Tag: Counseling for Depression

Making the Hard Life-Changing Decisions

by Nathan Chua

There are a few crossroads we face in life.  Who to commit to in a long term relationship or when is it time to quit one, what course to take in tertiary education, where to live, what school to send kids to.  These are all part of what life presents to us.  Many of us can get caught up in the rigmarole of decision making.  Many clients come to therapy hoping to get an expert opinion on which path to take.  It is quite the common sight that clients come to therapy with the idea that they can consult as many therapists as they can, and come up with a logical and sensible decision.  That search for a failsafe choice can be a red herring.  Many people, and that includes me, can get really stuck for a very long time in indecision.  

Clients may find themselves weighing pros and cons with an expert in therapy.  Unfortunately, this normally ends up with what is called counterpliance or the client making a decision that goes in the opposite direction of what solution was arrived at with the expert, basically demonstrating what our minds do.  You can experiment on this by remembering how many times you have thought about how successful a decision can be.  Pretty soon, you will notice your mind reminding you about the other extreme result, which is failure.  This is why, although tempting to me, I do my best to avoid dwelling on content when a client comes to me with this kind of dilemma.  If I wasn’t conscious, I can get carried away by the back and forth in therapy.  I avoid this because it isn’t something that the client is not able to do on their own before they come.  So any kind of move in this direction will probably be nothing new for the client.  

Fundamentally, our lives can flow into these situations wherein we have to choose one way or another.  In a wonderful demonstration of how an ACT (Acceptance and Commitment Therapy) therapist would work with someone who is going through some difficult decisions, Dr. Steven Hayes shows how our minds can trick us into thinking that we can make a difficult decision and not be scared.  The thought that hard choices should not be scary can creep into this process and paralyze us into not making them to our own detriment.  

I often give my clients a perspective towards the past and the future with a question.  I would ask them if they are familiar with scenes where people are gathered for one of those momentous occasions in life that are supposed to be filled with joy and anticipation.  If these were indeed just full of positive feelings and happy thoughts, then why the heck do we see people crying in these instances?  Isn’t that strange?  Just to refresh your memory, have you been to a wedding, a graduation, a debut (an 18th birthday party)?  More often than not, you and I will see people tearing up with smiles interspersing in their faces.  Why is this?  My client will often sit with mouth agape, not finding the right word to explain such a phenomenon.  I would tell them that the body language is precisely a description of what is going on inside of them. It is a mix of feelings.  It is not just purely happiness that is going on internally.  There could be sadness, fear, anxiety, and many more.  In other words, these are the bitter sweet moments in life.  You know, the ones that are eventually etched in our memories as the most meaningful.  For in life, the best moments are not the fun moments, although they can be, but they are mostly also those that are hardest.

I can still recall some of the happiest moments I had that I spent with a friend.  Although there was nothing but fun and joy at the time, there was still something bitter about it.  It had to end.  Life is sometimes bitter sweet or has to be, bitter sweet.  Otherwise, we could be missing it.  Making hard decisions usually forms part of living richly and meaningfully.  Being brave is not about having no fear.  It is rather doing what matters to us even when there is.       

Finding Your Purpose: A Behavioral Perspective

by Nathan Chua

In a recent article about Tim Cook, the current CEO of Apple computers, he had this to say about an old saying: 

“There is a saying that if you do what you love, you will never work a day in your life,” Cook said during the speech at the Mercedes-Benz Superdome in New Orleans.

“At Apple, I learned that is a total crock,” Cook said to a laugh from the crowd.*

How many times have many of us stared at the horizon to ask ourselves what our existence is for?  There have been many cases in the counseling room wherein people ask me why they have these feelings of emptiness, a lack of purpose or direction in their lives.  Believe me, I still ask myself the same questions.  I am not exempt from life’s difficult puzzles. 

I am quite sure that most of you reading or listening or watching this have browsed through countless articles that try to answer this question of finding purpose.  In this space, I would like to share my take on how this might look like, from a behavioral perspective.  

Here’s my understanding of the subject at this point in my journey inside the world of contextual behavioral science.  We all do things for a reason.  When you pick up your toothbrush in the morning, that has a purpose.  Deciding to use your time to go to the grocery store whether by foot or by the use of a vehicle is also based on reasons.  There are three ways of explaining why we do what we do.  We either think of them as activities that we should, must, or can’t do, that we have to do, and that we want to do.  Now, let’s break each one of them down.  

