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.
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.
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.
Depression has been portrayed extensively in pop culture and media, from R.E.M.’s hit song “Everybody Hurts”, to the television series “13 Reasons Why”. The phrase “I’m so depressed” is thrown around casually when someone has had a bad day or when they can’t get their favourite brand of ice-cream. But what is depression, really? How does it affect us, and can it be treated?
If someone was recently fired or lost a loved one, it would be natural to feel grief at such events. However, grief is not depression. Depression is classified as a mood disorder that causes unusually low moods for an extended period of time and may impair one’s ability to function at work and at home. Grief or other stressful situations may sometimes trigger depression, but unlike grief, there is often no discernible cause for the hopelessness and despair a depressed individual feels. Depression affects everyone differently, and factors such as one’s family background, environment, or physical state can impact their chances of developing depression, and how severely it impacts them.
Depression has a variety of symptoms that can vary in intensity, including;
Loss of interest in typically pleasurable activities;
There are several different types of depression, with the most common being Major Depressive Disorder (MDD). According to a study conducted by the Institute of Mental Health (IMH), 1 in 16 people in Singapore have experienced MDD in their lifetime. Major depressive episodes last about eight months and have a 70% chance of recurring within five years, though this varies with each individual.
There is also Persistent Depressive Disorder (PDD), also known as dysthymia. This type of depression can last for several years, with symptoms receding for no more than two months at a time. PDD is much harder to spot, as the symptoms are often not as severe as MDD. Due to the length in which PDD affects individuals, friends and family may eventually brush it off as part of their personality. Others may think that they are just naturally “gloomy”, or “introverted” and “withdrawn”. Some individuals may also experience major depressive episodes while in the midst of PDD. This is known as double depression.
If any of the above sounds like they might apply to you or someone you know, you may be wondering “what can I do?”. The first step would be to speak to a mental health professional, who can properly assess the situation and make a diagnosis if necessary. They can then recommend a form of treatment. However, there is no “one size fits all” treatment. It may take many tries to find one that works for you. To help find that, here are some proven methods of treatment.
Antidepressants prescribed by psychiatrists help to stabilise one’s mood by adjusting specific parts of their brain chemistry. SSRIs are the most commonly prescribed class of antidepressants and help to boost the effects of serotonin in the brain. Antidepressants take time to produce full effects so don’t be discouraged if you don’t experience any effects immediately. However, if the antidepressants do not work after an extended period of time, or produce unpleasant side effects, speak to your psychiatrist about changing medications. When taking antidepressants, be sure to adhere to the prescribed dosage in order to see the best results. There is a common misconception that if someone feels better after taking antidepressants for a while, they can stop taking it immediately. This is not the case, and can instead cause their mood to suddenly crash back down again. If you are feeling better after taking antidepressants, speak to your psychiatrists, and together you can work out a plan to reduce the dosage of antidepressants.
Unfortunately, even with the wide variety of treatments available, the majority of people suffering from depression do not actually seek professional help. In many cases, this is due to the stigma associated with mental illness and the fear of what others may say. People with depression are often told “just stop being sad”, or “you should be happy, you have so many things to be thankful for”. So they hide it. They struggle each and every day and they hope that they’ll just get better on their own. But that makes the process so much harder. Support from friends and family is crucial in the recovery process.
Depression is a disease that can happen to anyone. It could happen to the quiet kid that sits in the corner. Or to your best friend who’s always been bubbly and lively, and now seems like someone else that you can barely recognise. But just like other diseases, it is possible to recover from depression with the right support from friends, family, and therapists. So be kind to one another, love one another, and when things get tough, be there for one another.
With the recent revelation of American rapper, Kanye West, being diagnosed with Bipolar Disorder, the condition has been brought into the spotlight. The term ‘Bipolar’ (meaning “two poles”) signifies the polar opposites of emotional highs and lows. As the name suggests, Bipolar Disorder is characterised by episodic, extreme mood swings in which the individual experiences intense mania and severe depression. Formerly known as ‘Manic-depressive Illness’, the disorder is a fairly common, yet serious mental health condition.
For individuals struggling with the disorder, manic episodes can last days to weeks and are often associated with hyperactivity, an irritable mood, rapid thoughts, increased recklessness, or an exaggerated sense of self-esteem and power. On the other hand, a depressive episode can last weeks to months. In this phase, individuals may experience increased restlessness, a loss of interest in activities (including those that they usually enjoy), poor concentration or disrupted sleep patterns. In more severe cases, these people may also possess suicidal thoughts and behaviours.
In order to help us better understand the condition, we interviewed Deborah Seah, a peer support specialist at Psaltcare.
