Tag: Mental Health

“Every day I eat, play, sleep and repeat. Is it wrong to live my life like this?”, asked a tertiary student during a talk that I recently conducted. Well, this could be an easy or a difficult question to answer, depending on who the person is asked to answer it…

As my talk was about the statuses and conditions of mental health among young people, the question was raised during the Question and Answer segment, to which I had to provide a quick and short reply.

I remember I acknowledged that there was absolutely nothing wrong with the situation, as it was what normal human beings do. In fact, it also applies to the animal kingdom. For life and livelihood, we need to keep our bodies healthy to function well and behave in the desired manner. If we do not have a strong body and a balanced mind, we will not be able to use any power even if we were extraordinary human beings.

On this basis, I went on to show that the real challenge is what to do and how to offer other meaningful and satisfying things, after the daily routine of eating, playing, sleeping and repeating. To me, this is a more crucial question for us to take a moment and consider.

 

“It’s OK not to be OK”

It is especially important for me to recognise and be aware of psychological disturbances, mental destabilisation and emotional disruptions in young people. What they experience and encounter is really real and true. Never doubt their pain.

After all, our youth hold the key to creating a better future for our world. Keeping their mental state and mind in a stable and healthy perspective is essential. This expectation goes beyond the basic need of educating for knowledge, training for skill sets and fostering moral values.

Dr Daniel Fung, head of Singapore’s Institute of Mental Health, said that he has observed an uptrend in teenagers with emotional dysregulation, who may display destructive behaviour either towards themselves or towards things around them.

With this view and attitude, we should accept that the mental conditions of some youths are “not OK” at a particular situation and time. Besides this, “it is OK” for them to be in that state, hopefully for a short while. This position opens a vital and needed door for us to provide them with the right timely support and direction.

Take for example the story of Ms G, a young ex-client of mine.

 

“This is for your own good”

Ms G (name changed for confidentiality), was a Junior College student in Singapore. She engaged my therapy service because she felt “jaded, fatigued, lost” and she did not know what she “should do”.

Though Ms G excelled in her studies, she was dissatisfied and unhappy as she was taking some subjects that totally did not appeal to her. Forced by her parents’ pet phrase, “This is for your own good”, she was demanded to pursue these subjects that she did not like nor was interested in.

The endless cycle of assignments and examinations of these subjects which Ms G was expected not only to do and take, but to excel in them, drove her to an unbearable bottomless pit of emotional turmoil. Finally, she “collapsed and was paralysed” psychologically and mentally.

It was not easy to process Ms G’s affect concerning her emotions, feelings, sensations and moods, as she kept a distance from me. Obviously, these therapy sessions were arranged by her parents and “it was for her own good”.

Rumi highlighted “The gates made of light swing open. You see in.”. I saw the opportunity for me to use the same phrase as a key to enter Mr G’s tight-locked castle in her mind.

It was very helpful when I invited Ms G to comment on her parents’ pet phrase, allowing her to express her voice unreservedly. Along the way, I explored other possible angles and perspectives on why, what and how her parents had done and decided for her since her childhood.

With much compassion, empathy and understanding based on a non-judgemental disposition, Ms G eventually became open with me. Such a breakthrough in establishing a therapeutic alliance, facilitated a more directional and focused intervention for dealing with her unmotivated spirit and depressive state of mind.

 

“You don’t need to own them”

One of the therapy techniques and tools used and highly appreciated by Ms G was what I called “Externalisation”, in addressing her persistent low moods. I believe it worked for Ms G effectively as she was a very sensitive young lady about her own emotions and feelings.

In the therapeutic process, I requested Ms G to be very mindful of the gloomy emotions and grim feelings that she noticed and observed, whenever they engulfed and immersed her, which was totally out of her control and influence.

I guided Ms G not to possess such negative affect with vigilant self-talk, like:

• “Oh…There’s an emotion of sadness.”
• “Yes, this sense of melancholy is waving in again now.”
• “Ah…Isn’t it a sentiment of grief creeping around?”
• “Hmm…Here’s a feeling of sorrow.”
• “See! A sensation of heaviness is forming on the chest of the body.”
• “Right…There’s a mood of blues sneaking inwards at this moment.”