Musts, Shoulds, Can’ts:

As humans who enjoy being at the top of the food chain, we occupy this spot in part because of our capacity to follow rules without having to experience something first hand.  We can just be told about a rule and not have to test it.  You can imagine how helpful this ability can be if we go back to ancient times when a rule to follow might be, “Don’t go near a lion because it can be dangerous.”   Rules like washing our hands before we eat or avoiding certain places that can pose a danger to our safety are helpful in keeping us safe and alive.

However, this rule following capacity can otherwise be detrimental when applied to threats we sense from the inside.  If we yell and scream at our child or partner, sometimes following that rule can work. 

We get what we want, like a period of less frustration from someone we live with.  The rule here is I shouldn’t be getting to this level of frustration with my child or partner.  Or, I can’t stand this feeling any longer, I must do something to stop it.  Unfortunately, this can have detrimental long term effects on your relationship with the very people that mean most to you especially when done in a harsh manner. 

This can also translate into other consequential decisions in life.  Shoulds like you should be pursuing a career in a field only because it is what others say you should do.

A good example of this is, “I must be a doctor because that is what my family wants for me,” which often leads to burnout and poor performance.

The other extreme is to follow a rule that may not be available for us to follow at the moment.  An example would be, I must be an artist regardless of the fact that I am currently without any opportunities to be one.  

Another form is when we follow rules like I must have a drink when I am stressed; I can’t sleep without a sleeping pill; or I can’t speak before a crowd until I am relaxed.

This type of rule-following can lead to unhelpful and at times unhealthy behaviors where we don’t make advances in what we are capable of achieving within the finite amount of time that we have in our existence.

Have to’s: 

These activities fall under what Tim Cook was probably referring to.  Although we would like an ideal of working in jobs that give us the most fulfillment, we nonetheless would likely end up with aspects of the work that we don’t necessarily enjoy.  This is where some of that idealism has to wear off. 

If you are one who insists on being in that dream job, but can’t find any opportunities to land one, maybe it is time to think about the have to’s.  In the meantime, and we don’t know how long that meantime will be, you might have to work other jobs and pursue your passions through other avenues.  There are people who end up doing what they love on the weekends in a different setting.  Anyway what we love to do we can do even without compensation.  You’ll never know, you might even find it in whatever current job you have that puts food on the table. In other words, there can be parts of your job that allow you to do what you love to do even if it’s less than your ideal.

Want to’s:

Here is where most of us would like to be.  Unfortunately, not even the jobs that fit our passions are purely fun.  If you wanted to play a sport for a living, there’s also the hard part of long hours of practice in a very lonely gym.  So congratulate yourself if you are able to land a job wherein you are fulfilling your want to’s.  

Want to’s can also involve what we do for rest and relaxation.  To go back to an earlier example, your musts, like I must drink to remove my stress, can be changed to, I drink when I choose to remove my stress.  This is where we see the same form of behavior functioning differently in different contexts.

Here’s a quote from Ray Owen, that I believe is a helpful guide for us to know if ingesting something to relax from heavy stress is helpful or not:

“Remembering, planning, daydreaming, imagining, and so on–matter greatly to me too and I wouldn’t give them up.  However, I’d say that they’re good things when they’re chosen,” Ray Owen

You can add having some time off of work or other commitments with a drink or two (or whatever activity it is that you do for recreation) because you choose or want to, and not because you must, is a way to see if you are doing something with your time that is helpful or unhelpful to your sense of purpose.  It is probably something that works for you if you choose to do it rather than something you must do in order to achieve something, like relieving stress. 

So next time you do something that’s like following a rule, notice the rule first, then notice why you’re doing it and see if it is something you feel like you:

  • must, should, or can’t do,
  • or something you have to do,
  • or something you want to do. 

Maybe you will find your place in the sun or what we most of the time call, your purpose for living.  Nice rule of thumb, isn’t it?

*Source: IFL Science

Who really needs counseling? Why is there a stigma against mental health concerns?

by Nathan Chua

I am writing this in the hope that we can soon find ourselves disabused of the ways our current mental health system has set us up to think about who needs help in their journey towards better life skills.  This post is going to include a personal account of my learnings in the field and how elated I am to find my reservations affirmed by a group that believes in empowering people rather than casting them as one of those unfortunate ones who need correction.  

