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How Do You Find The Right Therapist For You

How Do You Find The Right Therapist For You

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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Gaming Addiction: What It Is and How Can You Self-Regulate?

Gaming Addiction: What It Is and How Can You Self-Regulate?

Predictive algorithms, the creation of alternate realities in which we are unlimited by the constraints of the real world we live in – such methods are extensively practiced by the gaming industry to draw players in. Gaming is undeniably a popular and widely-adopted mode of de-stressing, but how much is too much?

In May 2019, the World Health Organisation officially recognised “gaming addiction” as a mental health condition. It is diagnosed when a person displays a gaming behaviour pattern that causes significant disruption to their daily life for a period of 12 months. Meanwhile, a study showed that Singaporeans aged 18 and above spend a weekly average of 7 hours and 26 minutes playing video games, and that approximately 10 percent of Singaporeans game for more than 20 hours per week. This ranks us as the highest in Asia, and third highest in the world, falling only behind Germany and the United States. 

What leads these addicted individuals to their compulsive gaming behaviour? Besides the prevalence and ease of access to games on various gaming platforms, video games often act as a form of escapism for many players. As a shining proponent of the alluring, edge-cutting virtuality, games allow for players to throw themselves into a virtual landscape that is contrasted from their – comparatively –  mundane everyday lives, and can serve as a distractor from real-life problems that they are unconfident or reluctant to face. Moreover, it can be easy to fall into the trap set by game creators. Game designers construct games in a way that applies principles of behavioural economics as well as psychological mechanisms to explore stages and levelling up processes that trigger the brain’s reward system. In-game statuses matter a lot to gamers – the higher the rank you possess, the more pride and self-esteem you hold, knowing that you can show it off to your friends or gaming counterparts. As a result, individuals are often inclined to continue striving to climb the virtual hierarchy. 

Naturally, excessive gaming has its consequences. When an individual develops a gaming disorder, his lifestyles can be disrupted in more ways than one. What is also important to take note of, is that the harmful effects of gaming addiction is not only limited to the individual alone, but could also affect the people in his or her social circle. Some of these adverse effects can include:

  • Obsessive Behaviour
    Individuals who are addicted to video games are always anxious to get back to games and will often display irritable, bad-temper aggressive behaviour whenever they are separated from their games unwillingly.
  • Increased Social Isolation
    With extended periods of intense gaming, these individuals become more withdrawn and disconnected from family, friends and colleagues, causing them to drift away from their loved ones.
  • Other Mental Health Conditions
    Gaming addiction can eventually lead to other issues that include depression or anxiety disorders. Sometimes, depression may follow due to the prolonged social isolation.
  • Other Physical Health Conditions
    A gaming addiction can also have a number of physical effects. When one devotes an excessive amount of time to the gaming activity, this can lead to physical conditions such as the carpal tunnel syndrome, migraine, back-aches or eye-strain. Extreme addiction may cause gamers to skip meals and rest, or neglect their personal hygiene as they lose control of themselves and can’t resist the desire to play more and more.

Gaming addiction is a serious matter, and can be degenerative if not addressed in the early stages with the initial symptoms and signs. Habits, including unhealthy gaming habits, can be formed anytime between 1 to 3 months, and it will be significantly easier to curb such self-destructive behaviour the earlier we try to tackle it. 

While we are concerned with the various health risks and conditions commonly associated with gaming addiction, we cannot deny that video games are also undoubtedly entertaining and can be a good way to de-stress. However, as the risk of gaming addiction increases with increasing time spent gaming, what we want to advocate is moderation, rather than complete avoidance. With that said, if you are someone who is battling gaming compulsion, try to keep the amount of time spent gaming under control by setting time limits for play and stick to them. If possible, try reducing your playtime gradually by setting a timer on your phone, or use softwares such as ‘Cold Turkey Blocker’ to help you do this by blocking access to websites or applications so that you can get offline when you need to.

Like other forms of addictions, don’t try to go cold turkey at one go. Stopping altogether may cause you to feel as though there is a huge void in your life, hence increasing the likelihood of a relapse instead.  

Facing your addiction alone can be a daunting and lonely experience. If it comforts you, try joining peer support groups or online communities where like-minded people are going through the same experiences. One example of a global online video game support community would be ‘Game Quitters’, a forum specially designed to help gaming addicts connect and support each other on their road towards a normal life. And of course, don’t be afraid to go for professional help for addiction treatment like counselling or psychotherapy (therapy) if things get tough. Choosing to struggle alone is never a sensible option. 

