taken to promote safety.
For the child, this may be confusing if the source of difficulty from parents are due to attempts to parent or from inappropriate control. Or they may have siblings who like being bossy to their siblings. Here are some signs to consider in trying to differentiate healthy from unhealthy behaviours from difficult family members.
They are always blaming you while not accepting their own responsibilities.
Individuals who engage in unhealthy relational behaviours often have difficulty taking ownership for contributing to the problems that emerge between each other during disagreements or conflict. Their need to blame others is usually a defensive response against accepting their own guilt or responsibility for their fault or wrong in the situation.
They are always critical towards you.
Unhealthy family members also often present themselves as critical. This goes beyond a simple discussion to point out about errors if or when you or someone else has made them. But it appears more as a pattern or their habit in regarding you as a target of contempt. Words that undermine your character are often expressed. It is also often expressed regardless of the many accomplishments you may have achieved. It is often an expression of projection that reflects deep resentment or the unfulfilled wishes of the parent on a family member. Sometimes it is a resentment shared between both parents and projected on a child who they have identified as the “scapegoat”. The scapegoat in unhealthy families are usually children who are targeted for blame because the parents need to fault the child to avoid taking ownership of a problem.
They are dismissive of your feelings.
A healthier family is more prone to being encouraging or supportive especially in difficult times. But the unhealthy family member is often unconcerned of your feelings or even your opinion. The extent of their dismissal of you may show up as disagreement with you even if you are right. In severe cases, if you attempted to approach them to resolve a disagreement, they may even resort to convincing you as the problem. In this focus, they could convince you to see that you are the problem rather than to problem-solve in search of a solution that has mutual benefits.
They often make threats.
Physical altercations are not the only signs when the relationship or behaviour is unhealthy. Making threats especially when repeated is often employed as a means of control. This is going beyond anger which is a common feeling within long-term relationships. Anger is a sign when someone feels offended, frustrated or hurt. But the use of threats goes beyond anger to become an instrument of intimidation or domination, and a misuse of power. It is a common behaviour of abusive individuals.
They are controlling.
There is a difference between control from healthy parenting and unhealthy parenting. Healthy parenting is focused on what is in the child’s best interests. When discipline is exercised, it is done to facilitate learning for the child. In unhealthy parenting, control is displayed more because it is primarily attentive to the parents’ wishes and not in the best interests of the child. This is often expressed when the parent becomes forceful and induces fear on the child so that the parent can feel powerful or have his or her way. This control can also be applied between couples or siblings. The family member is expected to take the role of submission in their engagement for the controlling person to be pacified.
Additional signs for concern in this area is suggested by (a) prohibition of personal decision-making that is good for the family member, (b) issues of appropriate concern are denied from being raised for discussion, (c) material resources such as money or food are used to manipulate the family member towards submission, (d) there is direct restrictions into personal choices pertaining to clothes, appearances, spending, friendships, or even use of time, and (e) there is an opposition towards the family member becoming independent, to be separated from the unhealthy individual, or for the family member to be individuated (mature to become their own person) over time. Between couples, a controlling spouse is often violating the boundaries of his or her spouse. It is as if the controlled spouse is not allowed to be free to exercise his or her own choices.
They confuse punishment with discipline.
Discipline is the means to teach someone to abide by a code of conduct, or correction for a child to learn right from wrong. But for the unhealthy individual, punishment or discipline occurs when there is no lesson to be learned. It shows up usually because the person is unhappy for some reason. Their need to lash out is their attempt to vent out their anger or rage even if it becomes hurtful to others, and they feel justified conducting themselves this way. At other times, this punishment is expressed through passive aggressive behaviours when “silent treatment” is employed instead of yelling or shouting. Or the punishing behaviour is excessive and disproportionate to the action or event.
Unhealthy parents take sibling rivalries or ‘misbehaviour’ to the extreme.
This usually occurs when the unhealthy parent is resentful of all his or her children. They may feel that having children (or marriage) have become a personal cost to them because of the responsibilities required for the care of the children. They feel prevented or deprived of their freedom and so the children or family member are to blame. Or this could show up with a parent showing favourites to one child over the others. In the course of sibling rivalry, the unhealthy parents is revealed by (a) blaming one child more severely over the other and consistently, (b) humiliating the scapegoated child, or (c) the unhealthy parent experience the sibling rivalry or conflict as a personal or vindictive act against the parent.
