Tag: Face-to-Face Counseling

Going Inside Your Grieving

by Nathan Chua

If there is one facet of our internal lives that can be quite a puzzle to many, it could be grieving.  This is a part of life that can be difficult to understand.  It’s one of life’s mysteries.  Many faiths have come about in order to explain the reality of our own finitude.  In therapy, there are millions out there seeking help for this process that has so often been misunderstood.  Frequently, much of the struggles come from how the grieving process is supposed to happen.  Here are some examples of the puzzlement in question form:  There must be something wrong with me for not “grieving” the loss as much as others I know.  Why can’t I get rid of the guilt so easily just as everyone around me has been advising me to do?  Of course, there is also that most common difficulty of all, why can’t I seem to get over it as quickly as some of the people I know?  Will this pain last forever? 

Some of the misconceptions about grieving is that all of us have to go through a series of stages in order to qualify our process as “normal grief.”  As with many other areas in life, we tend to compare ourselves with the people we share moments with.  As a consequence of this inevitable mental process of comparing, it is understandable that we would feel guilt whether we go through the stages more or less quickly than others.  Or if we have reached complete acceptance or not, which is what most construe to be the final stage of grieving.  

Another misconception about grieving is that it involves just one feeling, which is what is expected, sadness.  Many can question themselves if they don’t feel as much sadness as expected.  Grieving involves multiple emotions and not just sadness.  Depending on your relationship with the person you had lost, you can feel anything from a longing for the departed one or a sense of relief that the person is no longer there.  And of course, everything in between.  It is not a sign of being abnormal for you to think that the loss provided some relief from the past abuses that a close member of the family had brought.  Feelings are not there for us to command.  You and I can’t just will ourselves to feel a certain way.  However our problem-solving, comfort-seeking, overeager and logical minds believe that to be true.  Our minds are very good tools for eliminating discomfort.  But our feelings are not an inconvenience or like mosquitoes that we can just kill off with a slap of our hands.  Our feelings tell us that we have lost someone we cared for very deeply, or on the other extreme, someone who might have caused much pain in our life,       

Another thing our minds do is comparing.  One thing that we fail to do when we focus on comparisons as we rush ourselves out of the process, or when we rant about the what if’s, is what I indicated in the title of this article.  In ACT or Acceptance and Commitment Therapy, we frequently help move people to look inside their pain just as we do for our own.  Within our pain, there could be a gift that we don’t see.  The gift of really loving and caring for another.  I often ask my grieving clients to shift their perspective by imagining someone who comes to them with a similar loss and says that the experience is of no consequence to them emotionally.  Would you be more or less worried about this person?    

And what do I mean about going inside our grief?  As I had indicated earlier in this piece, it is learning more about what is behind the pain.  This is part of our humanity.  The pain is part of what makes us deeply love and care while a person walks among us.  

Finally, there is probably something about the departed one that you treasure most.  Something that this loved one has taught you through their life,  Here’s one exercise you can do.  Write down all the wonderful things you experienced and learned from this person, and imagine this person sitting there beside you and you were reading this out loud to them.  What do you think this person would feel or say about what you just wrote or read for them?  And then ask yourself another important question.  Must this be that person’s legacy?  If your answer is yes, then what can you do to honor that?

And then look through what you have done in the past weeks, months or days, do these things that you do reflect a sense of honoring the life of this person who meant so much to you?  If not, then maybe it’s time to do something else that will.  You may end up doing something that involves either getting out of the pain, or carrying your pain with you while you live out a life worthy of your loved one’s legacy.  

When is it time to end a relationship or set an ultimatum?

by Nathan Chua

One of the toughest decisions to make in a relationship is when you think enough is enough.  I have seen quite a few clients agonizing over what to do with their partners.  Is this issue enough of a reason to remove oneself from the situation?  Am I doing what I think will be best for us or my family by ending it?  Is it just me who is being impatient?

Before I go on though, there are situations where giving up on a relationship may be called for.  For one, if you end up in a violent relationship where your life is in danger or your kids’ safety both physically and emotionally are at stake, leaving might be your best option.  You might also be in a situation where there is repetitive cheating that is emotionally untenable and also endangers your physical well-being.  When I say physical well-being, I am referring to chances of you becoming infected by a sexually transmissible disease.  Perhaps there is substance abuse involved that makes it impossible to have a meaningful connection with your partner.  Ending a relationship may even be more tenable if your partner is unwilling to seek therapy for violent behavior, cheating, substance abuse or a mental health concern.   