 


References: 

https://www.channelnewsasia.com/news/singapore/more-people-in-singapore-seeking-help-for-gaming-addiction-video-11974600 (Accessed 09/08/2020)

Photo by Patrik Larsson on Unsplash

Psychological Testing (Part 1)

Psychological Testing (Part 1)

Written by: S C Anbarasu, Senior Clinical Psychologist

Psychological evaluation is often helpful in understanding the strengths and challenges an individual may have in their cognitive, behavioural, learning and socio-emotional functioning. 

At Promises Healthcare, we believe that “one size fits all” is not an approach that is applicable to the treatment of psychological disorders and challenges. We provide tailored recommendations for parents, teachers, and therapists so that interventions and accommodations allow each child to reach their potential.

IQ and academic testings can provide important information about a child’s cognitive strengths and weaknesses, academic needs, and preferred learning style. These can assist parents and children in making educational choices and implementing strategies to ensure that the child’s learning is appropriately supported. 

Specific reasons for testing include:

  • Learning difficulties or delays (e.g. difficulties with spelling, writing, maths and/or reading)
  • Giftedness
  • Underachievement
  • Emotional and/or behavioural problems presenting in the classroom and/or at home
  • Admission to special educational programs
  • Increasing understanding of a child’s learning style
  • Concerns regarding possible attentional difficulties

 

What is IQ testing?

Intelligence testing is a method used by psychologists to measure a child’s intellectual capabilities. Intellectual assessment is a good indicator of a child’s potential. We use the Wechsler Intelligence Scale for Children, fifth edition (WISC- V). This is an individually administered instrument for assessing the cognitive ability of children aged 6 years to 16 years.

The WISC V is one of the most reliable and valid IQ testing instruments available and is the most widely used measure of IQ. The WISC V provided scores that represent intellectual functioning in four specified cognitive domains: Verbal Comprehension, Perceptual Reasoning, Processing Speed and Working memory.  During the testing session, a child is asked to solve problems and puzzles and to answer a range of questions. Generally, most children enjoy the testing session as it is an engaging process involving novel and fun tasks. Should parents have worries about their child’s emotional wellbeing during the assessment, raise it with us and, we can explore a workable collaborative plan to support you and your child during the testing process.

 

What is Academic Testing?

Academic Testing provided an overview of a child’s current performance across a range of academic domains. We use the Wechsler Individual Achievement Test (WIAT-III) with subtests including:

  • Oral Expression
  • Listening Comprehension
  • Written Expression
  • Spelling
  • Pseudoword Decoding
  • Word Reading
  • Reading Comprehension
  • Numerical Operations
  • Maths Reasoning

The assessment provides a rich source of information about a child’s achievement skills. Information obtained can then be utilized for intervention decisions. 

 

The Assessment Process

The assessment is conducted in several stages:

  • An initial assessment with parent(s) is an integral part of our assessment procedure.
  • A time is set to administer the WISC 5 and the WIAT-III and other relevant tests. Usually, you may have to set aside about two or more sessions for approximately 6 to 12 hrs (excluding initial consult session) for testing, depending on the capacity and the needs of the child/person. Spacing out testing over several days can help some children overcome fatigue and stress. 
  • A comprehensive written report will be prepared after all the testings are completed, based on the outcome of the assessment and testing process. The report will highlight relative areas of strengths and difficulties, with recommendations for home and school settings. 
  • A feedback session will be provided to parents after the completion of the report. During this session, parents can be given an opportunity to clarify and discuss any concerns regarding the report. 

 

Fees for assessments

  • The Psychologist conducting the tests will inform parents of the charges involved during the initial consultation session, based on the needs of the child/person and the different tests required. 

 

Payment Plans

  • Payment plans are available for our testing procedures. Clients may choose to pay the full amount for testing at the end of the initial consultation or they may elect to pay in two payments. Like most of the private practices, reports will not be released prior to receipt of full payment. 

 

Referrals/ For Information

Please do not hesitate to speak to our friendly reception staff at (+65) 6397 7309 if you wish to make an initial appointment. Alternatively, should you wish to clarify matters with me personally, you can leave your name and contact details with the reception at clinic@promises.com.sg

 


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SIBLING RIVALRY: Why it happens and how parents can respond to it

SIBLING RIVALRY: Why it happens and how parents can respond to it

Written by: Dr Mark Toh, Consultant Clinical Psychologist

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:

  • name-calling,
  • blaming,
  • poking,
  • stealing things,
  • lying,
  • challenging a belief,
  • arguing,
  • simply looking at each other (with the intent of intimidation)
  • tattling,
  • breaking something that belongs to the other one,
  • hitting,
  • 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.

 


References:
Coping with Sibling Rivalry —https://centerforparentingeducation.org/library-of-articles/sibling-rivalry/coping-sibling-rivalry/

Sibling Rivalry —https://www.mottchildren.org/posts/your-child/sibling-rivalry#:~:text=Sibling%20rivalry%20is%20the%20jealousy,frustrating%20and%20stressful%20to%20parents.