Strategies for Coping with Unhealthy Parents or domineering spouses and/or siblings
It may be a sad reality that parents can consider themselves parents simply because the infant is born following his or her physical birth. But beyond the biology, the emotional maturity, readiness or mental health can often be found lacking in parents to create the healthy conditions for the infant to develop or thrive. Controlling family members who are narcissistic in nature are also more interested in their control than the well-being of others. When family members regularly display the above behaviours, there is a need for concern. Given the potential for mental distress, developmental disruption and suffering, the following strategies may be essential to assist in coping.
Know that you are your own person.
Although you may share some traits or the same family name with your parents, remember that you are not 100% of the same people who raised you. If you recognise that your parents are emotionally unhealthy, understand that you do not need to follow their same values or behavioural patterns. When you realise that you have been hurt by them repeatedly and their use of authority serves their own interests over your needs to develop in a healthy way, be ready to break away from their self-serving values to work towards a healthy development for yourself. Explore to find healthy models of functioning among others to seek their influence over your lives rather than what is practiced at home.
Create space for your own emotions to nurture your own sense of self.
The unhealthy parent, spouse or sibling often do not respect your personal boundaries. They may deny your personal space or your feelings because they are preoccupied with their own. They may not discuss matters out or they may attempt to deny an essential part of who you are. While they deny how you may feel in their relationship with you, this does not mean you cannot acknowledge or express your own feelings by blogging or journalling.
Find supportive relationships elsewhere.
When your family members have made themselves unapproachable, you can turn to others for support instead. Friends, teachers, counsellors, or colleagues are often available to relate to who engage with a healthier appreciation for you. You do not need to go through difficulties alone. So find a support system from those who appreciate you for who you are and who value you in the person you can become.
Understand that your parent, spouse or siblings may have narcissistic tendencies or a self-serving biases so set your expectations low in conversations with them.
Unhealthy parents, spouses or siblings highlight the need to understand mental illness. Having to engage family members who have already discounted you, or hold you in contempt is often more reflective of them than of you. For this reason, understanding if they have a narcissistic or anti-social personality or tendencies is useful to recognise their biases. You may wish to have deep, meaningful or respectful conversations with them. But since this is not possible for those who are narcissistic or anti-social in nature, keeping exchanges brief and light is best to minimise stress or conflict.
Be prepared to employ diversion tactics in conversation.
Being diversionary may not be appreciated in social circles. But if your family member is controlling or looking for conflict, having a mutually respectful conversation may not be possible. As such, their attempts to dominate or argue can be diverted. For example, if they choose to criticise your choice about what you bought, you can note their comment while affirming your choice. Then this can be followed up by you changing the topic. This may allow you to have some control while you may be under attacked.
Recognise the traits that make you an easy prey.
For some, the need to dominate can be influenced by their perception that you have difficulty standing up for yourself. Their view that you are unable to be firm in protecting yourself may appear as an invitation to them to bully or dominate. Learning to stand your ground will help to establish yourself as deserving of respect.
Expect their angry response but do not surrender to it.
Your attempts to hold your ground or establish personal boundaries may be seen as a threat to the controlling parent or spouse. They see it as a challenge to their need to dominate or control. As such, anger can be employed as their weapon. It is important to not be paralysed by the person and to remember that you still have power. This power may not be accepted by them but you have power nevertheless. You can continue to pursue what is clearly in your best interests despite the threats and anger they express. Choosing the right timing to pursue your interests with them may be required. Or being able to refer to the credibility of someone else with authority on the subject may be helpful to borrow these views to help you to hold your position.
Aim to be self-sufficient and independent.
The need to establish your healthy sense of self and personal integrity is important. Your own mental health depends on it. In the face of parents or family members who are clearly focused against your best interests in pursuit of their own interests, you can set goals to be financially independent in order to become autonomous with what is needed to establish your own integrity and identity. Unhealthy parents often employ money as a means of keeping the child dependent. As such, learning to budget and be self-financing will help to establish your independence from them.
Do not accept abusive behaviour and the effects of it.
Recognising the signs of mistreatment from abusive parents, spouses or siblings should allow you to feel the anger you have reason to feel. Often these people may also engage in seduction or manipulation to downplay their dysfunction and hide their mistreatment of you. Being able to recognise their self-serving bias and the potential damage that this can create is important to not allow them to justify it. If their mistreatment is justified, it is more likely that you could minimise the damage and practice it yourself.
If the abuse is persistent or violent, be prepared to get help and seek shelter and protection outside the family.
