Tag: Psychotherapist Quezon City

Two MORE Shrinks Over Drinks! Video! Part 1

This is the second offering of our Two Shrinks Over Drinks series. This time we have a friend, who’s also a doctor and co-author of a book entitled, “Mastering the Clinical Conversation: Language as Intervention.”

Here you get another chance to eavesdrop on two MORE shrinks caught in a casual conversation. If you have ever wondered what it is like to listen to a couple of psychologists/counselors talk over a drink, well, here’s your chance!

We talk about a myriad of topics and it took two hours to do! In fact, this could have been topics that are fit for a whole day’s chatter!

So this will be the first part wherein we talk about:

– Dr. Villatte’s ACT story

– Philosophical framework in counseling or psychotherapy

– What Skinner referred to when he wrote about a pre-scientific way of explaining human behavior

– What we mean by an approach that has precision, depth, and scope; how this can affect the way therapists choose their approach or models of therapy, and how this can assist clients make decisions on the kind of therapy they want

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

How to create lasting change in your relationship: Video!

Living with Purpose and Intent

by Nathan Chua

“Live as if you were to die tomorrow. Learn as if you were to live forever,”

Mahatma Gandhi

Have you come to a point in your life when you feel like as it says in the Bible, chasing after the wind?  Have you ever felt like every day has become a pointless pursuit of comfort and tranquility?  Has your life turned into an endless problem to solve?  You go from fixing one problem after another.  When’s the next challenge going to come?  Will I be able to surmount the bigger ones down the line?

If you have, don’t worry, you’re not alone.  I came from the same quagmire.  Early in my career, I started believing that life was about fulfilling a role of being around to be the problem solver.  Furthermore, I had learned from my history that the secret to the good life is the comfortable life.  One in which I can be the great problem solver, conquering one obstacle at a time until there remain only the easier ones.  I dreamt of eventually coasting along as I moved into old age.

I lived that way for the first 20 years of my working life.  People around me would notice how I looked then.  I often carried a tired and angry expression on my face; always on alert for the next challenge that comes my way.  I was the hero who was always ready to come to the rescue.   

To borrow a metaphor I saw in a YouTube video, you can view a rabbit running across from a window, but you wouldn’t know if that rabbit was going for a carrot or running away from a predator.  I was like that rabbit that people saw from a window.  One couldn’t tell if I was in business because I simply enjoyed doing it or if I was doing it to avoid the shame that comes if I had failed in business.  For those who are new here, I spent the first 20 years of my career as a businessman.  A failure in business meant I had failed my family.  

You would probably understand why I often looked tired and angry.  Tired because life has become a struggle and angry because I didn’t see any end in sight.  Life was sending me challenge after challenge to surmount.  Like the rabbit running away from a predator that eventually tires out, I was exhausted escaping from the jaws of my shaming, “Whatever happens, don’t be a failure,” thoughts.  

One day I woke up and started noticing the hamster wheel I was on.  It was as if I was living backwards.  Like some of what I learned in psychodynamic therapy, I lived hoping to come back to the safety of my mother’s womb, wishing to get back to that fetal position of a tranquil life.

That tranquil life turns out to be a mirage.  No matter how much we try to avoid it, life has its challenges and running away from the feelings and thoughts that these challenges come with, is like becoming a rabbit that spends most of its time fleeing a predator, although in my case the predator is my own worst fears.

You and I can pivot towards a life in pursuit of what truly matters to us.  Rabbits run away from life-threatening circumstances.  We humans though can run away from our thoughts and not just actual threats to our safety.  It only takes the rabbit to notice when the noise behind the bushes was just a gust of wind to make it go and pursue food or a mate.  Although it is difficult, we can start to make changes in our life directions by noticing if we are spending much of our energies running away from our unpleasant internal experiences, or if we are pursuing the qualities of being and living that matter to us.

