Psychiatry Archives - Promises Healthcare
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Counsellor, Psychotherapist, Psychologist, Psychiatrist. Which is right for you?

Counsellor, Psychotherapist, Psychologist, Psychiatrist. Which is right for you?

If you’ve been pottering around the Promises Healthcare’s ‘Our Team’ page, and are new to the world of mental health in that you’re considering making the leap to seeking help from a mental health professional, it’s our hope that this casual guide to demystifying the titles, designations and dizzying abbreviations that adorn each profile will point you in the right direction.

 

For starters, there’s one thing that each of our mental health professionals have in common. They all possess at minimum a Master’s level certification in their discipline, so you can be assured of all their competencies.

 

Psychiatrists

As we’ve shared in a previous article, a psychiatrist is at their core a medical doctor, which certifies them to prescribe neuropharmacological support – i.e., medication.

But of course, psychiatrists more often than not do indeed possess relevant counselling and psychotherapy certifications, because being well-versed in the craft of patient care in the mental health sector does help them delve deeper into the minds and psyches of their clients, and assist them in skilfully and empathetically overcoming boundaries that some clients may consciously or unconsciously put up that stymie the therapeutic process. 

Prescribing the most effective neuropharmacological support is buttressed by the psychiatrist’s skill in interpersonal communication, both verbal and non-verbal. Psychiatrists often describe themselves as observers, but it goes without saying that navigating these one-on-one interactions requires input from their side of the desk. While you might think that psychiatrists have reached the peak of the career trajectory of a mental health professional, keep in mind that by no means should you think of a psychiatrist as the fount of all mental health knowledge. Think of the ‘helping’ professions encompassed in the form of a large tree, rooted in a common desire to help people in need and supported by a trunk of science and evidence based knowledge , from which grows different branches representing the many ways in which mental health professionals can help someone in need – certain disciplines are applied more rigorously in helping certain conditions or situations. This is why Promises is described on our page as a multidisciplinary team of mental health professionals. Your treatment plan is provided by our team, and under the shade of our tree, you will be prompted to reach for certain branches – but at the end of the day, it is your choice to pick the leaves which seem most lush to you.

Psychologists 

Psychologists differ from psychiatrists in one key authority. They are not medical doctors, and therefore cannot prescribe you medication. You’ll notice that our stable comprises a good number of clinical psychologists – so, what exactly are they, and how can they help you? Clinical psychologists possess doctorate degrees in psychology, and are imbued with the ability to cater to clients who suffer from any number of the discombobulating disarray of mental health conditions which sadly, are still negatively stigmatised in society. Think schizophrenia, bipolar disorder, depression, and their ilk. A clinical psychologist can make a diagnosis for you, if you think you are suffering from a mental health condition. Using the tools in their arsenals which they are trained in, such as psychometric testing, intelligence testing, personality testing, and much more, their diagnoses are firmly rooted in evidence based science. You could then make the logical conclusion that if they deem your condition treatable with medication, they would refer you to a psychiatrist. There’s a lot of symbiosis going on in our clinic!

 

The difference between Counsellors & Psychotherapists 

We’ll deal with counsellors and psychotherapists next, because the two fields are very much intertwined, aligned in some facets, while possessing in granular detail key differences. Counselling and psychotherapy are both broadly concerned with betterment of clients in need, and there is significant overlap in the goals of either mode of therapy. Now, on to the differences, which will help you better distinguish which leaf you’d like to choose. First, there is a temporal difference between the two in both the length of treatment and how far back into your life each mode of therapy delves into in order to solve your current issue.

Counselling, on one hand, tends to favour clients who are more self aware and sensitive to their emotions and thought processes, and need a helping hand in unpacking a recent difficulty or life altering experience that they wish to resolve. This is rather unlike psychotherapy, rooted in a humanistic tradition – some may refer to it as height psychology, a term which gained currency during the time of Abraham Maslow and his espousement of self-actualisation. Psychotherapy, in this sense, takes a long, lingering look at a person’s past, life changing experiences, deep seated traumas and neuroses, or any relevant factors – all to help a client gain mastery of self (self awareness) and challenge them to enact the necessary life changes that lead to self improvement. You might well think of counsellors more as “advisors”, and psychotherapists as the “life guides”. Of course, detract nothing from both disciplines – their practitioners chose their specialities precisely because they fit into their world-views and probably, because they thought that they were good at it!