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Demystifying Play therapy: Play ought to be taken more seriously

Demystifying Play therapy: Play ought to be taken more seriously

Written by: Dr B. Malavika, Psychological & Educational Therapist

Play is a critical part of a child’s development from birth. It boosts healthy brain development that is conducive for physical, cognitive, and emotional growth. It encourages imagination and creativity, and improves social skills and confidence. It is therefore not surprising that psychologists realised its power and tapped into it as an instrument of healing.

Challenges are a part of life. But in childhood, they can be harsher as children haven’t developed the capability to understand or deal with what they are going through.  In their tender minds, loss or pain could be something as small (to an adult) as a broken favourite toy and range up to a major loss in the forms of death, separation from a loved one,  hospitalization, abuse or other personal/family crises. While some children might manage to some extent by voicing their displeasure or through negative behaviours, others might just suppress their emotions. If the setbacks are beyond the coping skills of the child, the trauma can manifest as psychological or emotional disorders.

Parents often ask how they can know if their child needs counselling.  Some signs could be that the child is being more angry, nervous, defiant, sad, or withdrawn than usual, or than is reasonable. The child could also be showing changes in eating and sleeping patterns, a decrease in school grades or reduced interest in previously favoured activities. When in doubt, it is better to err on the side of caution and seek help.

Play therapy is one of the prominent forms of therapy for children and is practised by a variety of mental health professionals, like counsellors, psychotherapists, clinical psychologists, psychiatrists and social workers. It is an intervention which allows children who are experiencing emotional or behavioural issues to open up their emotions in the safe space of the ‘playroom’.  They are given toys to play with, and the children play as they wish, without feeling interrogated or threatened.  For the children themselves, play (therapy) is familiar and fun and they are thus able to work out their undesirable experiences and resolve their emotional and behavioural difficulties. What materials the child chooses to play with and how they play all have meaning.  The therapist watches their play to get an insight into their emotional or mental health problems. 

Depending on the issues faced by the child and their own training, therapists conduct non-directed or directed play therapy and provide play materials accordingly. Non directed play therapy is free-play and very similar to the free association of adult psychodynamic therapy. While in the latter adult clients are allowed to talk and ventilate to gain insight and resolve their problems, free play with limited conditions and guidelines, allows the child to express their feelings just through their play. Their verbal expression might or might not be as important.

Directed play therapy includes more structure and guidance by the therapist and several techniques are used to purposefully engage the child. These could be engaging in play with the child themselves or suggesting new topics, themes for play. Parents might or might not be included in the sessions. Materials may include art and craft materials, sand and water, clay, dolls, toys, blocks, a family of dolls, miniature figures, animals, musical instruments, puppets and books. While traditionally Play therapy is considered to be beneficial for children ages  3 to 12,  it has been modified and customised by researchers and therapists to help adolescents and adults also, and some mental health practitioners have started including video games as therapeutic tools. Apart from being used at counselling centres, play therapy is also being used at critical-incident settings, such as hospitals and domestic violence shelters to help children deal with deep issues. 

In regular lives, parents can encourage their kids to play indoors and outdoors and especially in nature. Lawrence J. Cohen has created an approach called ‘Playful Parenting’, in which parents are encouraged to connect playfully with their children through silliness, laughter, and roughhousing to enhance relationships and general well being.

Challenges are a part of life. While the purpose of therapy is to solve problems, playing for the sake of fun can prevent them. This can be applied not only for children but for the inner child in every individual to make life happier and more meaningful. As the proverb goes – All work and no play makes Jack a dull boy.

 


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An interview about Children with ADHD on Vasantham’s En Ullae S2 with S C Anbasaru

An interview about Children with ADHD on Vasantham’s En Ullae S2 with S C Anbasaru

Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Clinical Psychologist, S C Anbarasu, in the name of bringing greater mental health awareness to the Indian community in Singapore.

In En Ullae S2 episode 9, we are introduced to an exuberant boy, who upon closer inspection is revealed to suffer from Attention Deficit Hyperactivity Disorder (ADHD). Is he beset by developmental issues, or is there a more benign explanation? Senior Clinical Psychologist S.C. Anbarasu opens the episode with a parsimonious explanation of ADHD – simply, people with ADHD are distinguished by a lack of ability to pay attention, and appear to have vast amounts of energy, hence, ‘hyperactivity’.

In a dramatisation, the boy’s mother wears an expression of bemused exasperation – the problems began even before his birth. Prolonged labour (which occurs after 18 –  24 hours), and a possible Caesarean section heralded the coming of a “problem child”. Anusha Venkat then recalls how, at the age of 2 or 3, she came to the realisation that her son’s inability to focus was far more prevalent than what she observed in other children. Even a couple of seconds of concentration seemed to be a hard ask. He couldn’t remain placated long enough to complete any task. At the childcare, teachers baulked at how he pinged from corner to corner of the room. 

