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COVID-19 AND ADDICTION – RECOVERY USING ONLINE THERAPY

COVID-19 AND ADDICTION – RECOVERY USING ONLINE THERAPY

Author : Andrew da Roza

COVID-19 has posed a challenge to everyone, and those more physically vulnerable in our community clearly need our care and attention. 

There are also people whose mental vulnerability deserves equal care.

Mental illnesses such as depression, anxiety, and addictions are exacerbated by a pandemic crisis in multiple ways. 

Collective family and community fears are (in themselves) contagious; and the constant bombardment of medical and financial bad news, can leave those with mental illnesses lost in a cascade of negative rumination and catastrophising. 

The mentally ill and people with addictions commonly have compromised immune systems, and suffer stress or substance, tobacco and alcohol abuse related diseases – leaving them wide open to severe pneumonia with acute respiratory distress symptoms – and other complications from COVID-19. 

Isolation, separation and loneliness – caused by working at home and social distancing – are perhaps the worst contributors to: low mood; agitation; irrational fears; moments of panic; self-disgust; resentment; anger; and even rage.

People whose ability to pause, use reason and find practical solutions can be severely compromised. They may find themselves bereft of the motivation, and ability to engage in even the simplest tasks of self-care. 

Added to this, listlessness, boredom and frustration can lead to despair. Then self-harm and suicidal thoughts may arise, take hold, and even overwhelm them.

Those in recovery or active addiction may also turn to their compulsive and impulsive behaviours of choice, to sooth and find momentary respite from the moods and thoughts that have hijacked their mind. Triggers, urges and cravings may become relentless and unbearable. 

The solution may begin with finding a way out of isolation. 

Starting the journey out of this darkness can start with talking to people who can demonstrate unconditional positive regard, show kindness and compassion, and help reframe the situation. Such people can assist those suffering to put a name to and validate their emotions. 

In short – therapy can help!

In times of COVID-19, working with a therapist via teleconsultation can be effective using ZOOM, Skype, WhatsApp video and FaceTime. 

Although the calming and soothing sensation of the physical presence of a therapist is absent, for those in isolation – distraught with shame and despair – Internet enabled therapy can prove a lifeline.   

Isolation can be further broken, using similar Internet methods, by attendance in recovery groups such as Alcoholics Anonymous, Narcotics Anonymous and Sex and Love Addicts Anonymous – all of whom now hold Zoom meetings in Singapore. 

These Zoom opportunities in Singapore are supplemented by Zoom, Skype and telephone conference meetings in Hong Kong and Australia (in Singapore’s time zone) and in the U.K. and the US (during our mornings and evenings).             

Having broken the isolation, the second step therapists can provide is guidance and motivation towards self-care. This would include tapering or abstinence from the addictive substances or behaviour. A well thought through relapse intervention and prevention plan, specifically tailored to a person’s triggers, will also assist.

Triggers may be particular places, situations, people, objects or moods. 

The acronym “HALT” is often used by those in recovery; which stands for the triggers of being: Hungry; Angry; Lonely; or Tired.

When these triggers arise, people are encouraged to 

  • HALT their behaviour; 
  • breathe deeply, with long outward breaths;
  • think through consequences;
  • think about alternatives;
  • consult with others; and
  • use healthy tools to self-soothe.      

Daily mindfulness, meditation, exercise, sleep hygiene, healthy eating and following a medication regime are important aspects of self-care – and for some suffering mental illness – these actions – and time – may be all they need to find their footing again.

Luckily, the Internet gives a vast array of possible self-care options, including things to distract us, soothe us and improve us. 

Everything is available from: calming sounds and music; guided meditations; games; home exercise, yoga and tai chi; self-exploration and improvement videos; video chats with loved ones; to healthy food delivery options. They can all be had with a few keystrokes. 

Today we live at a time when suffering from mental illness and addictions is commonplace. But we also live at a time when the solutions are literally at our fingertips – if we only reach out for them. 

For information on teleconsultation for addiction therapy and addiction recovery meetings, contact:  Andrew da Roza at Promises Healthcare by email to andrew@promises.com.sg or by calling the Promises Healthcare clinic at: (+65) 6397 7309 

 

   

 

Defeating Shame with Group Therapy for Sex Addiction

Defeating Shame with Group Therapy for Sex Addiction

The Paradox of Getting Started

Attending group therapy for compulsive sexual behaviours (sex addiction) is commonly very difficult.

The fear and shame associated with the compulsion, and the desire to hide and minimise the behaviour subsumes a person’s thoughts. This drowns their motivation to attend. Procrastination or an outright rejection of the benefits of therapy group becomes inevitable.

Ironically, it is the benefits of group therapy that would motivate a person to attend in the first place. But they not be willing to attend unless they get these benefits first.

A chicken and egg conundrum.