 

How do you choose?

Of course, given the array of therapeutic modalities and mental health professionals, we understand that choosing the right leaves can be a bewildering experience. That’s why we feel it’s best that you browse the profiles of our therapists, read their biographies and see which of them you feel most comfortable seeing. In the near future, Promises Healthcare intends to refine and streamline your selection process by having a list of issues or conditions that you are having problem(s) with – your input will then guide you to the mental health professional in our team that is best equipped to deal with your issues. For now, take  a deep breath, sit back, read, absorb, think with clarity about what you want to deal with, and pick one to make an appointment with. Choosing the right therapist isn’t a one hit wonder – it takes time and patience, but rest assured that we’ll do our best to help you in that regard. 

 


Featured Photo by Evan Dennis on Unsplash

Dear Caregiver, You are not alone in this Circuit Breaker: Anger Management Tips

Dear Caregiver, You are not alone in this Circuit Breaker: Anger Management Tips

by Sharmini Winslow, Psychodramatist / Therapist

 

Anger is a response most of us have when we feel our territory is being threatened. This is a primitive reaction from our days as cavemen (and cavewomen) when a wild animal was nearby! This reaction has not quite been removed by modern civilisation.  When something threatens our security, the brain responds to it with a fight or flight reaction.  The body releases adrenaline which causes changes in the body.  The heart pumps faster, breathing gets faster, blood gets diverted to the legs and arms so we can run or fight back. The blood flow to the reasoning part of the brain is lessened so that thinking becomes difficult. Nowadays there are no saber tooth tigers coming out to attack us which require us to fight or flee.  However the body’s response to a threat remains the same and, unless we find ways to discharge the energy or change our perceptions, the fight response will persist. 

 

Powerless!! That’s the situation most people find themselves in at the moment during this Covid-19 Pandemic Circuit Breaker.  From the home maker, who has to see her family all day long to the child who wants to have his friends over; teenagers who are restricted in their activities with peers to husbands who have to adjust to being at home with no break! Cabin fever is setting in and many are not coping well.  Add to that mix an addiction that is running rampant in the household and you have a powder keg ready to blow!!! 

 

What can family members do at this time to stay sane and not get embroiled in another power struggle or argument with the addict in the house.  Anger that luxury during normal times is just magnified as all of us are forced to Stay Home. A simple request turns into a huge event; an innocent comment gets misinterpreted; and even demonstrations of concern become fuel for accusations of being manipulative or controlling. What to do??

 

Most family members of addicts or dysfunctional families (most of us can attest to being in this category),  have resorted for a while now to manage, manoeuvre, save or guilt trip.  This comes from a place of love and fear. However having time apart has always been a great diffuser of tension.  Now faced with a Stay Home situation things can get stressful. Once free to go out, meet friends, go to the gym and pursue our life goals, we find ourselves having to don a mask and stay six feet away from each other, with frequent temperature checks thrown in!  Yes we know it’s for our own good but just how do we go about removing that sense of irritation or frustration?? What’s wrong with me?  I never used to get SO upset?? Being stuck at home we ‘step on the toes’ of others or they inadvertently step on ours. 

 

So here are some possible ways to cope…..

 

1. Walk away and discharge the energy

Going for a walk, or a run and getting away from the source or trigger for our anger is one option.  Moving away and giving vent to the energy is what we need to do.  Digging in the garden, washing dishes, scrubbing the bathroom tiles or polishing the furniture is a great outlet for this energy. Shredding newspaper is another excellent technique.  After which you could turn the strips into Papier Mache pulp and create an art project.  One woman wrote that she would pull out weeds and imagine she was pulling out her husband’s hair! This is called Detaching.

 

2. Practice Deep Breathing and Self soothing

This taking in of deep breaths, helps bring more oxygen into the body and to the brain.  Especially important is the frontal cortex where our reasoning happens. Improved brain function helps restore some calmer thinking. Follow this up with doing something good for yourself such as listening to some music you like, dancing, playing a game on your phone, doing a craft or even having a nap. Seld care is important when you have to deal with a loved one suffering from an addiction.  We often say, “Put on your own oxygen mask before you attend to others.”

 

3. How Important Is It? 

Ask yourself this question.  After walking away and breathing for a bit, consider how the event figures in the larger scheme of things. Does this event require action right now or can it wait? Do I need to say what’s on my mind right now or can I pause and say it later.  Often I ask myself these questions- Does it need to be said? Does it need to be said by me? Does it need to be said by me now?? By the time ive asked myself these questions, my good sense would have returned and I can leave it for another time.

