Tag: In Person Counseling

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.”

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!

ACT Matrix for Anger

Interviewed by Jacob Martinez, ACT Matrix Expert and Professional Counselor from Wisconsin!

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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