Tuesday, August 4, 2020

Stressed or depressed but a bit shy to talk to a mental health practitioner? Here's what happens in the first session

Curious what happens in the first session? Read this!
If you live in a place where there aren't many mental health practitioners, or simply haven't been able to afford it, you might wonder what happens when you go for talk therapy. There is no standard approach, but if you work with me, here's what we do.

Before We Start
You contact me  (happy@lepak.com)  to say you want to schedule an appointment. Maybe you tell me all about yourself, perhaps you don't say anything. I write back and we schedule a free 15 minute session.

The free 15 minute session
I work online via WhatsApp, Skype, Facetime, Messenger and Meet. Each has pros and cons, and some work better in some countries than others. So the first thing is to make sure the technology works for us.

Then we have a brief chat about what you want from sessions.

I work with stress, depression and anxiety which covers a lot of situations. However, should you have an issue that is outside of my scope, we talk about where you might find another person to help you. If I can recommend someone, I will. If you want, I will also ask in my groups for you.

If we can work together, I explain how confidentiality works, about the notes I send you, what we do if there is a lightening strike or other interruption, how billing works and more.

After our 15 minutes, if you want to have sessions, we make an appointment.  I then email you the confidentiality agreement.

First Session
The focus on the first session is to get deep background so that we know more about how stress and depression are affecting you, and what exactly you want to manage. Basically, you do a lot of talking!

Structured Conversation #1: Your Overall Health
I am not a doctor. But as some physical issues can have a big effect on your mental health, I will ask you to tell me a little bit about your health status. Like, have you had any accidents recently, have you suffered from a lot of pain, been very ill, are you on medication of any kind, and when you last saw your family doctor.

Depending on your answers, I might suggest you talk to your doctor. In fact, if you are depressed and you can't think of a reason why you might be so, I strongly recommend that you have a checkup, just to make sure there's nothing physically wrong, like a wonky thyroid. The checkup doesn't have to be fancy. Just go and see your family doctor. You can read more on that here.

Structured Conversation #2: The Stress In Your Life Over The Last Year

Life stress can have a big effect on mental health, but sometimes we lose track of how much stress we're under. This conversation is about figuring out what's going on your life.

In this conversation, I ask you questions about your personal life, your relationships, and your work life. You may recognize parts of it because it is inspired by Holmes & Rahe's social readjustment rating scale that was published in 1967. I will also explain what their intention was, and why my conversation with you has no scientific value.

Why do it if it's not 'scientific'? Well, if I ask you what's been going on, you might forget things or draw a complete blank. With this structured conversation, we cover a lot of ground easily and quickly.

Structured Conversation #3: Your Support Network and Primary Relationships
We talk about how you get along with your immediate family, your work colleagues, and your best friends.

I want to know partly because early learning and the way your parents raised you have an impact on the attitudes, beliefs and behaviour on the adult you. The other reason is that positive relationships are important for good mental health. If you feel you need to strengthen ties, we add that to our list of goals.

Structured Conversation #4 Your Sleep
How well you sleep has a direct impact on your mental health. It's very important, so we talk in detail over when you sleep, how well you sleep, whether you're getting enough or too much sleep, and more. If sleep is an issue, we talk about ways to improve your sleep.

Structured Conversation #5 How Exactly Does Your Stress and Depression Affect You?
As everyone is different, we discuss common signs of depression and see whether they apply to you. We talk about your appetite, energy level, concentration and your mood and emotions, including guilt, fear, sadness and anger.

You will recognize some of the questions because ask about the nine criteria described in the Diagnostic and Statistical Manual of Mental Disorders used by doctors. Although my Master's training included methods and techniques for helping manage depression, I am not a doctor and I do not diagnose. The purpose of this part of the conversation is purely to see how your stress and depression affect you.

Part #6 Putting It Together
At the end of the session, we put everything together so that we have a good picture of what's going on. Then we discuss how we can get into a happier space. During this part, I will make suggestions about various approaches and techniques that may be useful. It's all about fitting the right methods to your needs.

At this point, we'll both be tired, so we make an appointment for the next session where we kick off with getting in the effective change.

The Day After Our First Session
I send you the notes, highlighting the most important parts with an outline of how we're going to work. Also, an invoice! If you pay locally, that's RM100 and if you're outside of Malaysia, it's US$35 over PayPal.

I hope you found this interesting. If you've questions, do ask. I'm super busy today but will save this post and get back to it when I can.

Want to make an appointment? Just email me. My hours are 8AM to 4PM Malaysian time (GMT+8) on weekdays and I have some early hours on the weekends.