Another caveat before you continue with this post or vlog, every couple is unique.  You may have a situation where you are torn between giving up on the relationship or making an ultimatum.  I recommend that you bring this concern to therapy.  Maybe you will see the best option for you with the help of someone who can see your situation from an objective standpoint.       

Nonetheless, this is about making a last stand in your relationship.  If you believe there is something about it that you want to see a change in, here are a few tips on how to determine if your situation is worthy of an ultimatum:*

  1. You are determined to stick by what you decide when the ultimatum is not met.  If you are not able to stick with your ultimatum, it will likely not be taken seriously by your partner.    
  2. This is about one issue alone.  It does not involve a number of steps or changes that have to happen over time.  If your complaint behind your ultimatum is the way he handles household chores, then this may not be a place to make an ultimatum.  This is because it involves a habit that will require time and patience to change.  These will need moment to moment awareness on the part of your partner.  Examples of one issue decisions may involve physical or verbal abuse of you or any member of your family, infidelity, or addictions that have gotten in the way of your relationship. 
  3. The change you are after involves a short time frame.  This is an elaboration of the previous point.  Anything that may require an indeterminate amount of time, is likely not a condition for an ultimatum.    
  4. The partner giving the ultimatum is not pressured to decide.  It is not a game for the person making the ultimatum.  It is rather a difficult and painful process to experience.  You are not playing a game of chicken with your partner.  This pains you to make.  It is not a way for you to gain leverage in your relationship.
  5. The ultimatum will ultimately be for the benefit of the partners involved as well as the people around them.  It can start off a change for the betterment of the relationship or for each of the couple.  Examples of these would be deciding on getting married or not, having kids, getting therapy to address some of the more pressing concerns that could be a reason for ending the relationship as enumerated earlier.

Remember for as long as you have not left the relationship, you are already making a decision to stay.  In the meantime, you are left to your own devices to live out those moments.  If there is one great advice I can give you as you contemplate on whether you should leave or make a final stand, it would have to come from Viktor Frankl who wrote:

“Everything can be taken from a man but one thing: the last of human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

Ask yourself, when you look back to these moments when you made a decision to set an ultimatum, would you know that you’ve done what is consistent with your deepest parts?  If your answer is a yes, then go for it.    

*Source: Reconcilable Differences by Christensen, Doss, and Jacobson

Should you ask intimate details about an affair?

by Nathan Chua

One of the most common questions that couples ask on their road to recovery from an affair is whether it is helpful for a hurt partner to inquire about intimate details.  This is quite expected and an understandable reaction.  However, couples need to be sensitive to the results of such inquiries.  It is also not surprising to see the participating partner feel uncomfortable sharing sexual details about the affair.  

There are some experts who say that the best advice a therapist can give to a couple is to refrain from going into the sexual or graphic details of the affair.  Although this may sound like good advice to many and could probably work for a majority of couples, it has the potential to backfire.  The thing that I like about the work of Drs. Andrew Christensen, Brian Doss, and Neil Jacobson, is its focus on functional rather than formal rules of engagement between couples.  Formal rules usually involve teaching couples to follow a rule based on what it says alone with less consideration of the unique contexts that surround each couple.  It’s like following a rule just because.  Functional rules are more sensitive to contexts as well as the consequences that occur when they are adapted by the couple.  

A Word About Context:

When I say context, it doesn’t only mean the physical environment of the couple.  Context can involve the very thoughts, feelings, and memories that each partner has going into the relationship as well as within the relationship.  What mindfulness teaches us about this is that we learn to see things from each other’s context or perspective.  This is rather hard to see when couples have narrowed their options to survival strategies like fight, flight, or freeze!  That would take a whole set of blog posts to discuss!  So let me leave it at that.

In therapy, I allow couples to engage in their conversations about an affair with a difference.  That difference is to learn how to do them better.  How is this done when it comes to discussing sexual details?

These questions are obviously mostly going to come from the hurt partner.  Again I don’t want to give formal rules about this, so please be sensitive to what works in your relationship and what doesn’t.  If what you’re doing helps you to move on in the healing or renewing process of your relationship, then go ahead and keep it up.  However, formal rules can end up frustrating both parties.  The couple makes a turn for the worse when these questions are asked devoid of context from the injured partner.  When they turn into demands without reasons or, just because the injured partner is angry and the participating partner must pay, conversations can become fraught with anger.  At times they can become rhetorical and sarcastic.  Interrogation has become a way to make accusations.  And for most of us who have not learned what context sensitivity means, couples can go about doing what they’re doing because sometimes they do end up getting what they want.  As human beings, we have a tendency to keep doing what we’re doing even if the success rates go down on our attempts to remove difficult thoughts and feelings.  Minor, short term successes can obscure long term consequences.  And for couples who have experienced infidelity, the injured partner believes the participating partner is responsible for removing these thoughts and feelings.  This is an impossible task for anyone who’s a human being, let alone a partner who is also experiencing difficult emotions like anxiety and fear about possibly losing the relationship, and guilt about having had an affair.  The injured partner can get rewarded sporadically when the participating partner grudgingly surrenders to the demands.  Unfortunately, such enduring, surrendering, or survival moves by the participating partner more often only last for a short while before the pattern of giving in to keep the peace becomes unbearable.  Thus, an explosion of pent up feelings occurs and the couple escalates. 