 

4. Respond not react

After calming down, consider a way to communicate which is kind and thoughtful. Say what you mean, mean what you say, but don’t say it mean. I’ve heard this said by someone- “Try to say it in ten words or less!”  Haha! Most of us have communication patterns that escalate tension! So, try this for a change.

 

Another great tool is the acronym – T.H.I.N.K.  Before I speak I need to THINK. 

Is what I’m saying Thoughtful, Honest, Intelligent, Necessary or Kind. If not take a piece of Masking tape and place it nearby.  This helps as a reminder to keep my mouth shut.  

 

When all else fails, go talk to someone you trust and let it out. A friend in need is a friend indeed.  Or seek one of many support groups or counsellors to help you cope. Whatever the case, we are all in this together! So don’t suffer alone. There are many helplines and people available to support you such as the ones listed below. 

 

    

What to expect during your visit to a Psychiatrist?

What to expect during your visit to a Psychiatrist?

If you’re considering seeking help from a mental health professional / psychiatrist, there’s a pretty good chance that you’ve realised there’s help out there that can assist you with whatever concern you have on your mind. Your mind may be in disarray, but remind yourself that whatever stigma against seeking mental help may exist in your mind, it’s there because of your lived experiences – created by the culture you live within. There’s absolutely nothing wrong with wanting to get better, or better yourself, and to feel constrained by some vague idea of what it means to be “a man” or “a strong woman” is unwarranted.

If you’re fearful of revealing your innermost thoughts and feelings to a stranger (by virtue of it being your first visit), keep in mind that your psychiatrist is first and foremost a doctor, bound by the Hippocratic oath, and second, believes in the value of offering a non-judgmental listening ear through their training and moral code. If that doesn’t comfort you, you should be aware of legal constraints that exist in your favour to protect the information that you share with them. Notwithstanding of course, if there is reason to believe you intend to injuriously harm yourself or another.

Because of the anxiety that may roil your thoughts, it may do you well the night before to sit in silent contemplation and pen down the reasons or thoughts you intend to divulge. Having a concrete list to bring into your psychiatrist’s office will help you ground yourself and serve as a reminder that you’re there for good reason – to get help. Nothing to be ashamed of, nothing to hide, nothing to unconsciously lose behind a preponderance of mistrust or other self-serving attitudes. Your psychiatrist’s office is a safe space.

If you feel that all this is a hard ask, consider bringing along someone whom you trust and knows you well, with your best interests in mind. They can serve as a calming influence that soothes your inner turmoil. Furthermore, they might be able to helpfully point out if there are discrepancies between what you tell your psychiatrist and the truth of the matter.

When you step into your psychiatrist’s office for the first time, you will most likely be greeted with an open-ended question such as “How may I help you today?”, or “What’s been bothering you?”. It’s normal to feel overwhelmed by the variegated ways you can choose to answer their greeting, especially if you have issues with how you are perceived by others. But remember, this is their way of getting to know you, especially since they have nary a clue of why you may have decided to make good on your appointment.

Because of the time constraints on your visit (your psychiatrist’s office is a place of business after all), you can expect them to try their best to elicit responses through a line of inquiry that their best judgment will allow them to evaluate and cohere into an accurate as possible diagnosis of your mental condition, if you are indeed suffering from one. No psychiatrist is a soothsayer or mind-reader, and you should be aware that the help you receive will very much be preponderant both the truthfulness of your responses and the skill of your psychiatrist, who is also trained in reading cues and tells that they feel will help them make a diagnosis.

As your visit comes to a close, based on the personal proclivities of your psychiatrist, you can expect a number of permutations to happen. They may prescribe you medication, if they feel confident in their diagnosis. They may point you towards psychotherapy or counselling (the difference between the two we will delve into in another post), they may prescribe both the former and the latter, or they may hold off on either if they feel that they cannot in good conscience do so.

Of course, it is very much your right to evaluate for yourself if the synergy between your initial choice for a psychiatrist is optimal for you. If you feel comfortable with them, do feel encouraged to continue on course, or if not, seek out another psychiatrist per a trusted friend’s recommendation, or look online for one that seems more promising in terms of a potential therapeutic alliance.

