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Managing Grief

Managing Grief

There isn’t consensus in the scientific community about whether Kubler-Ross’ five stages of grief is rooted in empiricism. Although much vaunted in popular culture, if you’ve experienced grief and resolved it in your own way, you’ll know that grief is an organic process that is by no means neat or orderly. It’s deeply unique to each individual, and this article is designed to hopefully help you through whatever loss you have experienced in the recent past.

The five stages of grief, which Kubler-Ross first postulated that terminally ill patients experience are: Denial, Anger, Bargaining, Depression and Acceptance. Denial in this context encapsulates a perfectly normal response to a tragedy, and is exactly what you would imagine – it’s simply a refusal to believe that “this bad thing is happening to me”. After reality sets in, and the sobering realisation that the tragedy has occurred is impossible to ignore, Kubler-Ross observed that people often display frustration, which culminates in Anger. Once that Anger has dissipated, people often move on to Bargaining, which is the hope that they can somehow extricate themselves from their dire straits and obtain the balm of a different circumstance. Notwithstanding the success of the earlier bargain, Depression follows, which is self-explanatory. The final stage of Acceptance is the sanguine realisation that nothing will change their situation.

If you are currently going through your own grief and taken a step back to evaluate how you are processing it, you might have noticed some incongruencies between the model and your experience. That’s perfectly natural because there has been some criticism levelled at the Kubler-Ross model in that there is confusion over description and prescription. This means you shouldn’t take it as a rule, no, or feel inadequate or “bad” that you aren’t “properly” grieving. We hope that what follows in this article will provide you with some breathing room to let your grief take its own course, and helps you handle a tragedy with the right tools.

Grief is a loss. It’s your prerogative to define what grief is to you, and even something as banal as losing a cherished item from your childhood can precipitate feelings of loss. So, you shouldn’t wall up these feelings behind what society has proscribed as appropriate. We’re talking about you here, not anyone else. It bears repeating that your grief is unique because of a multitude of factors, for those of you who don’t want to accept that it is your right to give yourself the breadth to grieve – your upbringing, your culture, your faith, your parents, the list is endless. So give pause and slip into your own rhythm of grieving.

To help ensure that you do not slip into the common fallacies that can disrupt your grieving process, we’re going to list some of the pitfalls that ensnare people and prevent therapeutic processing of grief. 

1) If you don’t show an outward display of grief such as crying, you aren’t “sad”

Just like the shortcomings of Kubler-Ross’ model, while crying is seen as a “socially acceptable” way of demonstrating sadness, it isn’t applicable to everyone. You may have been brought up to avoid tears at all costs, perhaps due to tough parenting or some childhood trauma, or you may not wish to “affect” others with your grief. No matter the reason, you should know that physiological responses to grief vary widely depending on your circumstances. Shock, numbness, anger, even hysterical laughter – just about anything is permissible in the initial, very private stages of your grief. 

2) If you don’t “get over it” within an “acceptable timeframe”, you aren’t good enough

Although your family members or people in your community may react to and resolve their grief earlier than you, you need to know that it is by no means healthy to affect the fragility of such a process by introducing the pressures of comparison. Some people simply have better coping-skills than others or are more inured to unhealthy thought processes that hold them back from the therapeutic management of their grief.

3) You feel like you need to “protect” loved ones from your grief, so you turn inwards

We keep emphasizing that grief is individual to everyone – this should tell you that there is no circumscription to how you handle it. Even though it might feel selfish to display your feelings openly because you think less emotionally able loved ones shouldn’t have to deal with your pain, remember that there is nothing shameful about the old adage, “Shared joy is double, shared sorrow is halved”. 

There are some simple coping mechanisms that you can use to help yourself through the process. Although the low mood is a given after the heartache of a tragedy or loss, and you might not feel willing or able to pick yourself up and carry on, remind yourself of the wisdom of eating and sleeping right. Drugs and drink might seem the most accessible ways to insulate yourself from poor mood, but these indulgences, in the long run, are hindrances to sustaining your mental well-being.

If you feel like the person you have lost needs to be remembered, you can do so in the solitude of creative expression, or you can choose to gather loved ones to laugh about cherished memories. If there’s one scenario where laughter in the face of loss is wholly acceptable – here it is! Whether communal or solitary, there are many ways you can raise someone up in loving memory – honouring them and helping yourselves. 