Deborah started experiencing extreme mood swings in her early primary school years. Having known that her paternal family had a history of mental illness, she identified that her condition was most likely to be genetic. However, she had chosen to suffer in silence until 2 decades later, when she sought psychiatric help for postnatal depression and work-related burnout. At that point, she was diagnosed with Bipolar Disorder as well as Generalised Anxiety Disorder. For Deborah, the disorder reigned control over her life – straining her relationships with her loved ones. Before her diagnosis, others could not understand why she was being so unpredictable, and her erratic behaviour had unfortunately caused numerous misunderstandings.
“It was very challenging to manage my mood swings at the tender age of 8,” she shared. “When I was experiencing my highs, I would talk very fast, have tremendous amounts of energy, get very excited, or become easily irritable and agitated. On the other hand, when I was experiencing my lows, I would feel very sad and experience low energy levels. I could cry for hours or days over trivial matters and be even suicidal at times. The experience of dealing with bipolar disorder consisted of feelings of helplessness, hopelessness and loneliness as I could not predict or control my emotions and energy.” Deborah’s experience with bipolar disorder led her to face an identity crisis – being confused over her contrasting “personalities”, and not knowing which was the real her.
Just like any other mental condition, there are bound to be misconceptions of the Bipolar Disorder, especially if people don’t open up and address it. One such misconception is that individuals struggling with Bipolar Disorder are incapable of managing their mood swings. However, Deborah takes this as an opportunity to debunk such a sentiment: “After a certain point in time, I’ve arrived at a higher level of self-awareness towards my early warning signs, and it has enabled me to gain self-mastery over my condition. When my mood or energy level starts to dip, I’m aware of what could effectively help me to increase my mood and energy. When my mood or energy level is overly high, I know that I need to be extra mindful of not going into overdrive.”
While on the road to recovery, Deborah made a commendable effort in helping herself cope with the disorder. This included reading up on the condition proactively to ensure that she could better achieve self-mastery. Of course, finding a silver lining and staying positive is essential over the course of recovery. Keeping up with articles on others’ success stories and breakthroughs helped her to stay hopeful and confident that recovery is not impossible.
Being highly motivated to make headway towards recovery, Deborah knew that she needed to make changes to her lifestyle. For starters, Deborah:
ensures that she keeps to a good sleep routine and to have sufficient rest
adopts a healthy lifestyle by having a balanced diet and staying active through exercise
stays in a conducive environment for recovery where all potential triggers are removed as much as possible.
She also notes that her Christian faith has played an essential part. Daily prayer and spiritual devotion helped her to calm her mind and provided her with the much-needed inner peace. However, Deborah stresses that one should not brush aside the idea of peer support or psychiatric intervention. The active use of medications coupled with peer support contributed to the turning point in her recovery, and restored any lost hope when the future was seemingly bleak. Connecting to like-minded peers can help one explore new coping strategies and stay on a personal wellness plan.
“Upon knowing my diagnosis, my family took the initiative to purchase books on Bipolar Disorder to understand my condition better,” Deborah recounted. “My family gave me space when I needed it and continually held hope for me even when I gave up on myself. They didn’t pressurise me to make quick progress on my recovery but assured me that they genuinely only wanted me to be happy and that is all that mattered to them. I was deeply touched by their love and concern for me and felt motivated to work hard on my recovery because I realised that they would always be affected whenever I’m suffering.” Through her experience, Deborah holds a strong belief that the hope and support from her loved ones had an immeasurable, significant impact on her, and encourages those who are also supporting their loved ones with mental conditions to stay hopeful.
As of today, Deborah has made promising progress and is well on her way towards achieving mental wellness. After consistently attending a Recovery and Wellness Sustenance (RWS) Workshop at IMH, Deborah graduated with a certificate of participation. Recognising that she benefited much from the workshop, she returned as a Mentor to co-train the subsequent class of peers. In addition, Deborah also completed a module conducted by the National Council of Social Services (NCSS) and was involved in the facilitation for the 3rd and current 5th batch of Peer Support Specialist (PSS) training. She said, “It gave me confidence and reinforced my own recovery as I pay it forward and encourage my peers in their recovery journey. Moreover, it has equipped me with effective coping skills to deal with my mental health condition and it brought my recovery to a higher level.”
To end off, Deborah hopes to pass on an important message to the readers: “To me, there is no shame to be on psychiatric medication or seeking psychiatric help. Just like how people with diabetic conditions need to be on insulin while some people who are asthmatic need to be on Ventolin, people with psychiatric conditions need to take psychiatric medication too. Resilience in Recovery requires these 3 things: Courage – to embrace the past, Gratitude – for the gifts of the present, and Hope – to make the most of the future. I believe that everyone can recover from a mental health challenge, as long as he or she does not give up hope because I am the Evidence of Recovery myself! Everyone recovers at their own pace, just like every flower blooms in its season – let us hold the hope for our loved ones and for those who are battling mental health challenges by cheering them on and being their source of support to believe that recovery is indeed possible.”
