Category Archives: Basic & General

咨询师评估时最喜欢用的问题

开始面谈时:

  • 今天是什么让你来到这里?
  • 你为什么现在来?
  • 为什么在这个特定时候寻求帮助?
  • 什么使你过来?
  • 你遇到了哪些类型的困难?
  • 你目前是否经历着任何不寻常的压力?

对于问题的评估:

  • 请描述今天使你过来的问题。
  • 将问题分解成想法、情绪和行为是有帮助的:当你体验____________时,你在想什么?感受?做什么?
  • 你对这个问题有多少控制(0-10级)? (10为完全掌控,0为完全没有控制)

目前的运作评估:

  • 你最近的睡眠和胃口怎样?你每晚睡多少小时?你今天吃了什么?在不寻常的日子呢?
  • 请从早上起床开始详细描述典型的一天。
  • 你的收入来源是什么?你有财务问题吗?
  • 你是否定期服药?什么药?什么剂量?
  • 你喝酒或使用毒品吗?哪些、多少?

风险评估和灌输希望:

  • 在糟糕的日子里,你会有时认为不值得活下去了吗?
  • 什么能帮助你度过糟糕的日子?当你想要伤害自己时,是否会想起一些人?
  • 自杀的想法以外,你是否曾自残/伤害自己? (给例子)

评估自我概念和自尊心:

  • 你如何形容自己这个人?
  • 熟知你的人(例如__________)会如何描述你?
  • 你会如何向其他人(例如,之前从未见过你的人,未来的雇主,朋友)形容自己?

评估家庭历史和社会支持:

  • 你是否像你家里的其他人?你家中的其他人是否有相同或类似的问题?
  • 是否有_______________的家族史?
  • 你如何形容你的伴侣?你妈妈?你爸爸?
  • 这世界上,你最亲近谁?如果遇到紧急情况,你会打电话给谁?
  • 你多常和亲近的人聊天或见面?(详情)
  • 你目前拥有哪些支持系统?

评估习惯,物质使用和滥用:

  • 在遇到问题时,你是否奖励自己?它们包括_________吗? (毒品,活动,食品,赌博,赌博,购物)
  • 这么做给你带来什么?
  • 你是否留意到使用酒精或其他药物帮助你应对这个情况或者是否妨碍了你的应对能力?

评估过去改变和治疗的尝试(应对方式):

  • 你过去尝试了哪些干预措施/治疗?
  • 这些干预和治疗对你有什么帮助?
  • 为了应对你的问题,你已经尝试过什么?管用吗? (或对你有效吗?)
  • 你过去是否克服过问题?如何克服?

结束会谈并灌输改变的希望

  • 如果你的生活中没有这个问题,你会做些什么不一样的?
  • 还有什么是我们今天应该谈谈的内容吗?
  • 我们有遗漏了什么吗?
  • 我还需要知道什么来了解你和你的疑虑?
  • 还有什么是我们今天还没有机会谈到,但是是一些可以帮我了解你的重要信息的吗?
  • 有什么要问我的问题吗?
  • 你对治疗过程还有什么想了解的吗?
  • 你希望从这些会谈中获得什么?
  • 你对治疗过程的希望是什么?
  • 你对治疗的希望和目标是什么?
  • 你是否有任何具体的目标?

 

[注:这些问题是在艾伯特心理学家协会(2004年11月和2005年1月)赞助的两个临床评估研讨会期间根据参与者的反应制定和修改的]

Dobson D & Dobson K(2009).基于证据的认知行为疗法实践。24-5.吉尔福德出版社

Female Vs Male Clinicians (Psychologist, Therapist, Psychiatrist, Doctor, Specialist etc)

Note: This is a very different post, it consists of mainly (think-out-loud) personal feelings and opinions, not so professional but I no longer have a personal blog to write this. So please do skip if you’re here for more proper topics and information.

I used to feel quite frustrated as a female therapist, kind of like vulnerable not being able to do home visits as needed. Because of this, I turned down quite some people and felt bad couldn’t help those who are not able to leave home.

Until two days ago, this news of a male psychiatrist “sexually harass his rape victim patient” became viral. (I’m not sure if it’s really viral, as in, if I were not in this field, would I come across this piece of “news”?).

I’m a visiting consultant in the same private hospital with this doctor (no, not the one where the victim consulted him). I don’t know him personally, in fact, I have never met him. But we have referred cases to each other, spoken over the phone for a number of times, and exchanged emails.

After a discussion with my male psychiatric colleagues, we suspect that we know who the victim is, she has consulted each of us before. (Two years ago she found me online, some weeks later I referred her to see one of the psychiatrists, and then not long ago she came to see another one of them).

Yet, I don’t know what happened, and having said so much, I don’t intend to talk about this news. Though I hope the psychiatrist will be found as soon as possible, whether or not he has done it. (It’s fairly unprofessional for those major medias to simply take the information from worldofbuzz and reported it as news as if everything that was said by the victim was 100% true).

No I’m not siding anyone. Not that because he’s my colleague or we are from the same field that I’m siding anyone. But, this incident makes me realised, how vulnerable those clinicians, especially the male ones can be. Because I’m sure 99.99% of the people who read about this news would find the doctor disgusting. (Similar to the politician case, who was accused by his maid of raping).

No I’m saying who’s right or wrong or indicating anything. I’m just saying, it’s important to listen to both sides of the story, if possible, especially before you condemn anyone, or leave strong comments. (Of course, it wouldn’t be possible if the person is missing… Well, then any conclusion can be drawn?)

As of now, I feel lucky, because I’m a female therapist. Of course females do molest and sexually assault others! But at least the stereotype and prejudice are not there to begin with.