Ultimately, don’t forget that your psychiatrist has your best interests in mind. They are committed to formulate a treatment plan for you that runs parallel to your values and is in line with your goals.

Promises Healthcare is committed to providing mental health services to those in need, and has realigned how we provide these services in light of the current COVID-19 pandemic. Not only do we practice strict social distancing in the clinic, we have a new teleconsultation service up and running. This may be a blessing for those who are not yet comfortable with in person visits. Simply visit our main website and visit our teleconsultations page.

Alternate services of help are also provided by the Ministry of Health & National Council of Social Services in the public health and non-profit sector respectively. The Minister for Health has also written in response to a question regarding the use of Medisave for mental health therapy and counselling treatment: “No Singaporean will be denied access to necessary and appropriate healthcare because of an inability to pay.” 

Dual Diagnosis: Anxiety and Substance Use Disorder

Dual Diagnosis: Anxiety and Substance Use Disorder

Anxiety, stress, and fear are common emotions people experience through the course of everyday life.  Anxiety disorders, on the other hand, go beyond our daily worries and fears. Stress and pressure is subjective to each person – anxiety disorders can induce heavy stress and pressure, and these feelings can become more intense over time. Issues that crop up for anxiety disorder sufferers range from anodyne to hair-raising. For example, some people are terrified of meeting new people and having to interact with strangers, while others suffer panic attacks when memories of past traumas surface. The most common types of anxiety disorders are diagnosed as:

  • Panic Disorder (PD)
  • Generalised Anxiety Disorder (GAD)
  • Social Anxiety Disorder (Social Phobia)
  • Agoraphobia (Perception of certain environments as unsafe, with no easy escape)
  • Obsessive Compulsive Disorder (OCD)
  • Post Traumatic Stress Disorder (PTSD)

Not only are there psychological symptoms, people dealing with anxiety disorders may also experience a litany of physical symptoms such as insomnia; inability to concentrate or relax; heart palpitations; gastroenterological issues; and sexual frustration, among others. When all these problems start impinging on one’s behaviour, mood and thoughts, life can start to feel like a slog through quicksand. A once “normal life” now appears out of reach, and getting there again can feel like a Sisyphean task.

What makes people suffering from an anxiety disorder seek out substances?

It’s important to understand a little more about addiction before dealing with this question. Addiction is indubitably a very uncomfortable disorder, and that’s characterising it mildly. For a “preference” to devolve into full blown addiction, a person must keep making the same conscious decisions every day, day after day, that facilitate  indulgence in his or her vice – in spite of a mounting cornucopia of problems. Maintaining an addiction certainly is tiresome. People suffering from addiction make these choices because their addiction serves them a purpose. Concomitant discomfort is tolerated in light of perceived benefits garnered from substance abuse.

A parsimonious way to think about addiction is to assume that it is a simple cost-benefit analysis. For someone struggling with an anxiety disorder, the allure of a “quick-fix” in the form of a suitable drug or drink is hard to ignore. What may begin as a misguided attempt to ameliorate paralysing fear can eventually develop into a fully-fledged addiction. With this in mind, it is now a lot clearer why substance use disorder (SUD) is a co-occurring psychiatric disorder that is one of the most prevalent among people with an anxiety disorder. The most recent and largest comorbidity study to date (with over 43,000 participants), the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), found that 17.7% of respondents with an addiction problem also had an anxiety disorder.

Ironically, the problem with the “solution” of substance abuse is that the ”solution” hurts more than helps. It can often exacerbate the anxiety disorder – which becomes ensnared in the convoluted mess that is addiction. Thus comes the slippery slope of anxiety, substance use, and elevated tolerance.

Chronic dependence is the likely consequence of this chain of events. For example, a person who suffers from social phobia might employ stimulants or anxiolytics to engender artificial confidence during a social situation. This can feel liberating, exhilarating, even, for someone who has spent a lifetime on the sidelines. The folly in this endeavour lies in the eventual normalising of this ‘chemically induced courage’ – if you turn it into a precondition to interacting with other human beings, you will only succeed in erecting progressively more imposing barriers in a completely self-defeating, tautological situation.

Are there psychotherapies out there that treat anxiety and addiction together?

Diagnosing a mental disorder in a person who also suffers from an addiction is challenging.