Find solace in your old routines. If you’re hurting after the failure to gain acceptance into a school of your choice, it may help to remember all the things you did well before that gave your life meaning and structure. At the worst of times, it helps to fall back on old patterns if only to hang on to some stability.

Lastly, know that there is a difference between clinical depression and the normal response to grief. You should be aware of critical signs or symptoms in both yourself and your loved ones that may indicate depression. For example, if you notice that your loved one isn’t eating or sleeping properly after a long period of time, or is displaying reckless tendencies such as driving dangerously or overindulgence in addictions, it may be time to seek professional help. Although many people can get through grief without the help of a mental health professional, when it all gets too heavy to handle, you may consider seeking grief therapy. Some of our clinicians are specifically trained in grief therapy, such as Joachim Lee or Winifred Ling.

 


Photo by Claudia Wolff on Unsplash

To Forgive Others, Is To Set Myself Free

To Forgive Others, Is To Set Myself Free

Written by: Dr Terence Leong, Senior Consultant Psychiatrist, Promises Healthcare

Translated by: Christian Tan

First published on Wan Bao Fu Kan on 31 May 2020.


 

“I forgive you.” while on the surface seems to be an innocuous word and easy to say. But in reality, it’s one of the most difficult words to express in our human language. A few years ago, a middle-aged man angrily dragged his 13-year-old son to our clinic, it turned out that Mr Zhang (pseudonym) had discovered his son hiding in a corner of his room smoking, and slapped the boy hard in a fit of anger. Even after being scolded the boy was recalcitrant and didn’t even feel remorseful. In her efforts to appease the situation at home, his wife suggested bringing the son to see a counsellor.

On that day, I happened to walk past the therapy room. I could only hear the loud arguments between the father & son, and loud sobbings of the mom. Just as I stepped into my office, my office phone rang. It was an urgent call from my colleague, the therapist, who alerted that the situation was getting a bit out of hand, and asked for my assistance in the therapy room. Upon arriving at the scene, I could hear the son’s angry retort, “You’ve never loved me since young, why are you trying to control me now? All you’ve ever done was scolding me. So what if I behave myself? Would you even notice?”

It took more than an hour to calm all parties down. After which, I carefully interviewed both Mr Zhang and his son, and I finally got to the root of why the situation had become so tense between father and son.

It wasn’t the 13-year-old boy who had caused the breakdown in their relationship. The issues stem from painful experiences when Mr Zhang was growing up. Mr Zhang had grown up with an abusive father who was not only alcoholic and chain-smoked, who often vented his anger on his wife and children. As a result, Mr Zhang made a vow from young to never touch alcohol and cigarettes. Unfortunately, his demeanour also became very stern with hardly any smile on his face and had high expectations with his own children. Why did it become like this?  It was because he had never forgiven his own father. The deeply buried hurts had made him prone to irritability, and thus he didn’t know how to praise or encourage his own child, and only knew strict discipline as his way of bringing up his child. Moreover, his biggest worry had been over his child coming into contact with alcohol and tobacco.

Mrs Zhang explained, her husband was a good man, but was a man of few words, and was not good in expressing his feelings. She knew that he really cares about the child, but it was a pity that communication was poor between the father and son. As a result of a craving for his father’s love and experiencing scolding and punishment from young, the boy had grown to become more rebellious in recent years.  

In fact, Mr Zhang’s father had quit smoking and drinking for many years. However, as a result of the poor relationship between Mr Zhang and his father coupled with a break in communications for more than a decade. Mr Zhang couldn’t come to terms with my conclusion initially. But for the sake of his own son, he finally agreed to receive counselling. After several months, he finally understood the root cause. He asked me, “I’ve finally understood that the root cause of my frustrations was the unresolved anger and hatred towards my own father, but what should I do after so many years?”

Fortunately, one day his mother decided to visit their grandson together with his father. Although he felt embarrassed initially, Mr Zhang struck up his courage, squarely faced his dad and said: “I forgive you.” This simple yet miraculous sentence seemed to untie the knots of anger and hurts between Mr Zhang and his father. From that day onwards, Mr Zhang began to smile more frequently face and he could finally express his love fully to his son. As a result, his son stopped being rebellious. Not only did he stop smoking, but also paid more attention to his studies.