This is a high level of consciousness directed the unwholesome emotions, feelings, sensations and moods externally, by not having “I, me, my and mine” involved.

Ms G was reminded that she did not need to own the adversative affect, of constantly telling herself that “I am sad”, “I am in a bad mood”, “I am not happy” etc. This mindfulness transformed her usual reactions to becoming responses, toward the destructive affect.

I further required Ms G to objectively check and scrutinise how the ebbs and flows of the unfavourable affect gushed to her and drowned her. This process assisted her to be aware of and understand better on what were the possible triggers and causes.

These moments of notification, observation, identification, labelling, naming, exploration, examination and investigation, are built on a non-judgemental stance as a cornerstone.

During these stages, intense and significant harmful affect requires the necessary place, space and pace for proper processing. Ms G told me how she could feel a movement of uneasiness and restlessness that rose and fell, before finally disappearing.

This therapeutic technique was adopted and adapted for Ms G’s conditions, primarily because of her personality and temperament. And through frequent practices, her sullen and surly moods stabilised, and eventually became more balanced.

“There is a crack in everything, that’s how the light gets in.”, says Leonard Cohen. After this stage of intervention, I seized the opportunity to facilitate a heart-to-heart conversation between the parents and Ms G. After much time, energy and resources, an agreement was made that Ms G was to continue with her Junior College in the same subjects, and she would be allowed to select her preferred faculty in the University she wanted.

I echoed what Carl Jung had emphasised, “Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness.”.

Pertaining to the episode in this family, the ripple effect of such a profound family dialogue cleared the relationship misconceptions and misperceptions between the parents and child.

Their expectations and affection with and for each other were re-defined and comprehended with new meanings and deeper love. The ties and bonds in this small family were thus becoming tighter and stronger.

In the last therapy session, Ms G declared to me that she sensed “lightness” in her, a feeling of weightlessness and brightness. To her, it was an outcome of her regaining emotional calmness and serenity.

The promise of Ms G’s parents in supporting her future academic pursuit, greatly energised and motivated her to finish her studies, which she did with flying colours. And Ms G indeed managed to enrol herself on the course programme she desired, at her chosen University.

It is gratifying to know that Ms G, one of our youths who hold the key to creating a better future for our world, had already used it to open a gateway for shaping and moulding her personal future first!

 

I will love the light

for it shows me the way,

yet I will endure the darkness

for it shows me the stars.

 

Og Mandino

 

Note: As this article is mainly catered to general members of the public, the case conceptualisation, intervention formulation, discussion and terminologies used are deliberately simplified and presented for an easy reading, comprehension and relevancy.

Image:    https://www.flaticon.com/free-icon/gate_1207197

Quotes:   https://www.goodreads.com/quotes/25498-i-will-love-the-light-for-it-shows-me-the

This article is written based on Krish Phua’s greatest aspiration to be a mind healer, facilitating his clients to cultivate and explore “Inside Mind Insights” for improving their Wellness, Wholeness and Wiseness.

This article was originally published on www.oberdanmarianetti.com on 22 Feb 2023.

Imagine that I suddenly sneeze uncontrollably and loudly during a therapy session with you. Your reaction to my embarrassing moment in the therapy room could be an indication of your relationship with me.

This was how Dr Theodore Jacobs, a child and adolescent psychoanalyst as well as an adult analyst, perceived his client’s therapeutic alliance with him.

In Dr Jacobs’ situation, his client offered him a hearty “God bless you” when Dr Jacobs could not hold back his sneeze while his client was commenting on Dr Jacobs’ “shortcomings”.

To Dr Jacobs, his client’s “expression of goodwill”, was a sign of the strong bond built between his client and himself. This amusing story was captured in his book, “The Possible Profession: The Analytic Process of Change”.