I remember back in my graduate training days, I was introduced to the Diagnostic and Statistical Manual of Mental Disorders (DSM).  The professor appeared very learned and quite self-assured that he knows the manual by memory.  I really felt like an idiot compared to how he was able to diagnose a case accurately as one of the exercises that formed part of the lecture that day.  In my mind, I thought, this person must be a genius!  The text we were using was even entitled as a simplified one and it was already more than 500 pages long!  The actual DSM manual is even less reader-friendly with more clinical language.  I told myself, I just want to be a helping person, a counselor.  Does it really take a photographic memory or an incredibly fast reading speed to become one?  

Moreover, as I read through the required textbook, I noticed how each syndrome or diagnosis ends with a segment that indicates a mental health disorder that is not otherwise specified.  So besides having to remember each symptom in a list of more or less 10 items, I also have to recognize the ones that cannot be found in the list!

Each diagnosis can be made if a client shows around five of these symptoms and voila!  You got yourself a diagnosis!  And off you go to your counselor or therapist, or to the local pharmacy to take the medication that will address your symptoms.  And as I read through each of the bullet points, I noticed that for almost every set, I could identify with a few of them!  I could at any given point in my life, be a person with a narcissistic or borderline personality!  I just miss out on one or two and then I can breathe a sigh of relief knowing that I don’t have that disorder!  

I told myself, if this is the way I should do therapy then I don’t think it is something I would find enjoyable.  What’s worse is that I see clients who have used such diagnoses on hand, and eventually use them as excuses for their behaviors.  Furthermore, it is used to cast blame on other people for not making room for their symptoms or weaknesses.  In other words, I can only change if others change the way they treat me!  And that includes the way my therapist handles me! 

In their work in contextual behavioral science, a group of researchers have found this system to be unhelpful or even harmful.  The group proposes that what we need is a system that uplifts people and identifies what people do that creates problems in the way they behave in society.  Their research has brought to fore the idea that all of us need therapy.  The metaphor used here is that of how preventive medicine works.  We don’t recommend a healthy diet and adequate exercise only to those who have already shown signs of high blood sugar or high cholesterol in their systems.  These practices are for all because there are certain processes that our bodies go through which are universal and can be addressed without having to wait for trouble.  The same is true with our mental health.  We need a regular diet of therapy or behaviorally flexible skills that we can practice in order to create better lives and relationships.  

Sadly, because of these models of disease and symptoms, many come to therapy rather late in the game.  People wait until their lives become stuck.  I am no exception.  I have seen my relationships destroyed and precious time unwisely spent on struggling with mental processes that are otherwise part of being a “normal” human being.  It’s time for a change.  It’s time for us to pursue this path and see if we can get better results in the lives of many.

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The Intentional Life

by Nathan Chua

When I was a young man in my schooling days up to my 30s and 40s, I often wondered about the magic that religious retreats did for many people.  All of a sudden, I see a huge chunk of the attendees turn into smiling, kind, and happy people, almost as if they had discovered something inside of them that had long been gone.  I see those who have been angry, depressed, fearful, and shamed in the past, turn into brave souls that share their experiences to a group that they hardly even knew before the retreat started.  With their voices breaking and their eyes welling up in tears, someone who was hardly seen in the crowd turns out to have quite the story to share.  

The wish was, for most of us at least, to have these events last forever so we don’t ever have to confront the real world with its problems.  After a few days of meeting happy faces and people with intentions to get the best out of themselves in the retreat, we go back to our mundane lives.  We go back to the parents we have a hard time getting along with, the pressures of work or school, the critical boss at the office, the obnoxious classmates or co-workers who we wish would just stay away, or even the usual challenge of navigating rush hour traffic.  These are all the challenges that we have to face outside the context of the retreat grounds.

In my journey through counseling, I think I have finally found a sound, scientific explanation as to how this works.  Wouldn’t it be great to have that “spiritual high” within reach and without having to spend a few days out of the context of the natural and challenging environment of our career, family, environment, etc.?