As a psychiatrist, I’m truly happy for this family and admire Mr Zhang’s courage in forgiving his own father. They continued with counselling for some time, and finally mended their father and son relationship that was formerly broken.

Therefore, forgiving others is also giving ourselves a chance to receive complete healing.

Auteurs, thespians, and emotions. Except it’s all truly heartfelt. Psychodrama!

Auteurs, thespians, and emotions. Except it’s all truly heartfelt. Psychodrama!

Written by an anonymous contributor

I am a self-confessed introvert. And I’m also an addict.

I was recently cajoled into attending a Psychodrama session. I’d heard things about it – years earlier, my then significant other lauded the raw emotional exploration her sessions afforded her. I encouraged her, it was good for her. Personally though, I found the idea of a group session’s ability to evoke genuine emotion alien. It was the antithesis of who I was.

I had never enjoyed group sessions. I hated them. The introvert in me screamed (silently) in indignation at being forced into a room with my peers, lorded over by therapists who would extol the heaven-sent power of vulnerability, hanging it over the heads of us sullen detainees. They would espouse connectedness with others, openness. To me, these were just unattainable states of being that I could never actualise. The years wore on, and I plodded along, entwined with my precious, thorny, addictions. Prison, pricey rehabs abroad. I took care to never bring my real self along to the banal group therapies – I merely presented them with an alter-ego. Faking it to get along. Or “faking it to make it”, in the parlance of addicts like myself who would say or do anything to achieve a discharge.

I was living an entirely unremarkable life, losing friends and embarrassing myself.

Then, I experienced a seismic shift in circumstances. To represent it as merely ‘mandated’ would be to deny gravity to what had happened. I had run afoul of the law again, and paid my penance with a 9 month long “drug rehab”. I got out, and three months later I was a year clean. Still, I wasn’t happy. I had done no soul searching, nor had I even begun to scratch the surface of my addiction, always lurking in the shadows. Of course, a large part of my reticence towards accepting sincere nudges in the direction of help could be attributed to personal and moral failings. But why was I the person that I was? That’s when I decided to attend a psychodrama workshop at the urgings of my boss, a sweet girl whose genuine concern had initially confounded me. Why did I acquiesce? To understand myself, I guess. So, I went in with an open mind.

Psychodrama is about exploring internal conflicts, by acting out emotions and interpersonal interactions. I wasn’t inclined to be the center of attention just yet, so I left other enthusiastic participants to play the protagonists. The director, a bubbly personality whose sharp wit was tempered by insightful, genuine empathy, herded a roomful of clueless attendees with a deft hand, schooling us in psychodrama’s basic concepts. I made myself small in the corner and watched as our director doubled volunteers, acting out scenes from their lives, giving voice to their unconscious. Revelatory perspicacity was the order of these moments. I watched as they were mirrored, experiencing themselves from the outside, drawing from a nonjudgmental pool of collective consciousness. I watched as roles reversed – mothers became their daughters, and wives their husbands. All of them seemed edified, comforted, even. Misty eyes and rivulet strewn faces, sighing into closures when none previously seemed possible. There was a woman pained by a frightful trauma, her repressed malefaction she seemed so sure she had committed driving her to seek expiation from whom had ceased to be able to give her any. From the outside looking in, I was sure her wound was self-inflicted – we all knew this, but one’s own guilt is deeply personal, often insidious. As her situation percolated in my mind, so did my own guilt. I hadn’t wept when I learned of my father’s and sister’s departures, I hadn’t wept at their funerals, I hadn’t wept at their memorials. I hadn’t needed to, because I had my addiction. Now, without the pernicious warmth of substances, these losses became some therapeutic cynosure of a starting point. I had begun to understand myself, through others. The cynic in me finally realised why, across addiction recovery literature, syllabuses are almost invariably characterised by the motif of benefits accrued by group therapy. I think it owes something to the collective experience of humanity, that no matter your guilt or your shame, there are people out there who have lived congruent experiences. It may seem cloying and mawkish for me to say that no-one is truly alone, but it’s true.

You just have to look in the right places.