 

The Influence of a Therapist

In my previous article, “Mapmakers and Travellers”, I shared the findings of a classic research, showing the influence a therapist might have, or could have, which is:

• 60% of “sense of control” over the psychotherapy outcomes, while a client has the remaining 40%.

• Out of these 60%, the therapeutic relationship between both parties takes up 30%.

• With this, it also means that a client could influence at least half of these 30% as well.

The importance of such a therapeutic alliance between a therapist and a client in determining the psychotherapy outcomes, can be illustrated with the story of an ex-client of mine.

 

Old Happy Self

Mr E (name changed for confidentiality) was in his 40s, single and had been on a long-term medication for his Bipolar Disorder for many years. He had suicidal ideations and attempts before.

He was living alone and was not close to his family and relatives. His social life was also very limited as he did not interact much with his neighbours, while his three closest friends lived overseas.

Due to the episodes of paranoia, anxiety and depression, which were beyond his control at times, he seldom stepped out of his house. This further reduced his interaction with people whist enhanced his aloneness and loneliness.

Although he had a successful career in the creative industry, he became unemployed for a few years because of his worsening mental health conditions.

It was fortunate that he was able to sell some art pieces he made at home, even though he could have produced more for sale. Yet, with the sale of these art pieces, he was able to lead a very simple and humble lifestyle.

It was a breakthrough for Mr E to finally realize that “enough is enough”. He had come to a stage where he could no longer “recognise myself” in a mirror anymore. It was during that moment he asked “Actually…Who am I now? I was not like this…I want to be my Old Happy Self again!”

There is a Chinese saying, “Heaven helps those who help themselves” (天助自助者). As the first step to recovery, he took the initiative to reach out to the counselling centre that I was volunteering with. His case was assigned to me.

 

Precious Moments

Most of the therapy sessions were conducted virtually rather than in person due to his high level of fear and rumination about leaving his house. Each therapy session was “precious” to me as I would not know if that will be the last session as he might refuse to continue with the therapy. Or he would have hurt himself so badly that a subsequent session was impossible.

Having this in mind, my main therapy goals were focusing on three areas:

• Safety and Security:

These were the prime priorities for me to ensure Mr E would not self-harm and self-destruct physically, mentally and psychologically. For his psychological and mental wellness, we frequently identified and processed the various cycles of maladaptive thoughts and unhelpful emotions, feelings and moods as well. He was also psycho-educated on the differences between “being safe” and “feeling safe”; “perceived fear” and “real threat”. He was requested to record such awareness of thoughts and emotions for tracing some behavioural patterns for self-monitoring and self-acceptance.

• Anchoring and Stabilisation:

Emotional anchoring through some mindfulness skills was shared with Mr E for grounding and self-soothing. He was facilitated to gain back regularity and consistency in daily life. We co-designed a timetable of daily living routine for waking up, marketing and shopping, cooking and having meals, making arts and working, cleaning and washing, exercising and entertaining, resting and sleeping etc. Regulating his consumptions on the prescribed medication at the right dosages and timings was a vital goal for his mental health stabilisation too.

• Regulation and Relaxation:

Mr E was trained on some practical strategies and techniques such as progressive relaxation process and diaphragmatic breathing etc, for regulating and easing his physical and mental state. The goal was not only to minimise the frequency, duration, intensity and severity of his emotional disturbances and mood swings but to prevent these encounters through regulating his autonomic nervous system as well. With some mindful relaxation techniques, his emotions of anxiety and stress were usually replaced by the feelings of relaxation and calmness.

 

Small Wins; Big Victories

Well, it is always easier said than done.

Mr E’s road of recovery was not a smooth journey. There were quite a few major episodes that he derailed from the therapy goals that we had agreed and worked at.

To a certain extent, it was understandable because Mr E had been habitually thinking, feeling and behaving in an inappropriate condition and manner for many years. It was not realistic to expect him to have a revolutionary change (absolute change) but evolutionary changes (incremental changes) instead.