The key here is for the injured partner to be more noticing of the softer emotions inside and able to enunciate them with less criticism and accusations.  Focus on asking for information and telling the partner why that is important to know.  Usually, the questions involve some kind of insecurity or a wound that informs the participating partner that such questions come from images or memories of past sexual hurts or rejections, if these are out in the open.  There could be strong feelings of insecurity about the injured partner’s attractiveness.  These types of revelations are more likely to induce compassion rather than defensiveness or withdrawal from the participating partner and allow for a more compassionate response to happen.  

So let me get back to what I mentioned earlier in this article.  In the counseling room, we are not attempting to help you end your difficult conversations.  We are there to help make better conversations, because like it or not, there will be conflicts in your relationship as your contexts change from situation to situation.  Learning the skills to make better exchanges in conflict situations can mean that these conflicts lead you to a richer closeness rather than rip you apart.    

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What to do after an affair

by Nathan Chua

This is intended to be a first aid kit for those who are going through a difficult discovery of an affair.  Please note that this is not a substitute for seeking professional help.  Affairs are situations that would likely require trained assistance.  Some who have taken such events lightly or have let these incidents slip by, often end up having to deal with it later with loads of pent up emotions that make it even harder to recover from. 

I am not sure if I ever had a blog post that enumerates a list of do’s and don’ts when it comes to dealing with cheating in committed relationships, particularly because applying such rules can at times do more harm to an already struggling relationship.  Let me emphasize to you, my audience, that I am listing them here not because I want to give you easy answers to your situation.  It is exactly that your situations are unique that I want you to take these tips with a grain of salt.  I am showing you a list of rules that can generally apply to most cases of betrayal without having the paradoxical effect of the couple ending up fighting about the rules instead of facing the problems affecting the relationship.  

Tip 1:  Know where responsibility lies

  • It is often that the hurt partner puts the full blame of the affair on the participating partner.  Yes, that is a fact that the affair or the recourse to an affair is the sole responsibility of the participating partner.  There is no excuse for an affair even as there are major problems in the relationship.  However, the difficulties in the relationship is the responsibility of both the partners.  We all have reasons for our behavior but they are not to be considered excuses.  Providing excuses can lead to the participating partner to blame the relationship for the affair, and for the hurt partner to justify their past behaviors in the relationship.  Reasons are different from excuses or justifications for either partner.   

Tip 2:  Problem-solve in the immediate aftermath

  • You and your partner may decide to live separately for the meantime if situations at home become too difficult to handle.  This could either be because you have a tendency to escalate or are afraid of how your escalations can affect your children.
  • You may want to get yourselves checked for possible sexually transmitted diseases.  
  • Couples are free to decide if the relationship is worth keeping but making a decision in an emotionally charged state may not be in their best interest.  Delay such decisions until you have returned to calmer emotional states.
  • Withhold conversations about the affair until you are in therapy.  Early on, it may be too much of a stretch for couples to know how to handle the problem without escalating.  Remember, what we want is for couples to move forward in their relationship rather than take steps that bring them to even more hurtful conversations.  Bring these conversations to the counseling room with your therapist.

Tip 3:  What questions to ask and how for the hurt partner

  • It is understandable that the injured partner will resort to questions fraught with accusations and harsh criticisms towards the participating partner.  Focus on what you want to know and tell your partner why that is important to you.  Let your partner know that this is part of the process of moving on rather than a way of punishing your partner.  There are tendencies for the injured partner to ask rhetorical and often sarcastic questions to their partners.  It is advisable that you make factual disclosures and revelations of your underlying softer emotions of fear and anxiety towards the possibility that this could happen again. 

This will be all for now.  For part two of this post, I will be discussing what the participating partner can say or do that can help in the moving on process.  It will also involve how partners can deal with future challenges that can happen if the participating partner is still able to remain in touch with the affair partner.  Another common question is, “Is it okay for the hurt partner to confront the affair partner?”  See you in the next blog!

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How to create lasting change in your relationship: Video!

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. 

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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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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.”