I’ve also heard of cases of doctors-to-be or specialists-to-be, during their studies or trainings, were complaint of sexually related wrong-doing (convicted or not I can’t be sure), yet eventually they were still allowed to graduate or to start practicing. I think universities are not there to just educate and train their students to become doctors, it’s also very important to determine, whether or not this person can be a doctor, in that sense. It’s not just about passing the exams academically. HEY med school professors, you are putting the patients out there at risk, if you know and do nothing about it.

So, if I may, I have three hopes here:

For the med schools, your roles are more important than just education and training.

For the law-makers, I think we need sexual offenders register (or sex offender registry in the US) in this country. Not just the child one (which was launched earlier this year, bravo!).

I hope all the doctors and therapists and counsellors out there learn to protect themselves, male or female.

What reinforces Suicidal Behaviour?

Suicidal behaviour doesn’t just mean the attempt or act of killing oneself, but also includes talking about it, thinking about it, threatening others about it, imagining it and even fantasising about it.

Here are some common reinforcers of suicidal behaviour:

  • relief from pain (even just thinking about it can lead to some instant relief from pain)
  • overt avoidance (can stay away from situations that one doesn’t want to be in)
  • diminished responsibility (people expect less from the person)
  • attention
  • forgiveness
  • identification with hero or idol
  • distraction from other issues
  • revenge (I wrote about this before here)
  • prevent abandonment (“if you leave me, I’m going to kill myself”)
  • escape punishment

 

Maybe you want to read about this too: Euthanasia

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my

How to respond to Worrying?

  1. Refocusing Skills: Notice that you’re distracted and refocus back to the present moments. Most of the traditional mindful breathing mindfulness exercises will help developing this refocusing skills. You can try the Benson’s method here.
  2. Observing Worries: If you happen to be in a private setting, try observing your thoughts. You can try leaves on the stream or the mind-train, being the observer of your experience and thought, realise that you have choice and control to not react. It requires some practice, and usually only possible to do it in private, not like when you’re in a social situation)
  3. Rapid Unhooking Skills (noticing, naming, refocusing) notice and name them “that’s my mind worrying” “that’s I’m not good enough story” “that’s something bad will happen story”, then refocus back to what you are doing.
  4. Acceptance of Physical Sensations: Quite often we are pulled to focus on thinking, worrying, being in our head, in order to run away from unwanted feelings and sensations in the body. Notice that you’re pulled into your head, then check feelings/sensations (e.g. sweaty palm, heavy chest, upset stomach, racing heart, numb fingers) in your body then try to allow those sensations.
  5. Use it as a trigger to reconnect with your values: if you’re worrying about your health, then obviously your health is important to you, decide how you want to treat your body, decide the behaviour to improve that, take actions, rather than just thinking about it over and over again.
  6. Reminder to practice Self-Compassions: life is difficult, a lot of challenges, obstacles and loss, acknowledge that it’s not easy and be there for myself, soothing yourself.
  7. Cue to start Problem Solving: Worry = fruitless problem solving. If it’s an important topic and a solvable matter, how about finding a time to sit down and properly solve it?

线上/网上心理治疗

在过去的几个月里,我越来越常被问到关于线上治疗的问题,而且也因为患者搬到海外并希望继续她的治疗,我已经做过一些。我一直有来自柔佛不同地区的患者,以及一些来自沙巴和砂劳越的,很多时候大老远过来就只是为了接受治疗。这些人必须花时间和钱定期过来。而我当然理解,现实的各种限制和拘束会导致其他很多人无法这么做。

所以今天在这里,我想更清楚地表达我对此的看法:

  • 我很乐意进行在线心理治疗,最好是用Skype。我也在Wechat上做过在线讲座,也是可考虑的。
  • 有一个明确的初步条件:我要亲自见过你至少一次(理想情况下是两次),进行评估,可以的话也进行一些初步干预。这对我作为治疗师来说非常重要,能够恰当地评估我的病人并一起决定最佳治疗方案。
  • 这不只是即时文字通讯,而是透过视频通话(我要看到你)。我早就听说过一些病人尝试通过电子邮件或即时文字通讯进行在线心理治疗,但通常效果不太好(尤其是问题相对严重的话)。反正我原本就为我的所有患者提供免费whatsapp / wechat支持

所以是的,如果你在寻找线上心理治疗,或想讨论更好的想法,请联系 017-2757813 或 hello@huibee.com。你也可以在这里留言。

附:我也将从今年(2019年)年尾开始在柔佛州(新山或峇株巴辖)开始作咨询和服务。

Re: Online Psychotherapy

I’ve been asked about this quite often in the past few months, and have done it a bit due to clients moving overseas and wanting to continue with her booster sessions. I have always had clients coming all the way from different parts of Johor, and a few from Sabah and Sarawak, just to see me (or sometimes with the psychiatrist drs in my clinic). These are people who have to spend time and costs travelling regularly. I understand it’s not always possible due to all sorts of constraints and logistic issues for many others.

So in this post today, I’d just like to make my opinions about it clearer.

  • I’m happy to do psychotherapy online, ideally over Skype. I’ve done online lectures over Wechat as well.
  • There is a clear preliminary: I’d like to see you at least once (ideally twice) in person first, for the assessment and hopefully some initial intervention. This is important for me as a therapist, to properly assess my clients and decide what’s best for them together.
  • It’s not just instant messaging, I’d want to be able to see you live. I’ve long heard of others trying online psychotherapy that runs through emailing or instant messaging, but no, it doesn’t usually end well. And I offer free instant messaging (whatsapp/wechat) supports to all my patients and clients anyway.

So yes, if you’re interested, or have better ideas, do be in touch on 017-2757813 or hello@huibee.com. You can also leave a comment below.

P.S. I’ll also be starting my practice and service in Johor Bahru or Batu Pahat from later this year (2019).