As such, my objective was to let Mr E progressively experience some small wins, rather than big victories in a short run.

 

A Therapist’s Role in Recovery

It is said that a therapist is always “sitting big in a therapy room”, having the “power” over a client.

Like the image I used in “Mapmakers and Travellers”, I rather be a clear map, a sturdy compass and a tough haversack, whilst playing my role as a “fellow traveller” with Mr E.

• As a Map:

Mr E was facilitated to understand the meanings of self-directed growth milestones in a life map, striking to reach his full potential for a better life stance ahead.

During a vital therapy session, under some intended and controlled confrontative intervention, his financial status was brought up on the table.

Having a full-time permanent employment was not a comfortable topic for discussion as he had been in an avoidance stage for a long time. With a few resource-based options being explored and analysed, a decision was made by him, for getting employed again, within three months.

The good news was that he did eventually land a full-time managerial position, which was related to creativity that aligned with his strengths and enjoyment.

• As a Compass:

As for Mr E’s Bipolar Disorder, his moods could swing intensely, especially during those days when he was reluctant to take the prescribed medication. Sometimes, it would cause him to not even want to get up from his bed for days.

During an in-person therapy session with me, he was in a deep self-doubt and low mood state. He raised his head, looked into my eyes and asked me, “Do you believe that I could lead a happy life?”

I knew it was critical for me to support him to determine a route direction like a compass, but it was a difficult question to me. No matter what of my reply, as a “Yes” or “No”, it could be interpreted in different meanings and might direct to two extreme ends of psychotherapy outcomes and impact.

I noticed that I had a pause for a moment, before telling him, “I choose to believe that, you could change.” Upon hearing this, his eyes filled with tears and smiled at me contentedly. It was at this moment, the therapeutic alliance between us raised to another higher level.

• As a Haversack:

He was guided to believe that “strength is within”, by practising self-compassion as well as injecting hope and aspiration constantly into his life haversack for himself.

He might be badly discouraged if he could not sustain the expected positive changes too. Thus, I supported him to regain himself with some success stories in a prolonged timeframe that he could accumulate for himself. This helped him to have more sense of self-control and resiliency.

For instance, it was challenging for him to follow a “daily” living routine as such a more balanced lifestyle was relatively new to him. I guided him to revise it to become a “weekly” living routine. This allowed him to have more leeway and flexibility to slowly adapt to a more controlled daily living, without feeling frustration with himself.

Similarly, I changed his perception of his “To-Do List”, to become a “Done List”. This worked for him as he could maintain his motivation in doing things that he set for himself, rather than having a sense of failure when he could not finish the targets.

 

Leading and guiding Mr E to reach his final destination – to be his “Old Happy Self”, was a path filled with many thorns and rough terrains. An established rapport based on trust, respect, acceptance, non-judgemental, genuine care and concern between us, did motivate his determination to go on.

Aesop said, “Little by little does the trick”. Along the way, Mr E was assisted to uncover what internal and external resources that he already had and could have, accompanying him to continue on the journey. In addition, the sufficient place, space and pace rendered by me patiently to Mr E, nurtured and enhanced his little voice for finishing his journey of recovery, louder and louder!

Courage doesn’t always roar.

Sometimes courage is the little voice

at the end of the day that says

I’ll try again tomorrow.

 

Mary Anne Radmacher

Note: As this article is mainly catered to general members of the public, the case conceptualisation, intervention formulation, discussion and terminologies used are deliberately simplified and presented for an easy reading, comprehension and relevancy.

Image: https://learnpatch.com/2018/06/action-learning-can-accelerate-team-psychological-safety/#prettyPhoto/0/

Quotes: https://www.passiton.com/inspirational-quotes/7300-courage-doesnt-always-roar-sometimes-courage

This article is written based on Krish Phua’s greatest aspiration to be a mind healer, facilitating his clients to cultivate and explore “Inside Mind Insights” for improving their Wellness, Wholeness and Wiseness.

This article was originally published on www.oberdanmarianetti.com on 16 Feb 2022.