The happy rabbit is the one that pursues nourishment and the possibility of a mate.  Take it from there, are you willing to start pursuing the rich and meaningful life, even if it means that your fearful inner experiences will become more evident as you go.  Maybe that’s what Gandhi meant in his words.  His life was mostly about pursuing something that was good and noble, rather than about running away from the dangers his mind reminded him of.  He pursued the irrational move to expose himself to the dangers of a life spent for the welfare of others, and paid the ultimate price.  Nonetheless, he lived, not the tranquil life, but the meaningful one.  He is the quintessential rabbit moving in the direction of what he wanted to do with his time…every single minute.

Listen to this blogpost on Spotify!  Click here!

Getting Hooked by Angry Thoughts!

by Nathan Chua

If you are old enough to watch the daily news or get regular updates online through social media platforms, you would be familiar with the all too common sights of road rage or someone who had just lost his or her temper and did something that was captured on a phone camera.  We have seen how people do things that they would never have even dreamt about in reaction to their angry thoughts and feelings.  How many times have we seen previously law-abiding citizens commit heinous acts and then later on regret what they had done when it was too late.  In Acceptance and Commitment Therapy (ACT), the term used to describe this process of fusing with thoughts is “getting hooked.”  Fusing with thoughts means our thoughts dictate what we do.   

Yes, I should have seen it coming!  It was in late September this year that I realized I had to re-register to vote.  For those who are not from the Philippines, the background is about being automatically delisted as a voter if one has missed voting in two consecutive elections.  I had thought all along that I had just missed one midterm election, but only to realize accidentally when I came upon a Facebook post that assessed my eligibility as a voter in late September, that I had missed voting in a small town (barangay) election that was held one year before the midterm elections.  Of course, that induced some panic in me when I recalled online videos showing the horribly long queues of people lining up in the midst of a pandemic to register before the deadline set by the end of September!  As I attempted to find ways to register where there were shorter lines and found out how tough it was to navigate the government website to print out the necessary forms, I realized that this will take a herculean effort.  Sacrificing a day of productive work just to register as a voter was not exactly what I had envisioned for what is supposedly a democratic country where the right to vote is protected, facilitated, or made as easy as possible.  

To cut the story short, I finally ended up having to deal with getting requirements to register all over again.  And true enough, I felt the process was disproportionately tedious for the simple act of voting.  Upon completing my documents I set out to register only to be told rather nonchalantly that my documents were unacceptable!  You can just imagine how frustrating that could be after you had braved the long lines and a pandemic just to register.  

I eventually got into a heated argument with the two people in charge of checking my documents.  It took me about five minutes to realize that I had gotten hooked by my angry thoughts!  Upon noticing what I had been doing, I quickly apologized for my behavior.  It was not the person I wanted to be in that moment, and not the way I wanted to handle the situation.  As you can see you are not alone in struggling with your anger.  Even counselors like me can get hooked!  

Here are other examples of getting hooked by our thoughts:   

  • Have you ever had an experience when you were having a dinner conversation with someone important only to realize that you missed half the conversation?  
  • Have you ever played with your child and all of a sudden noticed that your toddler is just about to fall off the crib?  
  • Or drove all the way to work and didn’t know how you got there or which route you took?  
  • Have you ever come home after someone tried to steal your bag during your walk?  Once you arrive to your family, you would probably be talking about this experience with them for hours and even days.  The experience can get you off your normal routines at home.

All of these involve something grabbing your attention and our minds start giving us reasons for not playing with our kids or hugging our partner.  In other words, your world stops in those moments.  You become less of the kind, loving, and caring person you used to be.   

In my case, with all the bureaucratic requirements I had to go through, I was hooked by the thought that the government is bad.  Hence, I felt physically tense the minute I went into the registration site.  I failed to notice this and went about the business of registering not ready for any possible frustration that might come my way. 