 

The Benefits of Group Therapy – Shame Busting

One of the main benefits is group therapy’s ability to “bust” shame and fear.  The same shame and fear that prevented the person from attending.

It is in a group environment of compassion, kindness and lack of judgment, that a person can find the courage to face their reality, and gain hope and purpose in their recovery.

In group, people discover that they are not alone in their secret thoughts, urges and cravings – and that they are not uniquely “broken”. It lifts the impossibly heavy weight of secrecy, lies and half-truths, that people carry – often for years.

They also find out that others – very much like them – have found a way to start a journey to change their behaviour, beliefs and feelings.

 

Sexual Compulsivity is an Issue of Intimacy

At its roots, sexual compulsivity is an issue of intimate relationships. Group therapy is therefore a uniquely effective way to learn how to build healthy relationships.

Having and maintaining personal boundaries and respecting the boundaries of others, is a skill set that can best be learned, and safely experimented with, in a group. Effective communication and emotion management are also learned skills – and a group of peers is the best place to practice them.    

Simply by interacting with someone struggling in similar ways, learning from them – and, in turn, helping them – enables recovery to bloom.

 

Group Therapy and Self Knowledge

One aspect of sexual compulsive behaviour is the struggle with self-knowledge.

A person struggling with compulsivity may common to ask: what motivates my behaviour; why this particular behaviour; why is volition and control so hard; why can’t I learn from my experience; how did I get my calculation of the risks so wrong?

In group therapy, we also ask: what needs is this behaviour really serving; is it really satisfying my longer-term needs; what is the price I am “paying” for dealing with my needs in this way; are there other ways to meet those needs at the “right price”; and what else can I do to meet my needs?

 

The “Mirror” of the Group members

By exploring these questions together in a safe space, a group can feedback their observations of each other’s journeys – and pool their collective wisdom.

Having a “mirror” of four to six people, reflecting back their experiences of who a person is, enables that person to truly see themselves as they are – perhaps for the first time.

 

Group Therapy – the Safe Space Rules

To create a safe space, the group therapy the rules are made clear.

Confidentiality is paramount. Further, members are encouraged to talk about themselves and their perspectives, and not assume or impose things on others.

Advice is offered only if expressly requested. Comments are positive and constructive; and a person’s strengths and skills are celebrated.

 

The Outcomes of Group Therapy

With the dark pall of shame lifted – what other outcomes can be expected from group therapy?

The benefits are many. Self-awareness, self-esteem, honesty, skilful management of relationships, emotions and communications – and greater motivation to stay the recovery course. 

Ultimately, not only does behaviour change, but so do perspectives and desires.

Needs are better understood and met. Purpose and meaning in life return – and having a full life becomes a probability –  not  just something other lucky people have. 

 

If you’re interested to start your CSBD group therapy journey, with a safe, non-judgmental and connected space for peer support and learning, you may want to consider writing in to clinic@promises.com.sg to be a part of our  Sex Therapy And Recovery (S.T.A.R.) program facilitated by Andrew da Roza.

Living with a Sex Addict – Pt. 1

Living with a Sex Addict – Pt. 1

My partner says his sexual behavior is normal – but he is hiding it and I know something is wrong. Am I crazy? What are the signs of compulsive sexual behavior disorder?

Partners of people with sexual compulsivity often come to the clinic in great distress.

They have just learned about the latest infidelity, daily Internet porn use, visits to Orchard Towers, massage parlors or KTV lounges. The images accidently left on the family computer may be shocking or alarming.   

Perhaps they have discovered condoms in the person’s luggage after a business trip, unexplained expenses on their credit cards, and unexplained absences from their hotel rooms late at night when they tried to call the person. Childrens’ birthdays, graduations and family celebrations may be mysteriously abandoned for “essential” business trips.

Partners may notice strange messages or nude photos on the mobiles; or perhaps odd phone calls at night, that seem to make the person excited or embarrassed. They may come home intoxicated at 3:00 am, after a night out with colleagues, with unexplained credit cards slips in their pockets for hundreds or thousands of dollars. They may find an STI clinic report.   

The person acting out will likely try to vigorously “manage” all this fallout with their partners.  

They may rationalize, minimize, intellectualize, normalize – or simply lie, to explain away all this overwhelming cumulative evidence. They may “gaslight” their partner, making them think they are crazy.

And it may work…for a time.

Meanwhile partners may feel: shocked; rejected; confused; angry, even rageful; anxious; and depressed. They may even blame themselves and feel inadequate as a partner and  ashamed.

They may: become irritable, angry or overly anxious with their children; stop doing things they enjoyed, stop seeing people; forego self-care and grooming; or try to become overly sexual and breach their own boundaries to save the relationship.