This is hard to do for children but the sad reality is that some parents are poorly prepared to parent or they are mentally ill when they decided to have children. It is a sad and tragic reality that children have died from neglect, abuse or mistreatment while in the hands of their parents or caregivers. Children have been starved, exploited, tortured in the hands of violent, mentally ill parents. This has also occurred between couples as indicated by one spouse being regularly abused by another. Abuse can be physical, emotional and/or sexual, and they can happen between couples and on children within a marital or family system. If only one parent is aggressive or violent, the other parent has to be prepared to seek shelter to protect themselves or their children. If in the case of one parent being violent and the other parent ignores the child being abused, the children need to be protected from both parents.
This article is a call to alert those who may be suffering within families. Tragically, there are hidden dangers that vulnerable family members may be exposed to. They may already be suffering in subtle or obvious ways at the hands of unhealthy, abusive or emotionally damaging family members. Our collective concern for the weak calls out for us to be sensitive to when this danger is present within our community to protect the vulnerable among us.
Faubion, D. (2020, Apr). Toxic family dynamics: the signs and how to cope with them.
Chen, C. (2015, Feb 25). What to do when the toxic people in your life are (unfortunately) your parents. The Huffington Post.
Streep, P. (2016, Dec 14). 8 strategies for dealing with the toxic people in your life. Psychology Today.
Thorpe, J. (2015, Sep 18). 7 tips for dealing with toxic parents. Bustle.
The 2nd Singapore Mental Health Study (SMHS) which began in 2016 (reported in December 2018) was initiated by the Institute of Mental Health (IMH) in collaboration with the Ministry of Health (MOH) and Nanyang Technological University (NTU). The study focused only on those 18 years old and above. The findings show that 13.9% or 1 in 7 Singaporeans have experienced a mood (major or bipolar depression), anxiety (obsessive compulsive disorder and generalised anxiety disorder) or alcohol use disorder (alcohol abuse and alcohol dependence) in their lifetime. These are the top 3 mental disorders in Singapore among the conditions assessed in the study. The study also reported that more than three-quarters of those with a mental disorder in their lifetime did not seek professional help. In the first SMHS study in 2010, the lifetime prevalence rate of mental disorders in the Singapore population was 12% or 1 in 8 persons.
In a 2012 publication on Depression by the Ministry of Health, it was reported that depression affects between 2.5% to 18% of youth*. Depression among youths in Singapore is considered common. But it is a serious mental health symptom because of it what it reflects of children’s experiences in their environment. In particular, it is a serious reflection of what they may experience in the family or relational environment. If not adequately treated, the depressed child is likely to bring their depression into adulthood. This means that the emotionally wounded or damaged child is likely to carry their wounds forward as adults. This is a likely scenario because it is estimated that an initial episode of depression increases the likelihood of a second episode by 50%. A second major episode of depression increases the likelihood of a 3rd episode of depression by 75%. A third major episode of depression increases the likelihood of a 4th episode by 100%. Not surprisingly, depression has been found to affect brain structures and functioning. It is this recurrent tendency of depression that the suicide risk often increases over time within the same individual with a history of depression.
The risk of depression in childhood needs to be a major consideration for all those concerned with the development of children. Depression among children is a serious health problem because it can impair the emotional development of the child. It can seriously affect identity formation which is foundational to how the emerging adolescent learns to relate to themselves, to others and to the world at large. Later as adults, depression can impair psycho-social as well as occupational functioning. Depression is associated with significant morbidity and mortality. Also, depression can be triggered by, or lead to, other mental health conditions such as substance abuse, anxiety, schizophrenia or personality disorders.
Signs to watch for in children who may be depressed:
Continuous feelings of sadness and hopelessness
Irritability or anger
Increased sensitivity to rejection
Changes in appetite — either increased or decreased
Changes in sleep — sleeplessness or excessive sleep
Vocal outbursts or crying
Fatigue and low energy
Physical complaints such as stomachaches, headaches that do not respond to treatment
Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
Feelings of worthlessness or guilt
Impaired thinking or concentration
Thoughts of death or suicide
Not all depressed children display these symptoms. They are more likely to display different symptoms at different times at different settings. When depression is significant, there are often noticeable changes in social activities, loss of interest in school and poor academic performance, or a change in appearance.
The young child is most vulnerable to depression due to the quality of relationships with his or her caregivers. This vulnerability increases when the family environment is also accompanied by marital conflict, abuse, violence, illness and/or low socioeconomic status. However, it is in the quality of relationships with caregivers that is crucial because of what it can offer as a buffer or protection from other external events or causes. Therefore, the mental health of children begins with thoughtful parents who genuinely understand and care about their child’s emotional needs and development.