In hindsight, I was already hooked even before the challenging situation happened!  It’s hard to recognize a hook until we notice that biting the hook has brought us in a different direction!  This process of unhooking from our thoughts is based on what Dr. Steven Hayes explains as looking at our thoughts rather than looking from our thoughts.  The original name for ACT was comprehensive distancing, which means distancing from the thoughts that our minds give us, so our thoughts don’t dictate what we do.   

The first step in being able to distance ourselves from our thoughts is to be more noticing.    

On that afternoon at the voter registration facility, I got hooked!  I noticed only about five minutes into my ranting and quickly made amends to my ways.  Some damage had already been done though and my thoughts began to run wild with shaming accusations that I am just not a good enough person, much less a counselor.  

Well, here’s what ACT has to say about that too.  We will get hooked no matter how hard we try to be more noticing, for we are only human.  What doesn’t change though is that little voice in our heads that reminds us of what we want to be about in each and every moment.  Realize that and ask ourselves after getting hooked, “Has anything that was important to us changed?”  Perhaps not.  Every time we fall into not noticing, we can always get up again and do our best in moving towards the person we want to be and the life we want to live.  

Listen to this blogpost on Spotify! Click here!

The Surefire Way to Save Your Relationship!

by Nathan Chua

More often than not, couples come to counseling explaining their respective sides of the mess that has become of their relationship.  Each of them has turned into a lawyer for their respective cases to prosecute and defend.  For the trained eye though, they are engaging in a pattern of attack and defend.  They’ve come to therapy to find an advocate or the ultimate authority in the person of the counselor.  It is the therapist or counselor who will make the final determination of who is right and who is wrong.  In some cases, they see the therapist as the final arbiter who can determine the fate of their relationship. 

For those who are hoping to find some ways of resolving their differences, they face the dilemma of still loving and caring for their partner, but at the same time, can’t wrap their heads around why they end up fighting like mortal enemies over some trivial matters.  It’s like their partner turns into something else other than the person they fell in love with.  This while each shows glimpses of that lovable side in more sober moments.

Couples find themselves dealing with two dilemmas.  These twin dilemmas are what I described in the first paragraph of this blogpost.  The dilemma about who’s right and who’s wrong (i.e. who should back down and submit to the authority of the counselor), and the dilemma of whether the relationship is worth saving or not.

Fortunately, there is a surefire way to save your relationship.  I believe that no matter what you end up doing as a couple, a successful handling of your dilemma means that you retain a relationship with your partner regardless of whether it remains together or not.  With this silver bullet to all relationships, a couple may end up having a better way of handling their conflicts, or discover that they might be better off as separate individuals who can still learn to be friends after.  

The best way to find out what the ultimate fate of the relationship will be, is to change the only thing that each partner has the most control over:  Themselves!  In other words, if you change yourself for the better, you are more likely to enjoy a couple of possible results.  You either end up having a better relationship because your partner notices your positive changes, or you realize that no matter how much you change, your partner doesn’t.  

Let’s take the first possible result.  If your partner senses the positive changes you have made, there is a greater likelihood that they will change too.  For example, when, after years of trying, you decide not to badger your partner about how messy the room is.  Your partner may notice that sudden but welcome change.  Having felt relieved of the constant reminders, your partner may in turn show you their appreciation by, well, cleaning up the room!

Changing yourself can also solve the dilemma of whether you should stay in the relationship or otherwise.  If you have done your part to make changes in yourself and see a lack of response in your partner, then maybe it’s time to come to the realization that you no longer share the same ideas about who or what is important to both of your lives at this moment.  By getting yourself out of the attack and defend pattern, you will know that your partner’s unresponsiveness is not rooted in the way you handle conflict, but a difference in your life directions.

To end this post, just remember that when all things seem hopeless, you still have yourself to count on for change.  

“Be the change you want to see in the world,” Mahatma Gandhi.

Listen to this post on Spotify! Click here!