The intention of the happy life vs. the life well-lived:

The secret lies in the degree to which we remain in touch with what is important to us.  When we are in a safe environment, there are no problems that are present for us to solve.  Sadly, we are often caught up in trying to fix problems that are quite tragically, unfixable.  Our feelings, thoughts, and relationships are not problems to be solved.  Neither are our partners, kids, parents, friends, problems to solve.  Just like you, I  believed that our problem-solving skills should apply everywhere.  I wanted a life without problems, loved ones and friends without conflict.  It’s what some authors would call the fix-me trap, which we often apply to other people as well.  We come to believe that their styles of relating are also problems that are there for us to solve or what we can refer to as the, fix-them trap.

When we let go of this agenda to remove our very own capacity to feel or to have difficult thoughts, then we can shift our focus on those that are important to us.  Like how important is it for you to be kind even in the face of a difficult relationship?  How important is it for you to be patient and caring when the situation arouses your anger?  I often use a short meditative practice that I got from a book that used the word intentionality a lot in referring to this skill of going back to what truly matters.  

Here’s the text verbatim in italics:

As a way to start this session, I’d like to suggest we do a short settling-in exercise. Then, if it feels useful to you, we could start our future sessions with it. 

Take some time to let your body find a comfortable position in your seat. You’re looking for a position comfortable enough that you won’t have to move around over the few short minutes this exercise takes. 

Once you’ve found a comfortable position, see if you can let your gaze rest in front of you. Then, if it’s comfortable for you, let your eyes close gently, or just keep them open. Now let your attention come to rest on your breathing, just noticing the movements in your chest and belly, as you inhale…and as you exhale… 

If you notice your attention wandering away from the breath, that’s perfectly normal. See if you can just note where your attention went and then gently bring it back to noticing the movement of your breath in your chest and belly… 

Now see if you can turn your attention toward the thoughts and feelings you’ve had about today’s session, either since you got up this morning or over the past couple of days. See if you can simply notice whatever shows up… 

Now see if you can identify or choose who or what is important to you for today’s session. Again, see if you can simply notice whatever shows up… 

Now, if you’re willing, see if you can form the intention to take steps, in this session, to move toward who or what is important to you for today’s work… 

For my part, I’ll support you as best I can in taking those steps… 

Now bring your attention back to the room, back to the chair on which you’re sitting, back to the two of us here to work together today…And when you feel ready, if you’ve had your eyes closed, let them open again.

As you and I wake up each morning, can we form that awareness and intention of being the person we want to be and living the life we want to live.    

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How Anxiety Can Limit Your Life Choices

by Nathan Chua

Anxiety is probably one of the most common complaints that people come to therapy for, which makes me wonder why this has not been a subject that I discuss more often.  I think a lot of my own anger issues stem from a deeply held anxiety about an assortment of issues in life.  I grew up in a home full of unpredictability and the sight of anger and acts of intimidation familiar.  It is therefore quite easy for me to feel anxious about any kind of turn of events that don’t go my way.  I became very strict with rules that I felt were needed to keep things in check even if much of these were out of my control.  

I recently came up with a metaphor that I hope people who suffer from anxiety due to a past traumatic experience, can benefit from.  This provides a simple imagery of what goes on in us when we become overly controlled by our anxiety in situations that could mean a lot to us if only we could “overcome” our difficult feelings.  Unfortunately, that is most of what we have learned from mainstream psychology for many decades now.  We should be able to bring anxiety down to certain levels in order to function and live meaningful and purposeful lives.  I will have to leave this discussion for another time.

The subject I wish to talk about is how we can understand what we do when we allow our anxiety to dictate our lives.  Sort of a step backwards to see the unworkability of the things we do when we experience anxiety.  Let’s say one day a person gets involved in an accident caused by a yellow car.  As we have minds that are capable of remembering much more than other animals do, that person’s mind will remind him of the terrors caused by yellow cars in his life.  In fact, even the word yellow can bring back all the sordid details of the accident.

Now let’s imagine that this person went for a pleasure trip someday where he enjoyed sightseeing so much that he forgot that there will be no options to get back to his hotel anymore other than riding a yellow cab.  Unfortunately, he or she or they would have to walk to the hotel in the middle of the night where there is less certainty that it will be safe.  Would the person summon the courage to take a yellow cab then?  If safety and enjoying the vacation is important enough, one can be forced to ride the cab and by forced I mean, by the person’s own free will, and how much more workable taking a yellow cab would be. 