Parenting Practices that promote Good Mental Health in Children:
1. Love your child unconditionally
A genuine attitude to decide in the best interests of your child, and not in the parent’s convenience. Children thrive under certain physical and emotional conditions. The long-term view is needed. Parenting must understand the healthy outcome effective parenting can produce. This helps to plan to optimise the emotional development of the child. Loving well in the best interests of the child provides the best head start towards orienting the child to relate to themselves and others in a healthy way. Children’s need to establish a healthy identity, to uncover and stretch their potential, and learn to self-actualise will require parents to stretch their own emotional ‘ceiling.’ This means parents who desire to raise emotionally healthy children have to face their own insecurities so as not to impose them on their own children. Parenting with the best interests of the child will often be at the inconvenience of parents especially if parents do not appreciate the value of nurturing relationships which children thrive on.
Loving your child well answers the deep longing for the child to later ask, “Am I worthwhile?” The need for children to recognise their own personal importance, value and worth prepares them to find that their later life will amount to significance. The child at risk of depression commonly struggle with this sense of self regard. Loving the child unconditionally is not based on the social or academic performance that society may hold out for children. Instead, mistakes are accepted as a natural part of their learning. If the parents placed their importance on their children only in reaching their own ambitions, or social or academic accomplishments, these indicate conditional expectations for them to find approval or acceptance. The will view their worth based on what they do instead of who they are.
2. Ensure safe and secure physical and emotional surroundings
Secure attachment, which is offering an ongoing, consistent, soothing, accepting presence to the infant is the important beginning in the parent-child relationship that helps the infant to learn to feel safe and secure in the world. This is a foundational need for positive mental health in infants and children and later adulthood. Emotional safety from the secure bond offered by a secure parent helps young children to trust the caregiver and to experience their world as safe and predictable. Through this quality of care, a child is encouraged to first accept themselves as as lovable, as important. It also prepares them next to want to explore their world as they mature physically. This means parents who wish the best for their children have to prepare them to become independent over time.
Punitive, harsh or neglectful parents, especially when physical punishment is employed, leads to children questioning their worth or value and increases the risk for later depression. Parents who frequently employ shame, threats, insults or convey other derogatory messages to their children tend to raise a child who view themselves as defective. This is particularly damaging to children. Indeed, the DSM-V lists the sense of hopelessness or worthlessness as a common symptom of depression. Children can be raised to view themselves as defective, and that their life as meaningless.
Promoting a safe emotional environment emphasises listening and empathy as skills, and being age-appropriate supportive as an attitude. Being emotionally present and listening well will foster the child’s wish to share their experiences. It builds on the bond already started from providing a secure attachment. It encourages children to view the parent and other people as a safe resource they can count on later if needed. It answers the important question that children ask, “Is it OK to be me?” This also fosters familiarity with emotional intimacy that better prepare children for friendships and significant relationships later. Familiarity with close and supportive relationships also mean that the child is less likely to isolate themselves socially when they face problems later on. It is a wise parent who value interactional activities with their young children early on rather than let them become overly attached to computer games and the internet to amuse themselves. Excessive computer use at the detriment of other activities has been linked to increased loneliness, poor social development and depression.
3. Nurture Self-confidence and High Self-esteem
Self-confidence is most easily found when children grow up feeling loved unconditionally.
The foundation provided when the child feels loved should be supported by the child’s search for mastery in the world when they are ready to explore. Starting with simple activities, their need for autonomy and mastery over their environment allows them to gain confidence over the tasks they wish to take on. It is important for parents to support this rather than to over-protect them from exploration. Parents who are over-protective of their children and anxious about possible mishaps will find it difficult to foster the autonomy and independence their children need. To build their self-confidence and nurture high self-esteem, parents should be ready to praise their children’s exploratory efforts, be honest with them about their own mistakes, participate in the children’s activities, encourage them in activities where their interests match their ambitions and allow them to be tested by the tasks they take on.
The child’s ability to overcome, which allows them to be exposed to the frustrations and disappointments along the way, is something they have to face as well. Children should be encouraged to enjoy the process in the process of becoming. Learning to face their own frustrations, disappointments and failures will also serve to build self-confidence. Avoiding frustrations or disappointments or learning through determined effort and even failure tends to undermine self-confidence. The opportunities for children to grow through tasks and responsibilities is the beginning from which they can discover and establish their personal power and resilience.