Why People Relapse

by Nathan Chua

Seeing a client again after a while evokes mixed feelings for me.  Part of me says, I am happy to meet an old friend again and someone with whom I had deep, important, and meaningful conversations.  But another part of me tells me that I might have not done the best job that was possible within the means that I knew.  The pendulum swings to the negative even more, if I hear a loved one of a former client inform me of a relapse.  What is wrong with my approach?  Why do people (myself included) relapse?

I have two things that can explain this.  One is, it is quite normal for us to have relapses.  In fact, before 2019, I often tell my clients that they are welcome to come back on an as-needed basis rather than our usual weekly or bi-weekly meetings.  Now that they have improved in handling their difficult emotions, I fully expect them to have relapses every now and then.  I am relieved though that even as some clients do come back for the sporadic follow-up sessions, they do manage to rekindle some of what they had learned from our previous work more quickly than they would otherwise.

The second reason I believe relapses happen, is the focus on symptom-alleviation in the approaches that I had available to me.  In 2019, I learned about Acceptance and Commitment Therapy or ACT.  Since then I have begun to understand that not all of these relapses are to be counted off as expected realities.  

Helping clients manage their symptoms has its weak points because recovery is based largely on their level of distress.  In this case, the client’s attention is focused on whether the depression, anxiety, etc, are still around or not!  It’s like regularly watching your back to see if the symptoms have gone or are kept to a minimum.

The reality though is life can often hand us challenges that can go beyond what we believe is our capacity to manage these symptoms.  The randomness of life can give us something that can overwhelm our capacities to suppress these painful feelings.  Running away or keeping these feelings underwater like a giant beach ball has its limits.

I love the way Dr. Russ Harris uses the metaphor of the two donkeys to illustrate this.  Let’s say we have two options to make two donkeys move in a certain direction.  One donkey was made to move with the experience and the threat of being hit by a stick, while the other was prodded by a carrot in front of it.  Which donkey do we think will last longer?  I presume most of us would say that it would be the second donkey with the carrot.  Secondly, which donkey do we think would be happier as it moves in the direction we want?  It’s quite a natural choice for us to say that it will still be the second one.

I used to call myself eclectic in my approach simply because I had to use different techniques and frameworks to address different problems.  However, there is one underlying presumption in these approaches that I had adopted for the first 10 years of my work, that counseling was all about alleviating symptoms or suffering, so people can go on living their “normal” lives.  

Under these approaches though, clients would tend to measure their progress by the absence or suppression of their symptoms.  For example, if my depression or anxiety is kept to a minimum tolerable level, only then can I move on with the tasks of living.  The end result becomes achieving a life absent those overwhelming feelings again.  Clients end up thinking that feeling good is what makes them “normal.”  This is what in behavioral terms is called living life under aversive control.  It is just like the donkey that is motivated by the avoidance of the stick.

In ACT, an alternative way of motivating people to live the kind of lives they want for themselves.  I learned what it means to be the donkey motivated by the carrot ahead of it.  Wouldn’t life be so much more fun if we had the carrot that we follow until the very last breath we take?  In behavioral terms, this is life lived under appetitive control.  It is not looking behind our shoulders every now and then, and reminding ourselves that we have BPD or OCD or MDD, etc. that is just waiting for us with open mouths to swallow us again.

This is about looking at ourselves as a whole human being and not just parts of ourselves.  We are whole.  We are not broken.  These painful experiences, emotions, thoughts, and physical sensations are part of our makeup as human beings.  We are not machines to be taken apart and having to remove parts of ourselves that we think are causing the depression, the anxiety, or the obsessive thoughts, or whatnot.

Being human means we chase after our carrots in life with the pain that comes along in that chase.  That’s when we know that we exist with a purpose.  Maybe with this in mind, a relapse only signals a need for a refresher on what is important to my clients, and not just being reminded of the ways to run away from pain.  What a difference ACT in 2019 made to my practice!

Listen to this blogpost on Spotify! Click here!