Now here’s how this story can relate to our own histories of past traumas.  In Acceptance and Commitment Therapy or ACT, not being able to realize the different contexts in which real danger should be avoided is at the heart of what is called psychological rigidity or what I prefer to call behavioral rigidity or inflexibility.  

One thing that happens if we start following rules that our minds offer us to protect us in situations where there is an actual danger or threat, we begin to lose sight of other options available.  We hold on to limited patterns of behaving in dealing with the myriad of situations that happen as we go through different life stages or even daily challenges.  

If you are like many of us who have lived with imperfect parents or caretakers, there will be situations that will cause us to feel anxious.  But some of these situations can call for our willingness to open up to these difficult feelings in order to enrich our lives.  Noticing how our minds overgeneralize with rules is the key to breaking out of the limits our minds make.  Opening up to our past histories and noticing them as they are is key to what is possible.  

If we stay and see behind our difficult memories, there may be something that we can learn which is important to us.  In my case, I hated my own anger because I cared about being kind in the presence of that anger.  If you have been bullied or rejected, that hurts because you care about not being bullied or about being accepted.  There’s much to learn from what is painful.  Don’t run away.  Stay and watch how much your pain says about you and the beauty of all that you hold dear and care about.  In other words, don’t run away from your own humanity.  As it is often said in ACT, open up to your painful thoughts and feelings, and see what gifts lay behind.

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Not Everyone is a Zelensky, Not Everyone Ends Up a Hero

by Nathan Chua

How many times have you and I been discouraged at the results of our hard work?  How many times have you and I loved but failed?  Have you ever taken care of a stray puppy and ended up seeing that puppy die in just a few months?  Have you ever done something that you thought would benefit your organization but end up unappreciated?

Welcome to the club my friend.  This is something that you share with countless others who have lived long enough to experience the pain of the human condition.  Oftentimes, we get disheartened by the results of our hard work and our standing up for what we believe is important.  This could be mostly because we often miss seeing the value behind the goals that we set for ourselves.  Goals are guideposts that tell us that we are heading in the direction we want for our lives.  Goals are benchmarks we either look forward to or look back on with much pride and sometimes with mixed feelings.  Goals are also not a sure thing.  They can be elusive or even unachievable in our lifetimes.

Our values on the other hand, are qualities of being that we aspire to be about.  It is inexhaustible.  It does not have an end point that we either look ahead to or look back on.  It can be the fuel that burns the fire for our daily existence that could otherwise be meaningless or pointless.       

As we live our values and pursue those goals, not all of us will end up getting the acknowledgement we want.  Not all end up on the cover of Time magazine like the president of Ukraine, Volodymyr Zelensky.  Even in such challenging places like the Ukraine, many soldiers in the Ukrainian army or even civilians, have bravely stayed to fight for their territorial rights, but unlike their president, many of them will die unknown.  At best, their names might be engraved in some memorial one day, but how many of us really take the time to get to know each one of these heroes.   

Ask yourself this question, regardless of the results of your small but heroic endeavors, whatever your lot in life, would you still do what it is that you just did?  If you were to dedicate most of your adult life to something you want to do, and no one would know, what would you choose to do?  Maybe you can relate to these stories:

  • A security guard earning what can hardly be called a living wage, returns a bag full of cash to an unsuspecting tourist;
  • A homeless person rushing in to save another pinned underneath a burning car;
  • A dedicated worker who contributes daily to their organization without much recognition or reward but a measly salary.  

So let’s get back to the questions that I started this article with.  Read them again and ask yourself, would you have still done it?  Would you have still worked hard to help the group of people who toil with you everyday in the office?  Would you still have loved that person the way you did?  Would you still have taken that stray puppy?  Would you still have done that for your company regardless of the results? 

If your answer is yes to any of these questions, then welcome to the club again my friend.  You are in the company of the nameless soldiers who died in war for the sake of something bigger than themselves.  You may not end up a Zelensky or on the headlines of a broadsheet, but you stood for something you wanted to be for that moment.  

If you ask me why we do it?  Blame it on Darwinian evolution.  There is a part of us that has never left us in millions of years of evolution.  We are the most social of all primates.  We have that gene, that social gene that tells us that we are capable of doing caring things even at the highest of costs, with little reasons for these deeds than just being the creatures that we are.  That’s the kind of programming we have, fortunately or unfortunately.  We can do really big things, for nothing more than love.    

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