Looking for ways to nurture your child’s self-confidence and develop high esteem answers the child need to know “Can I do it?” It requires that parents focus on building strength or resilience through the children’s autonomy –their learning to exercise control over their environment– rather than emphasize ease or comfort through avoidance.
4. Promote opportunities to Play with other children and self
Play is an integral part of emotional development of children. It is the primary means in which children learn to explore, to discover themselves in their world, and socially to cooperate, take turns and help in friendships. Studies have even suggested that inadequate play time for preschool children lead to more disruptive behaviour. Besides social interactions, play allows for the development of emotional awareness and fosters empathy where children learn about their own emotions as well as the emotions of others. Play also allows children to enjoy the process of becoming one self. This is important in a goal-oriented world that emphasises only winning or success or grades. Indeed they can discover the truth that frustrations and disappointments are often the price we all pay to achieve success. In so doing, play allows children to learn how to emotionally regulate their feelings when they are presented with opportunities to learn to express thoughts, feeling and behaviours in socially appropriate ways.
Play is an important part of the child’s need to learn and experiment. Participation in play individually or in a group is an integral part of this learning process. Parents who are open to social interactions offer their children important advantages because they can facilitate their children’s emotional regulation and social learning when they play with their children on a regular basis. Children are more likely to enjoy other people contact when they already enjoy warm relationships with and have fun with their parents. TV or computer use should be monitored so that children are encouraged to engage more in active learning through participation. Computer games designers have made it easier for children, especially children who are neglected or are alone a lot, to be addicted to computer games. Excessive computer use has been found to be linked to depression in children.
Play offers the opportunity to address the questions that children ask, “Am I OK and is it good to be me?
5. Provide appropriate guidance and discipline
While children need to explore, develop new skills and become more independent and responsible, they also need to learn that certain behaviours are not acceptable. They need to be offered guidance and discipline that is fair and consistent from the family unit. They tend to take these social rules to their school and eventually to the workplace. Expectations may be expressed firmly but they need to be kind and realistic. Again, children learn best within encouraging and nurturing relationships. Parents need to be aware of their own maturity and growth and emotional status as they seek to help their children develop self-control, self-discipline or become kind. Their children cannot be expected to growth in those areas which parents have not grown themselves.
Explain “why” the child is being disciplined and the consequences of their actions. Criticism should be focused on the behaviour and not the person. Threats, nagging and the use of threats should be avoided. The power that the parent wields should emphasise guidance and instruction in the best interests of the child that allow for children to learn from their mistakes. Those parents who practice excessive domination or coercion should understand that it is not helpful in the long run if children are forced to accept a place of surrender in order for them to survive in the relationship. They need to be encouraged to exercise their own power when appropriate. What has been described as authoritarian parenting, characterised by high demands with poor feedback or nurturance has also been found associated with a higher incidence of depression in children. This is in sharp contrast to authoritative parenting which is characterised by high demands accompanied by responsiveness to the child’s emotional needs. This approach is found to produce children who are responsible, they can regulate themselves, they can make good decisions on their own, and they are respectful to others and to rules.
Parenting is primarily a personal and emotional project in raising one’s children. It is foundationally an emotional process to secure the child before a young child eventually matures to believe in themselves. This is crucial before they begin to actively learn to navigate themselves in an increasingly complex world. It is widely understood as a parent’s most important life task since the emotional outcome show up in emotionally healthy or unhealthy individuals even before adulthood beckons. There is an emotional ‘birthing’ process where the Self of a child arrives at a healthy place in their identity formation. Or the opposite will happen. Quality parenting in this ‘birthing’ process create the foundation in which the next generation of children find the basis for their own survival, happiness and fulfilment. As such, parents learning to parent with optimal outcomes will do well to emotionally mature and be healthy themselves so that their children have the best chance to establish themselves in a healthy place in preparation to thrive in life.
The Ministry of Health, Depression: MOH Clinical Practice Guidelines, 2011.
Woo BSC, Chang WC, Fung DSS, Koh JBK, Leong JSF, Kee CHY, et al. Development and validation of a depression scale for Asian adolescents. J Adolesc. 2004 Dec; 27(6):677-89.
Woo BSC, Ng TP, Fung DSS, Chan YH, Lee YP, Koh JBK, et al. Emotional and behavioral problems in Singaporean children based on parent, teacher and child reports. Singapore Med J. 2007 Dec; 48(12):1100-6.