It may be hard to determine which came first, the addiction or the anxiety/depression. A clinical history, which is triangulated with loved ones, teachers and others may assist to know which came first. In any case, both the addiction and the disorders have to be treated at the same time. Otherwise, if untreated, the anxiety and depression may lead to the resumption of drug or alcohol use.  Cognitive behavioural therapies (CBT), meditation and mindfulness therapies, experiential therapies and medication can assist to address both compulsive behaviour and anxiety and depressive disorders.

A trained and experienced mental health professional can help you navigate your addiction recovery journey to ensure that you get the best possible outcome within the guidelines of your values and needs. While this article is about substance addiction, you will find that our team of psychiatrists, psychologists and therapists have the expertise and experience to work with a variety of addictions, and mental health issues such as anxiety disorders.

You can manage your ADHD better – by thinking about it differently

You can manage your ADHD better – by thinking about it differently

In this episode of the Health Check podcast, Dr. Winslow reveals that he suffers from attention-deficit hyperactivity disorder. No-one would begrudge you your raised eyebrows, least of all him. After all, it is precisely his duty to educate you about ADHD.

Dr. Winslow joined journalists Joyce Teo and Ernest Luis at The Straits Times’ podcast studio, where the duo court the expertise of medical professionals to inform and enlighten. Armed with myriad perspectives, Dr. Winslow availed his own brain to help demystify ADHD.

It wasn’t until Dr. Winslow began to see the parallels between his childhood behaviour and those of his clients with ADHD, that he realised he too had the disorder. It didn’t seem to bother him too much – he laughs at being chided by his son’s teachers for his pride in his son’s ability “to pass exams exactly the same way” as he did, without paying attention in class.

Dr. Winslow says that in the brains of people with ADHD, communication between cells is difficult – that’s how they are more likely to lose focus, become distracted, or give in to impulses. Singapore’s regimented education system doesn’t help either. Students with ADHD face real disadvantages, in their inability to sit through lessons, and in the way educators see those who refuse to (or simply can’t) pay attention for long stretches.

Dr. Winslow recalls being forced to run laps around the school as a child by his teachers, who had hoped to wear his indefatigable energy down into submission in time for class. He admits that it worked surprisingly well. ADHD can be managed, as he would learn.

It is unfair to say that ADHD is “not a real disorder”, and that one merely needs to “concentrate on overcoming it”. That just doesn’t make sense. ADHD is a medical condition that can be tackled with correct tools and the right will. Dr Winslow says it’s possible to address the few big symptom groups (Hyperactivity, Impulsiveness, and Difficulty with Distractibility) with practical advice in the right contexts. For example, you might teach your always-tardy child about time management with to-do lists.

Dr. Winslow says parents should try and come to terms with their child’s ADHD, or risk more worrisome aspects spilling over into adulthood. Adult ADHD often comes packaged with low self-esteem, where inability to complete tasks due to inattention becomes internalised as laziness in a self-defeating cycle.

Overcoming ADHD is easy, says Dr. Winslow, when you understand this maxim: “The more you understand the complications brought by your limitations, the more you can do to manage your symptoms.” It’s an expansion of the classic “knowledge is power”. 

Once you begin to appreciate the ADHD brain for its quirks, advantages become more apparent. The meandering thoughts of people with ADHD often help them develop novel solutions to problems – “thinking outside the box”. 

The doctor’s recommendations? Don’t panic, try to understand ADHD, and don’t forget the fish oils!

Listen to the Health Check podcast over at The Straits Times website, or search for it on your favourite podcast platform.

Psychosis

Psychosis

Psychosis can be a debilitating experience for individuals experiencing it. Hearing voices or thinking unusual or disturbing thoughts is common in psychosis. Having psychosis makes it difficult to figure out what is really happening and there is a break from reality. It results in individuals not being able to do the things they usually do—such as going to work or school and enjoying time with friends and family. Family members may also struggle as to how to help their loved ones through these experiences.

The truth is that psychosis is a treatable condition. Treatment for psychosis is provided by healthcare professionals and support groups. This involves a number of different approaches which include medication, therapy and peer networks. At Promises we provide support through doctors, Counsellors and Case managers. There are peer groups in which our clients attend to hear the shared experiences of individuals who have lived through periods of psychosis. So do know that help and options are always available.

At Promises Healthcare, we are committed to helping you through your journey to recovery. Please contact our clinic for inquiries and consultations.

Written by Jesudas Soundhraj, Therapist, Promises Healthcare Pte Ltd