So if you feel anxious, depressed, stressed, or even suicidal? What can you do? Too many people suffer in silence and don’t seek help! Come join a conversation about mental health issues! Our experienced panel will consist of mental health professionals from various disciplines, a Senior Consultant Psychiatrist, Senior Clinical Psychologist from Promises Healthcare Clinic, and an Assistant Head of a Family Service Centre! The panel will be moderated by Casework Manager of SG Accident Help Jevon Ng, an advocate for mental health and wellbeing. Our panel members all have a lived experience of mental health and will be answering questions from the audience.audience participation is encouraged. Please click the link below to join the webinar: https://us02web.zoom.us/j/83397902082Date: Saturday, May 16 2020Time: 4:30 pm – 6:30 pmEvent Categories: Raise Awareness Organizer@Migrant workers Singapore Support by SGcare Physiotherapy Clinic
The basic characteristics of all religions are similar. There is a firm belief in a higher unseen power who is the supreme master.
Religion and Spirituality, Is There A Difference?
Religion Is an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality).
Spirituality is the personal quest for understanding answers to the ultimate questions about life, about meaning, and about the relationship with the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of a community. Spirituality is thus a more inclusive concept than religion.
Mental Illness In The Middle Ages
The idea that religion and psychiatry have always been in conflict is still very prevalent. Today, most people believe that in the medieval ages, most mental disorders were considered as witchcraft or demonic possession. People with mental disorders were recognized as different and treated in various ways. Early medicine men, considering such individuals to be possessed by demons, introduced a technique called trephination, which Involved drilling a hole in the head of the individual to let evil spirits out of the body. Many other civilizations independently developed such a procedure. For example, among the remains of the Incas in Peru are skulls with holes and trephination devices. The treatment of mental illness deteriorated in the late Middle Ages and remained poor through the eighteenth century. As the medieval years progressed, insanity became linked to witchcraft and demon possession. Those considered to be possessed with demons were exorcised. This ritual, performed by a priest, would call upon the demon to come out of the individual and to transfer itself into an animal or inanimate object. Both the Greeks and Romans thought that the mentally ill were capable of causing major social problems, as well as harm to themselves. They made provisions for guardians to take care of the insane. Realizing that these people could hurt themselves or others and could destroy life and property, laws were passed that set specific guidelines. Since there were no lunatic asylums, people with mental illness were a family responsibility. The seriously impaired were restrained at home, but others were permitted to wander in the hope that evil spirits might fly out of them.
Certain saints were thought to be more active in the domain of madness. In northern France, the shrines of Saint Mathurin at Larchant and Saint Acairus at Haspres were known for healing. In Flanders, now Belgium, citizens of Geel developed a shrine to Saint Dymphna that became a hospice to house the mentally ill. During the early years of the Middle Ages, the community took care of the mentally ill. Later, hospices, then asylums were developed to house them. London’s Bethlem asylum—better known as Bedlam—was founded in 1247, making it one of the oldest institutions of its kind. The term “bedlam” became associated with chaos, confusion, and poor treatment, which reflected the general attitude toward mental illness at the time. It was only in the nineteenth century that scientists and society began to reconsider deviant behaviour from the perspective of mental illness rather than as a manifestation of evil spirits.
Religion And Psychiatry
Persons with mental disorders can sometimes present with symptoms such as hyper-religiosity (manic episodes as part of bipolar disorder) or delusional beliefs such as possessing godly or religious powers. Rates of religious delusions in schizophrenia remain high. These symptoms and signs need to be carefully assessed by mental health professionals. Certain groups in Christianity such as Pentecostal Christians “speak in tongues”, which is not a symptom of mental illness, but an expression of their religious beliefs. “Speaking in tongues” is mentioned in the Bible.
In the last two decades, rigorous scientific research has been done and published in mainstream medical and psychological journals. David B. Larson, Jeffrey S. Levin and Harold G. Koenig were some of the authors. They have conducted a series of studies looking at the relationship between religious involvement and mental health in mature adults, either living in the community or hospitalized with medical illness. Since then, many other researchers have produced a large body of research that has usually, but not always, shown a positive association between religious involvement and mental health.
According to the Harvard psychologist, Gordon Allport, a person’s religious orientation may be intrinsic and/or extrinsic.
Extrinsic Orientation Persons with this orientation are disposed to use religion for their own ends. Many find religion useful in a variety of ways – to provide security and solace, sociability and distraction, status and self-justification.
Intrinsic Orientation Persons with this orientation find their master motive in religion.