Anusha reveals how a serendipitous discovery that Carnatic music could calm him down enough to remain in one spot for more than 10 minutes. A breakthrough! Anbarasu explains that while a child suffering from ADHD can disrupt classroom proceedings, it is pointless to use force to discipline them. ADHD can make someone feel like they are “constrained within a container” if they are impelled to do a task in which they have no interest. Instead, they expend their energy reserves by indulging in some other activity – like running around and being a little menace. For parents who are unaware of ADHD as a mental health condition, seeing their child act out can be scary. In fact, Seelan (the boy protagonist) went undiagnosed at age 3 – doctors merely offered that most children are, well, rambunctious tots at that age. It takes a diligent parent to make a reasoned conclusion that their child may suffer from ADHD. Seelan was given assorted tasks to complete, with his attention span closely watched, even who he liked or disliked in class was logged. 

 

(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep9/958092)

However, Anbarasu recommends that care must be taken to conduct a diagnosis per the Diagnostic Statistical Manual (DSM-5). First, the test must be conducted on children below the age of 12. While school-going children come with a larger raft of observable behaviours due to differences in environment (home, school, etc), Anbarasu admits that is is not easy to chalk up roughhousing or rowdiness to ADHD when those are developmentally appropriate behaviours for a child. Apparently, six or seven are ages when an accurate diagnosis is reached easiest. 

Aside from Carnatic music, Seelan’s attention span was helped by repetitive menial tasks like peeling potatoes, chopping ladies’ fingers and carrots. Anbarasu acknowledges that dealing with ADHD in children is a time-consuming task because they aren’t able to complete tasks as quickly as their peers. He calls on parents to pick up the slack – strategising holistic ways to help their child, both at home and in school. It’s a collaborative effort between teachers and parents to then carry out an agreed-upon strategy.

All is not doom and gloom, however. Seelan is observed to play with Lego building blocks for hours on end, despite not performing in the classroom. Anbarasu calls this ‘hyper-focus’. It is a state of mind wherein the mind eliminates noise that potentially distracts them from the task at hand, a sort of “perk” if you will. We are cautioned that encroaching upon this state of hyper-focus can exacerbate emotional issues and precipitate anger. People with ADHD are victim to ‘emotional dysregulation’, which may manifest from frustration in perceived inability to complete tasks satisfactorily. Seelan was unable to appreciate the benefits of delayed gratification, getting restless and upset if things didn’t go his way. Anbarasu explains that this results from emotional dysregulation as well.

At some point, Seelan faces potential expulsion from his class due to the complaints of other children’s parents. Especially in Singapore, where grades are paramount, a poor academic performance which results from an inability to work with a child’s ADHD can be distressing to parents. The teeth-gnashing frustration can make parents feel helpless, and Anbarasu suggests that these situations call for a consultation with a professional therapist who will elucidate the behavioural issues at hand. This gives parents more information to plan future steps. Parents of children with ADHD also attract stinging criticism from other parents. They might feel inadequate in their roles as nurturers and mentors. Anusha has accepted this to be a part of life, chortling as she muses that “you can’t change people”. Whatever the case, it isn’t fair to fault parents for a child’s ADHD. Or the child. Anbarasu clarifies that ADHD is a neuro-developmental disorder – in other words, that’s just how the cookie crumbles. Blame should not be apportioned. Anusha recalls how Seelan used to behave like an attention hog – in its absence, tantrums would be the order of the day. According to Anusha, dealing with instances of emotional dysregulation like this is challenging, especially if you have to deal with the needs of your child while observing social propriety. 

Every child’s circumstances are different, so Anbarasu recommends that care be taken to evaluate if danger is imminent. Shouting for a little is perfectly OK. Deal with them after they have thrown their fits because anger is not conducive to receptiveness to advice. Anbarasu is careful to eschew the notion of a “cure” for ADHD. Rather, he says that it is “treatable”. Whether with medication or psychotherapy, or a combination of the two.

Children with ‘combined-type’ ADHD are challenged in a triune of areas – attention, hyperactivity and impulsivity. For these cases, neuropharmacological support is required, to aid concentration and retention of information in class. If the ADHD is not as pronounced, therapy alone could manage the condition. For parents who are especially harrowed by their child’s condition, they should know that there is ample evidence in favour of managing ADHD through the concurrent administration of medication and therapy. On top of psychiatric interventions, there are support groups inside and outside the classroom for parents who are overly stressed.

The episode closes with the narrator speaking over clips of Seelan looking positively cherubic. The viewer is called on to spare the snide remarks, replacing them with positivity, understanding, and “plenty of support”.