Tag: Counseling Manila
How to create lasting change in your relationship
by Nathan Chua
There was a time in my practice as a counselor that I thought working on a relationship only required learning skills of communication that anyone can practice. Well, nothing has changed until this very day except for the realization that the skills have to come with a motivation that creates lasting rather than fleeting change. In my continuing search for what truly works for my clients, I have always been watchful of signs that tell me if what I do works or otherwise. From my over-a-decade’s experience dealing with couples, I have gone through multiple approaches that I thought were the holy grail of couples therapy. They all seemed to make sense. One of the approaches involved highly emotionally charged sessions that got into the deepest feelings that have thus far remained unseen by the couple. The other approaches involved learning skills on how to communicate better and keep couples from spiraling into their usual patterns of unending arguments.
It turns out that I would find both of these approaches to make sense but also knew that there were areas that needed to be addressed. It was only until I found a way to marry these two approaches that I sensed an end to my search. Well, at least until a time comes when a better approach is discovered. While digging into deeper emotions was important, constantly employing this approach can prove rather exhausting for the couple as well as the counselor. Realistically, people don’t get into heavy conversations about their deeper emotions on a day-to-day basis.
On the other hand, with the skills training approach, couples can be very imprecise with their ways of handling conflicts. It is hard to always be accurately following rules of engagement. Moreover, this technique coming from an expert can mean that couples are motivated more by complying with what the therapist is telling them to do or following rules outside of context sometimes, and end up fighting about these rules.
I found an approach that blends these two rather seamlessly. Something that has to do with exposing the deeper emotions that are difficult to show, and at the same time developing skills that can be practiced not just because that is what the couple learns from therapy but rather because they feel empathy towards each other.
It is about guiding the couple rather than following an imprimatur from the therapist. It is allowing them to discover what they can adapt as their own, because let’s face it, not every interaction that a couple does ends up in a wreck. They would have had at least a few conversations that worked in the past without any instructions from therapy. The rule only requires that couples be more observant of these successful instances in the past that don’t get noticed, repeated, and turned into habits of course.
So rather than teaching couples about what to say or do, it is more a process of discovery or trial and error. In addition to this, couples learn how to make disclosures that create empathy rather than defensiveness. It is part of our nature as social beings to have a sense of empathy towards another if only the words or gestures exchanged create room for safety and bonding. It is one thing to say that your partner is insensitive to your needs and another to say that you feel hurt when your partner behaves in a certain way in a given situation. Disclosing your vulnerable feelings over attacking your partner will usually influence your partner to feel empathic and act accordingly.
Lasting change usually happens when the motivations for change are not just about what couples learned from their therapist in the counseling room, or what they read in some self-help articles or books, lasting change comes from caring. That’s the part that happens when couples learn to feel safe enough to share their deeper, softer feelings. A metaphor that I often use for couples is that of a child who rants and throws a fit in order to get its way. Parents would then panic and address the fit rather than what it is that was causing the fit in the first place. A child, though, that learns to speak about its fears rather than its frustrations, would more likely have that fear addressed by a compassionate attentive parent. A pouting child would normally get a defensive reaction, while a fearful child would probably get attention. The former would usually end up being, at best, disciplined, and at worst coerced by the adult parents into behaving properly, while the latter would likely end up with getting assurance and affirmation. In summary, lasting change comes not just from learning skills, but more so from caring for the other. The other half of it is becoming more aware of what approaches you do with your partner that evoke caring and which ones lead you back to square one.
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.
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.
Do you have irreconcilable differences with your partner?
by Nathan Chua
Couples often wonder how the person they loved has turned into someone they can’t stand at all. Why can’t he be responsible enough to take care of our finances? Why is she so disorganized and impulsive? He seems to care more about his family than he cares about me. I’m bored in this relationship. My partner doesn’t care about what I feel. She is too quiet and aloof. I don’t feel any closeness anymore.
Of course, there are legitimate reasons for you to consider leaving your partner such as violence and infidelity. But most couples often say that their issues mostly revolve around their differences. Thus comes the term, irreconcilable differences. What I enumerated in the first paragraph can be summed up in this term that we often hear couples declare as their reason for separating. Now don’t get me wrong. I don’t mean that these cannot be legitimate reasons to call it quits. I am in no position to tell you that you should stick to your relationship just because your problems simply fall into this category. And if your partner refuses to seek the help that your relationship could benefit from, then you may have a legitimate reason to find a more meaningful life either without a partner or with someone else.
Herein lies the beauty of Integrative Behavioral Couples Therapy or IBCT. One of the details that I look for in couples as I work with them, are the reasons why they fell in love with each other in the first place! Let’s take the complaints that couples bring to the therapy room that I enumerated in the first paragraph.
Contextual Thinking vs. Essential Thinking:
Complaint #1: He’s not responsible enough. He is disorganized and impulsive.
You may have liked the idea that your partner now was, during your dating days, the helpless person who appreciated it everytime you would come to his rescue. Somehow you found a role that was satisfying in this relationship. It could also mean that your partner’s impulsiveness in certain contexts, can be an endearing quality! Why, he would buy me an expensive gift out of nowhere!
Complaint #2: She seems to care more about her family than us.
I think this is one of those issues that couples complain about quite often. Given our culture of being in a context where family is a Filipino’s greatest resource in hard times, is it any wonder that your partner finds it difficult to split loyalties in the context of your relationship?
Complaint #3: I’m bored in this relationship. My partner doesn’t care about what I feel. She is too quiet and aloof. I don’t feel any closeness anymore.
Maybe when you were looking for a partner, there was an attraction to this person’s aloofness. It made this person mysterious and interesting. She is also quite the opposite of the noisy, agitating people you grew up with as a child. Finally, I can have the peaceful and quiet relationship that I was looking for. At the same time, your aloof partner may have liked the idea that you gave him the emotional element in his life. So goes the saying that opposites attract.
IBCT encourages couples to see that their partner will never be everything to them. No couple is one hundred percent compatible. In fact, the chances of you ending up with someone who is incompatible with you is 100 percent! Let’s face it, your partner who goes at a snail’s pace will go at a snail’s pace in situations when this quality can be disadvantageous to facing life’s inevitable problems as you go through it no longer as individuals but as a couple.
So if you are wondering what I mean by contextual vs. essential thinking, your partner and you behave differently in different contexts! Your partner is not essentially a bad person. (Believe me, I have yet to encounter a client who I felt had inherently harmful intentions!) If you come to therapy with the same intention of saving your relationship, it is more likely that you and your partner are doing your best to show that you care and you want your partner to be happy. Your partner is not essentially defective. They just learned to behave in certain ways in certain situations that at times covers other situations that do call for a different behavior!
That’s what IBCT makes you aware of as aspects of your relationship that are better off accepted and may take a long while or even forever to change. If we can learn to notice and accept these so-called irreconcilable differences, chances are, your partner will notice that. And having the minds that we have, I always go back to what Carl Rogers had said many years ago. Let me paraphrase it to apply not just to yourself but also for your partner and your relationship.
The Quote from Carl Rogers:
“The curious paradox is that when I accept myself, just as I am, then I can change.”
Paraphrase:
“The curious paradox is that when my partner accepts me, just as I am, then I can change.”
Interview on DZAR Sonshine Radio About Anger and Violence
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.
Watch this on YouTube!