Monday, July 6, 2020

Pandemic Rage: Is It Hitting You?

Nobody expects the covid pandemic, to paraphrase Monty Python. In the last few months, life has changed in many terrifying ways, overt and subtle, and it's packed one hell of a punch in terms of mental health.

We may see some conference papers out soon but it's likely we'll need a few years perspective before we really understand how it's affected us.

When we do, my bet is that one issue will stand out most: pandemic rage.

Since the start of 2020 we've been frightened by a invisible killer disease, inundated daily by horror stories from all over the planet, and reminded that we're helpless. With a rider threat that if covid doesn't get us, a crashing economy will.

Anger is a notification that something is wrong. Adding hopelessness and fear supercharges it, creating either revolutionary rage or spiraling horror.

I suspect that what we feel, depends on how we're triggered.

I know that when I saw the first film of George Floyd circulating on Twitter, I understood why some people support the death penalty. It's a stance that goes against my code of ethics, but for minutes, I was possessed by rage. It was quite frightening.

On another day, I read some hateful comments on FB and they really bothered me. That's unusual; I've a strong streak of arrogance mixed with optimism that functions to protect me. But at that instant, I felt chilled. For a moment, the hate out there hit me.

Why am I wittering on? Because I think too many of us act as if we're okay. Like kids who hope to fool the monster under the bed by feigning ignorance, we tell ourselves that it could be worse, that we mustn't complain, and that we'll see it through.

However, by pushing away our feelings, we're falling into classic error. As Freud pointed out, repressed feelings don't die. They are buried alive and will emerge later in uglier ways.

Today, repressed fear is fuelling "righteous zeal", the kind of anger that we tell ourselves is cool because we're only enforcing rules for everyone's good.

That kind of thinking is dangerous as it destroys respect for diversity of opinions and values, and seeks to normalise and justify violence.

Righteous zeal powered the witch trials in medieval Europe, the French and Russian Revolutions, and McCarthyism in the USA. It also created atmospheres of paralyzing fear and scapegoat populations that allowed holocausts to take place in Europe, Cambodia, and Yugoslavia.

I don't know what triggers you, but I'm monitoring my anger and taking active steps to recognise it, accept it for what it is (reaction) and deal with it carefully.

In the process, I found it useful to take a long break from social media and to unfollow and snooze all those who posted triggering content. It's not personal, it's me caring for myself.

My news stream is now limited to novels (escapist stories, not anything deep or meaningful) and cats.

In addition, me and the cats are practising our selfie taking and writing our next book.

It's not perfect, but as a short term band aid, I'm finding it excellent.

What are you doing?

And in case you haven't seen the Monty Python, here's the video

Monty Python's "Spanish Inquisition" - The Musical from StormAngel on Vimeo.

Thursday, June 4, 2020

Anger isn't a problem: it's a notification

Hi there, I hope you're all safe and well during these scary times. I'm talking today about anger, a topic that some of us find a little difficult. 

I hope you enjoy it - and excuse the super long hair. My fringe is beyond my chin and I'm feeling like a Borzoi.  

This is Blesk, the Borzoi, from WikiCommons.

Thursday, May 14, 2020

The perils and dangers of forgiveness

You hear it all the time, "Oh, just forgive them." Forgiveness is presented as virtuous, and as an attitude we should aspire to.

With respect, that's bunk.

Here's my reasoning.

First, there are clearly limits to forgiveness. Ask yourself, should we forgive mass murderers? Serial killers?

I would argue that it's nonsensical to hate them, they're probably sick, but forgiveness just isn't possible for outrageous crimes.

Few of us will engage directly with such an extreme case. However, in daily life, easy forgiveness leads to issues.

#1 Example: Fiona hurts Bob with her comments, and Bob forgives instantly. What happens next?

Takeaway: If you just forgive, people will hurt you again and again. You need to use hurt to push for positive change

#2 Example: Bob is furious because John sabotaged his promotion. Supposing John says he's sorry, and Bob feels compelled to say he forgives him, even though he's still mad. What happens when Bob swallows his rage?

Takeaway: Forgiveness is a process. You can't shortcut it because ignoring emotions will come back to haunt you as depression, suppressed anger etc

But the most toxic of all the "Oh, you must forgive" mantras out there is this:

#3 Example: Mary is deeply hurt when Sue laughs at her wish to become an engineer. Britt tells Mary to just forgive Sue. What does Britt think about Mary's hurt feelings?