 

 

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 

 

   

 

Do I Have a Sex Addiction? Is My Partner a Sex Addict?

Do I Have a Sex Addiction? Is My Partner a Sex Addict?

DO I HAVE A SEX ADDICTION?    IS MY PARTNER A SEX ADDICT? 


These questions become urgent when your or your loved ones’ repeated sexual behaviour cause you acute distress. 


It may be that you feel empty, frustrated, anxious, depressed or ashamed by your behaviour.  Or you may be a loved one who suddenly discovers their partner is sexually acting out, and you feel betrayed, angry, raging, resentful, humiliated, confused or depressed; and have nagging doubts about your own adequacy as a partner. You may be worried for your children and your family life. Your health – or your finances – may be in serious jeopardy.   


Not all sexual behaviour that causes you or a loved one suffering is a sex addiction – even if the suffering is profound and long lasting, or the behaviour is considered by others “deviant” or even “risky”. 
However, if it amounts to an sex addiction, there is a solution in recovery, and a loved one can play an important role. 


It is therefore important to know – is it an addiction?   
Once sexual behaviour is persistent, it sometimes becomes impossible for a person to know whether their behaviour has become compulsive, obsessive, impulsive or even dangerous or intrusive. 
People can become confused.

“There is a way through – and that is to take a clinical assessment and discuss the results with a professional therapist, trained in interpreting them. “


Is the behaviour continuing because they consciously choose not to change? Is it just “normal”, “natural”, “justifiable”, or “cultural”? Is it the loved ones or others who are mainly at fault, because they can’t or won’t give the sexual intimacy needed? Is it just “temporary” or “a one off”.

Is it just a product of some unusual circumstances – such as being in a new country, starting a new job, having a baby, going on business trips, or feeling bored, stressed, anxious, lonely, isolated, neglected, or depressed?     

If the behaviour has been persistent for a period of time, a person may think that it is safer than it really is, or that the risks of being found out, and the consequences, are minimal, manageable and within their control.

Sometimes a person my think that their chosen sexual partners are freely consenting, or that they enjoyed the experience – but  the truth is otherwise. 


Sometimes a person may lie, cover up, tell half truths and keep silent about their behaviour, because they want to protect their loved ones. They may not be willing to admit to themselves or others that they mainly wish to avoid the painful consequences of their behaviour.

After a while, they may even become confused or uncertain about what the real truth is. Being persistently deceitful and living a double life, can become a crushing burden.


There is a way through – and that is to take a clinical sex addiction assessment and discuss the results with a professional therapist, trained in interpreting them.

There are a number of assessments available online. However, some are not thorough or confidential enough, or they cause unnecessary alarm. Many do not provide a clear interpretation; and some do not provide a path towards a workable therapeutic solution.


The International Institute for Trauma and Addiction Professionals (IITAP) provide Certified Sex Addiction Therapists (CSATs) with an anonymised, online questionnaire, called the “Sexual Dependency Inventory – 4.0”. 
It takes a client 2 hours or so to complete, and a confidential, detailed client report is automatically generated for the therapist to view online – and subsequently share it with the client. 


The report compares the client’s responses with the responses of many thousands of other respondents, both with and without sex addiction, to gauge whether the sexual behaviour and preoccupation are likely to indicate a sex addiction.  


The report provides the client and therapist with a thorough review of the client’s: sexual behaviour and preoccupations; the consequences; the possible origins of the behaviour; and the potential future course and direction of the behaviour. 


The report also helps the client articulate their motivation to change their behaviour.  


This report is coupled with a subsequent clinical interview session, that assesses: sexual, medical and psychiatric history; family of origin history; education and employment history; intimate and social relationships; and other information. Together, this information permits clients and the therapist to determine the next steps. 


If the client’s behaviour is likely to amount to an addiction, the recovery path has been clearly mapped by the IITAP programme; and CSATs are trained and skilled in helping client’s navigate through their recovery using workbooks, videos, books, articles, and other therapeutic interventions.


The recovery path engenders great hope for those who start on it. Life gets better quickly, and keeps getting better with each recovery step that is conscientiously taken. 


What causes the greatest suffering is not knowing. Am I a sex addict? Is my partner a sex addict? 

Contact us today to take a free clinical assessment.