All posts by huibee

Pity, Sympathy, Empathy, Compassion

This is a great graphic created by Psychologist Robert Shelton, comparing Pity, Sympathy, Empathy and Compassion:


People working in the health care sector (nurses, doctors, counsellors, carers etc) are always told that we should have “empathy”, which was also something I used to think I should always aim to have, to feel the pain and the suffering of my patients and sometimes of their family members. And I’d say, sometimes that becomes so natural in me, that seeing people suffering or talking about their sad past and weeping, tears would start filling my eyes too.

It’s good to understand and feel how others are feeling. Quite often I can help them better, we feel very much in-sync with each other. But sometimes this emotion that I sense interfere with the therapy. And not just that, I get so emotional long after the session has ended.

I realised that what we’d want to aim, is sympathy, or even better, compassion, but, not empathy. When I have compassion, even when I do not feel their suffering, I’m still very eager wanting to help them, to release their pain. This makes me feel better, as I quite often got stuck with “I can’t imagine how it’s like to go through that.” (e.g. a friend, who is the only child of a single mother, lost her mother quite suddenly. I have siblings, even if I lost my parents, it’s still not the same for me, I can’t imagine how it’s like for her. – I can give many examples like this, where I can’t imagine and hence can’t sense their pain. What’s more, even if I could imagine, it might still not be the same as experiencing and feeling it for real).

So now I’m no longer insisting that I should be empathising with all my patients. Of course I still do, somehow naturally, quite often. But if I do not, I have learnt that my job has a lot to do with a heart of compassion, I want less suffering in people, I want them to be able to help themselves and ease their pain. This way, the emotion affects me less, and I can help more people too.

焦虑(Anxiety) VS 担忧 (Worry)


担忧或许可以算是焦虑的一种,尤其比如说你对生活中任何大小事情都有忧虑,那你可能是“广泛性焦虑障碍” (Generalised Anxiety Disorder, GAD),如果你特别担心自己的健康有些什么状况,不断在网络搜寻关于健康相关的资讯,不断进行不必要的体检,那你可能是”健康焦虑“(Health anxiety),等等。


  • 担忧更多时候发生在头脑里(以文字/语言的形式),焦虑则更多时候发生在身体里(心率上升、冒汗等);虽然焦虑也可以以认知的方式(包含文字/语言、意象/画面)呈现,但一般都会带来躯体的症状。
  • 担忧的事物一般更具体一些,焦虑的事物更含糊(或广泛)。
  • 担忧比较可能(但不一定)带来问题解决,焦虑则比较不会。
  • 担忧带来的是比较轻微的情绪困扰,焦虑可以使人无法正常生活和工作等。
  • 担忧的原因一般比较实际和具体。
  • 担忧一般持续的时候比较短,焦虑却可以长时间不断地存在着。
  • 担忧属于正常的心理现象,焦虑则往往需要心理或药物的治疗。



正念练习:河流上的飘叶(取自“接受与承诺疗法”Acceptance and Commitment therapy)

这是个闭眼练习。首先阅读说明,当你理解了这个练习的过程后,闭上眼睛开始。 (或者你可以使用这篇文章末尾的录音)



(图像的生动或清晰程度无关紧要,只要有这个概念在就可以了– 觉察自己的想法,一旦发现它们就轻轻地放下)



当河流在流动,你也能注意到想法并轻轻地把想法放下时,这就是认知解离 (Cognitive defusion) 的时候。记得头脑本来就是设计来思考的,所以它总是会不断弹出各种想法,你虽然不能控制这点,但你能选择是否对这些想法作出反应,或者选择轻轻地放下它们。如果你认为“我做得不对”、“这个练习对我不起作用”或“我怎么会没有想法”,留意到它们也是你其中的一些想法,后退一步,把它们也放到落叶上。一些其它特别“粘”的想法(比较难以觉察和解离的想法),包括含强烈情绪的想法、比较性的想法等。






Mental Problems Relapse Prone Situation

Relapse Prevention plays a big part in treatment of mental disorders. It normally involves two parts, (1) to identify high risk situations, what are the situations that are likely to cause relapse? (2) to prepare of coping plans, what would you do if you find that you are in one of these situations and feeling overwhelming?

Here are some general examples of relapse-prone situations to most commonly seen psychological, mental or psychiatric problems. There are normally some high-risk situations that are specific to each individual and the psychological problem that s/he has.