Takeaway: When we dismiss other people's hurt, we disrespect them.

This is as plain as the nose on your face, and yet, we have the mantra. Why?  Why are victims being told to forgive? Who's saying this and why?

Why don't we tell the perps to change, do better?

Why do powerful people counsel "just forgive"? What's in it for them?

Victims are told to shut up because it is useful for the powerful that injustice continues. It's what keeps them on top.

And the flying monkeys, the people who will helpfully rage at victims, trying to scare or guilt them into shutting up, do so because they feel it's too scary to challenge powerful people.

It's easier to side with a powerful abuser than to stand up for what is right.

Also, abusers control others by gaslighting. As discussed here: how abusers act when caught out

I'm not saying you should take account of every little thing that happens. People mess up, and that's okay. Small things don't need to be called out. But for deliberate or consistent hurts, we need to speak up, for ourselves and for others. It should be done without anger, without nasty scolding, but with the intent to make it better for everyone.

True apology: accountability + steps to positive change – adding an apology is icing on the cake

Monday, April 13, 2020

Covid and suicide counselling in developing nations with little or no support system

Covid is causing havoc in terms of mental health, and so we've probably all got a friend or two who we are worried about. Most suicide prevention guides focus on listening and calling the authorities for help. If you want one of those, the Columbia University offers a great one.

That's awesome - IF you live in a country that has that kind of help. For many people around the world, there isn't a hospital or a doctor or a mental health professional. So what do you do then?

I'm going to kick off by saying I don't have a definitive answer. I work with people in difficult situations and I have found there are no easy solutions.

I do it because life is uncertain, and I believe that if we only dealt with simple things, people in difficulty would be alone. That can't be good. Also, mental health practice is always risky; it's part of the deal.

So, with that caveat, here are some thoughts.

#1 It's damn scary when someone says they are suicidal. So when you are scared, that's perfectly okay. You'd be a bit of a twit not to be afraid. Breathe and accept it's part of the situation.

#2 Immediate things that you can say:
I'm glad you're sharing this with me
I'm sorry you are hurting
Tell me, what brought this to a head? <- and then listen
How can I help you?

#3 Although it's tricky, you can distract your friend from suicide by focusing on the internal coping skills your friend has. You might start this by asking, "Do you remember another time when you were in crisis or near it? What did you find helpful then?" <- and then listen

#4 Identify who your friend trusts in their life who is close by and who can help: family, friends, house mates, neighbours.

This is where it gets tricky: be aware that in many places, asking for help can be actively dangerous. For example:

A woman living in a country where women have few rights, may be sent to live with abusive relatives. This is because those cultures believe in 'out of sight, out of mind'. She may also be beaten, whipped or jailed by the authorities simply for wanting to leave her husband.

An LGBTQ person who asks for help in a country where homosexuality is illegal can be jailed, whipped or executed. Even if they don't divulge their orientation, this fear may prevent them from seeking any kind of help even from a family doctor or tribal healer.

Another issue is that mental health is seen as a personal weakness and form of willful stubbornness in many cultures. Therefore, seeking help results instantly in a lecture that can be summed up as, "Say your prayers, obey your parents." Sometimes, it comes with community shaming. You know, because everyone loves a good shaming and it's so incredibly helpful 🙄

If you are from a free, democratic country, this can be hard to believe but it's vital that you understand and respect how dangerous the world is for marginalized people. 

So, when you talk it over, be respectful and understand that the person you are talking to has probably already tried all kinds of reaching out.

But, supposing they can think of someone, in that case, discuss what they might say and what the person they reach out to might answer.

If it sounds good to both of you, discuss who will make the call. Your friend may want to do it themselves, or with you on a conference call, or they may feel shy and want you to do it for them. Whatever they want, be gentle. 

#5 If there is nobody to call and there is no doctor, hospital or other help, then keep talking until the situation de-escalates. Then make a plan for being in touch.

My suggestion is that for your own peace of mind, you should make one firm appointment to text within a few hours, otherwise you'll be on tenterhooks.  And when you text, see how things are and take it from there.

If you can, open up the network so your friend get loving support from more than one person. Note: this may not be possible. Often, people who are driven to extremes by despair are alone. So be prepared to be a sole support for some time.

Well, that's my two Sen. If you've any suggestions, please comment.

Thursday, April 9, 2020

How Abusers Act When Caught Out

People who are into getting power and control think and act differently from the rest of us. Therefore, it can be tough to get your mind around how manipulative they are.

One way to see through trickery and gaslighting is to analyse apologies.