They may become sleepless, without appetite and lose weight – or over eat and gain weight; and they may use medication and alcohol to numb their emotional pain. They may keep getting flus and colds that refuse to go away; or chronic backaches and neck aches that make sleep or activities painful.

The shame may be crushing.

Some partners may have experienced earlier traumas in their own childhood or adulthood, in which emotional and sexual or other physical abuse, neglect and rejection were prevalent.  The acting out person’s behavior may therefore trigger strong trauma reactions, and lead to bonded relationship traumas, resulting in self-harm or even attempted suicide.

How can a partner respond when they get a feeling something is not quite right?

If they can persuade the person acting out to undertake a clinical assessment, the person will be able to understand that their behavior has become a serious self-destructive compulsion, and that they need treatment.

Even if the person won’t attend therapy, the partner can take an assessment of the extent of their trauma, and the role of the person acting out. The partner can then receive sex addiction treatment, and explore the options for the family. Do they stay or go?

Promises Healthcare Pte Ltd. provides therapy for both those with compulsive sexual behavior and their partners, so that together they can find a way out of their suffering and plan a better future for their families.  

Living with a Sex Addict – Pt. 2

Living with a Sex Addict – Pt. 2

“My partner’s sexual behaviour has left me devastated – should I stay or should I go?”

Many clients come to therapy wondering whether they should leave or stay, after they have discovered their partner’s infidelity, or other compulsive sexual behavior. This may include a combination of: serial affairs at work; Internet pornography; sexual massages; use of sex workers; and use of anonymous dating Apps. Excessive alcohol, drugs and workaholism may also be involved.  

Even though the behavior is intolerable or very risky, and causing great suffering – there may often seem compelling reasons to stay.

Young children may be involved. If the acting out partner has been a “good enough” parent, the children will suffer greatly if they leave. Further, the burden of parenting the children alone may seem too much.

The client may worry about the family finances – that they may not be able to support themselves and their children if the partner withholds money or does not agree to split the money appropriately.

The client may have to return to their country of origin and may not be able to bring the children with them, if their partner contests this.

Leaving may cause the client great shame, particularly with their family, friends and work colleagues.

The client may fear loneliness; or may ardently fantasize that things will get back to the way they were – eventually. After all, the couple may have a long, shared history, and may have weathered many other difficulties together.

Starting with a new relationship in future may be as daunting as living alone forever.

Some clients may be so angry and resentful, that leaving may seem like the partner getting away it. Leaving may appear like giving the partner a license to continue their intolerable behavior – unchecked and unavenged. It may result in the partners frittering the family money away.

Friends and family may be unhelpful – full of directive and conflicting advice.  Clients may be ashamed, or too anxious of the reaction they will receive to even share about their suffering.

However, some clients are unaware that there may be a solution to sex addiction.

If the partner is assessed for a compulsive sexual behavior disorder and subsequently undertakes recovery; and the client works in therapy on taking care of themselves; learning and growing from the experience; and improving their relationship – there may still be hope in keeping the family together.

Ultimately, both need to work on themselves and the relationship, if it is to be saved.

But the first step may just be contacting a professional to seek help.

Promises Healthcare Pte. Ltd. provides support for both the partner and the person suffering from compulsive sexual behavior and can help the couple to work on the solution.  

Can Sexual Behaviour Also Be Compulsive?

Can Sexual Behaviour Also Be Compulsive?

There is a proposed new law on exploitative sexual relationships – but can sexual behaviour also be compulsive?

The proposed new law in Singapore that will make sexually exploitative relationships a new offence, is controversial because it results in prison and corporal punishment. 

https://www.singaporelawwatch.sg/Results/what-constitutes-an-exploitative-sexual-relationship-proposed-law-on-new-sex-crimes-sparks-debate

Those suffering from compulsive sexual behaviour are urged to seek treatment before they become embroiled in criminal prosecution. 

The World Health Organisation has included compulsive sexual behaviour as a mental disorder in the recently published International Classification of Diseases, Edition 11. 

Do you have a persistent pattern, over 6 months or more, of being powerless over controlling intense, repetitive sexual impulses and urges, which result in repetitive sexual behaviour? Has this behaviour made your life, and the lives of loved ones, unmanageable? 

As with other addictions, the disorder results in neglecting health and personal care, family, work and other responsibilities. 

Typically, those with this compulsive  behaviour have made numerous unsuccessful efforts to significantly reduce it – but it continues, despite severely adverse consequences. 

Clinicians qualified in sex addiction treatment use validated and reliable questionnaires and detailed clinical histories to assess clients, in order to determine whether they have a sexual behaviour disorder. These clinical tools have high sensitivity in detecting the disorder. 

There are also clear therapeutic protocols to assist a client into and through recovery, substantially reducing the risk of re-offending behaviour. 

Contact Andrew da Roza, a qualified and trained addictions psychotherapist, at Promises Healthcare Pte. Ltd.