  • Stress: from any source really, it could be accumulative, or due to single (major) event
  • Negative emotional states, such as anger, anxiety, depression, frustration, and boredom
  • Physical illness: when you don’t feel well physically, your emotions are affected too
  • Social isolation (Very important! Face-to-face social interaction has been found to reduce risk of depression, yes F2F, not through whatsapp or instagram!)
  • Major life transition events (graduating from college, starting a new job, getting a promotion, getting married, becoming a parent, ending a relationship, loss & grief, moving house etc)
  • Going back to the environment that is related to your onset of previous episode(s)
  • Social pressure, interpersonal conflicts (especially for relapse of addictions)

So yes, do pay attention if you are in one or some of those abovementioned situations, and watch out for those early warning signs, including by watching out how your sleep patterns, appetite, mood level and (physical & social) activity level are.

LGBT in Malaysia

Everyone has been talking about the change of government since the GE14 in May. Yet my blog seems so cold about this whole shift as if I don’t care, because I have not mentioned it at all so far, but this does not represent how I personally feel about it.

This morning I heard on the 89.9 BFM regarding LGBT in Malaysia. Some were hoping that with the new government, “something” can be done for this minority group. Today I’m not commenting on the Sharia (Islamic) law or how pervasive the discrimination towards LGBT is in Malaysia, I’m writing this as a psychotherapist who works in private psychiatric clinics and private hospitals. I do not represent one or any of them.

In the year of 2007, statistics showed 8% of the Malaysia population thought that homosexuality should be accepted, while in 2013 there was 9%. One of the lowest rates of acceptance in the world.

I’m pleased to see some of them appearing on the newspaper and in the public sharing their stories occasionally. But those were just a very small percentage of the people. From time to time, the clinic and myself received phone calls and emails from people suffering from them. They do not contact us because of mental distress, they get in touch because they want us to “change them back to normal.” They do not want themselves to be like this.

Yes you can set up any law to control their appearance in the media or even in the public. You can also stop them from entering your country. You can prosecute them for cross-dressing and other behaviour. Your law enforcers can also assault and humiliate them however they like it without getting into any trouble. etc. etc.

You can pretend that you don’t see them and disallow them to appear anywhere you don’t want them to be seen, but they don’t just disappear. They suffer. They continue to suffer. In silence. They seek help from private services like us. They avoid the general or government hospitals. Many of them even never speak to their family members about it. They do their best to hide it.

No I’m sorry I can’t change them back to normal. Because who is there to decide what is normal and what isn’t. Not me. Not you either. I can help them though, with all the anxiety and depression that stem from the discrimination and problems in their everyday lives.

So I’m really hoping that whatever laws and regulation the new government may come up with, consider each of these unique individuals, how the interests of the public and theirs can be served, and how can there be less suffering for all. And for the public, I’d really like to urge everyone to be more open, you don’t have to accept them or like them or befriend them, but just bring an open heart and mind, and see what happens.


Related read: Can we help with Sexual Orientation “Issues”?

Why do I need Psychotherapy on top of Medication?

Case 1:

My OCD client. She used to take medication many years ago, and has stopped after her condition was well under control and they were planning for pregnancy. The symptoms came back quite aggressively during her pregnancy, but with the support of her husband and family, she didn’t take any medication till her delivery, then she found me. We started psychotherapy (mainly mindfulness and Exposure Response Prevention) few months back, if you ask her what her advice was based on her experience, she would tell you, “I should have started psychotherapy when I was taking medication. That was when my symptoms were less intense with the medication, and the exposure would have been much easier. That way I could learn the techniques and use it later when I no longer medication. I wasted the opportunity. When my symptoms returned and I couldn’t take medication, I don’t know what I can do at all. I struggled till my baby was delivered.”

Case 2.

My anxiety client. She was referred to me by a psychiatric consultant, when we first met, she was rather cheerful and calm, and was tailing off the medication instructed by her doctor. Then she never came back for follow up. Till two months later, she texted me saying she had been so anxious and was unable to sleep for the past nights. We had our second session where she learnt some coping skills. When I followed up with her over the phone, she told me she was much better practicing what I told her to, and was able to sleep. Another month gone, and I received her text again saying she was under much stress and worrying a lot. She asked if there was anything she could do to stop worrying and being so anxious about things. I told her to come back for a follow up session.


Psychotherapy doesn’t work like tranquiliser. You pop the pill into your mouth, within 15 minutes or so you get much calmer. Psychotherapy doesn’t work like anti-depressants either. You take the medication regularly for few weeks, your depressed mood, your anxiety and OCD symptoms subside significantly.

However, psychotherapy equips you with coping skills and techniques, if you practice regularly, it becomes YOURS. You become your own therapist. When you spot the early warning signs and symptoms, you can treat yourself, without medication, without any wait.

So when you get much more stable after taking medication, it’s always good to start psychotherapy, which help you tail off medication more easily, understand yourself and the illness better, and prevent future relapse better.