Many abusers are careful to maintain a façade of decency, respectability and fairness, so they operate behind closed doors. But with videos and the #MeToo movement, they're being called out more and more.

When confronted, you will hear them make 'apologies' that go like this:

#1 They state horror and pretend they don't know what's going on
#2 They appeal for pity through personal illness or sick children
#3 They make a non-apology
#4 They point out some completely unrelated virtuous act

Something like this:

"I'm totally shocked!  I don't understand. I'm just a simple person. Why are you angry?  You know I haven't been well recently. If I did something, and I don't know what, I'm sorry. You know I go to church every week and I volunteer."

The approach is actually very clever because it's a layered effort meant to attack you.

#1 They state horror and pretend they don't know what's going on
It's a deliberate misdirect that has two aims: to make you doubt yourself and to get other people to question whether you are truthful.

#2 They appeal for pity through personal illness or sick children
It's a deliberate misdirect with two aims: to make you feel guilty and to get other people to think you are attacking an 'untouchable' target.
Even if they are sick etc, this is a red herring, a deliberate attempt to gaslight you. Put crudely, men with dicky tickers and single mums of autistic kids can be abusive predators.

#3 They make a non-apology
Because some people will see the word sorry and not realise that it's meaningless because of it being sandwiched in between denial and attack. Also, predators offend face to face but they apologise in public and not to the victim if they can possibly help it. The remorse is a show to get public opinion on their side; they have no interest in the feelings of the victim.

#4 They point out some completely unrelated virtuous act
This is to appeal to black and white thinkers who see humanity as simply good or bad. In truth of course, we are all mixed up with bits of good and bad floating to the surface all the time.
Predators hope that the audience will say, "OMG, a person who did something good once can't possibly be an abusive predator." It's powerful stuff, which is why so many clever predators opt to work in religious institutions. If you aim to enjoy a life as a predator, that kind of authority and white hat regalia offers good camouflage.  

A real apology sounds like this:

#1 Owning the act
#2 Saying you're sorry directly to the victim
#3 Asking for forgiveness
#4 Offering to make amends (if appropriate)

"I'm so sorry I called you a twit. It was wrong of me. Can you forgive me? May I give you two tickets to the concert to make up for it?"

Analysing how people apologise is important for figuring out if you're in a toxic relationship. It's also useful for "she said, he said" situations. And in the time of the Covid, it might make watching the news more interesting ??

Photo Credit: The nose is from Pixabay

Wednesday, March 25, 2020

What to do when your friend is in lockdown or quarantined with toxic parents or partners

Abuse isn't limited to beating the hell out of people with a cane or strap. <- and if you do this outside of consensual adult bedroom fun and games, I hope you go to jail.

Abuse can be verbal.

"Did you hear Tim got a promotion? Why don't you get a promotion?"
"Julie is married. You're almost 16/21/23/29. Nobody will want you."
"What do you mean, you're gay? We don't do that in our family!"
"You're too fat. This is a good time for me to help you diet."
"You're a failure. This is a good time for me to make you study really hard."
"You always make the wrong choices."

There are people who live with really horrible emotionally abusive people, nasty types who don't leave physical bruises but who run their prey down remorselessly.

I'm already seeing a spike in people becoming sick because of their toxic parents and partners. I'm hoping to God there isn't a spate of suicides.

What can you do?

Don't say, "They love you really." Because toxic people are shitty and that's not love talking.

Don't offer 'fixes' because toxic people are about power and control. They can't be managed when you're all shoved in the same house together.

Do say, "You are a good person. I care for you. Other people care for you too. This situation is horrible but it's not going to last forever. When this is over, we talk about how to get you out of this situation. In the meantime, lock yourself away as much as possible, know I'm here for you, and we keep talking." 

Then, LET THEM VENT. Let them say horrible things and just be there for them. Don't be shocked or tell them off. Living with toxic people is poison, so letting them vent lets them expel part of that poison.

If you think they're actively suicidal, call your local police. They can go and get your friend and take them to hospital. Or call your local council office and ask for help. You can also try suicide call centres like the Samaritans, Befrienders or whatever they are in your country to ask for emergency numbers.

Also note, the US is making a huge public library available for reading - free and internationally. If you are suffering from emotional abuse (horrible parents, nasty partner, evil boss) please read one of Dr Susan Forward's books.

Note: you can read it online but it's best to install the FREE adobe software so you can read it nicely. I've just done it. It takes a few minutes to download and install, no issues on Windows 10.

Click here to see Susan Forward's books on the FREE library

I hope this helps.