Other needs, strong as they may be, are regarded as of less ultimate significance, and they are, so far as possible, brought in harmony with the religious beliefs. Having embraced a creed, the individual endeavours to internalize it and follow it fully. Usually, the intrinsic orientation is associated with healthier personality and mental status, while the extrinsic orientation is associated with the opposite. Extrinsic religiosity is associated with dogmatism, prejudice, fear of death, and anxiety, it “does a good job of measuring the sort of religion that gives religion a bad name.
Physical health: Religiousness was related to decreased smoking and alcohol consumption. Religious commitment and participation seemed to affect longevity, as well, especially in men.
Suicide rates were consistently found to have a negative correlation with religiosity. In Hinduism, if you take your life prematurely, you have to suffer in the next birth. Most research findings support that religious affiliation, especially participation, lowers the rate of alcohol consumption. Being religious results in more hope and optimism and life satisfaction.
Belief Systems, Cognitive Framework
Beliefs and cognitive processes influence how people deal with stress, suffering and life issues.
Religious beliefs can provide support through the following ways: Enhancing acceptance, endurance, and resilience. They generate peace, self-confidence, purpose, forgiveness to the individual’s own failures, and positive self-image. On the other hand, they can sometimes bring guilt, doubts, anxiety and depression through an enhanced self-criticism. ‘Locus of control’ is an expression that arises from the social learning theory and tries to understand why people react in different ways even when facing the same problem. An internal ‘locus of control’ is usually associated with well-being and an external one with depression and anxiety. A religious belief can favour an internal ‘locus of control’ with an impact on mental health.
Public and private religious practices can help to maintain mental health and prevent mental diseases. They help to cope with anxiety, fears, frustration, anger, anomie, inferiority feelings, despondency and isolation. The most commonly studied religious practice is meditation.
It has been reported that it can produce changes in personality, reduce tension and anxiety, diminish self-blame, stabilize emotional ups and downs, and improve self-knowledge. Improvement in panic attacks, generalized anxiety disorder, depression, insomnia, drug use, stress, chronic pain and other health problems have been reported. Follow-up studies have documented the effectiveness of these techniques.
Role of the Psychiatrist
During assessment, the psychiatrist should be able to determine whether the religion in the life of his patient is important, has a special meaning and is active or inactive. Four basic areas should be remembered when taking a spiritual history.
Does the patient use religion or spirituality to help cope with illness or is it a source of stress, and how?
Is the patient a member of a supportive spiritual community?
Does the patient have any troubling spiritual question or concerns?
Does the patient have any spiritual beliefs that might influence medical care?
The clinician who truly wishes to consider the bio-psycho-social aspects of a patient needs to assess, understand, and respect his/her religious beliefs, like any other psychosocial dimension.
The idea of becoming mentally incapacitated is often so frightful that most people simply avoid the issue. Discounting the various other ways someone can lose control of their mental faculties, in Singapore, 1 in 10 people above 60 will succumb to dementia and 3.6% of people will suffer from obsessive-compulsive disorder, 1 in 50 people will experience a psychotic episode at some point in their lives, and 1% will suffer from schizophrenia, all conditions that might precipitate the loss of mental faculties. It’s a statistic that we’ve not brought up to alarm you, but simply to help you decide if you have someone in your life you trust to protect your interests, in the realm of your personal welfare, and property and affairs.
You simply have to be above the age of 21, by law in Singapore, to appoint one or more “donees”, who are people you trust “to make decisions on your behalf, in your best interests”. You, as the appointer of your donee(s), are known as the “donor”.
The Ministry of Social and Family Development suggests that it is beneficial to make an LPA as a protective measure against any untoward happenstance as it relates to your mental well-being. It is obviously best to decide what the best permutation for you is while you are capable of making rational decisions on your own behalf. Broadly, your appointed donee(s) will have control over one or both of the following aspects of your life: your personal welfare; and your property and affairs.
The LPA is designed to safeguard your interests, so it grants you the latitude of choice in deciding if: you want a single donee, whose powers are defined in Part IV of the Mental Capacity Act, or multiple donees. In the event that you decide that you would prefer multiple donees, you also have the power to decide if you will allow any one of them to act alone in making a decision on your behalf, or have them come to a consensus on undertaking a decision.
The difference between LPA Form 1 and LPA Form 2 is that LPA Form 2 allows you to appoint more than 2 donees, more than 1 replacement donee, or grant your donee(s) customised powers above the general powers with basic restrictions that donees are granted under LPA Form 1. LPA Form 2 requires the services of a lawyer.
After you have decided what’s best for you, and filling upLPA Form 1, or LPA Form 2, which you can do with the help of a lawyer, there is a “critical safeguard” in place to ensure that the LPA is not made under duress. This means that your LPA form will have to be witnessed and certified by an LPA certificate issuer, which can be: