Category Archives: Basic & General

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.

The elderly companion

I came across quite a few “love-less” relationships in some elderly couples recently. They are normally above 60 years of age, retired, spending a lot of time together (if not all the time), and starting to argue within 5 seconds of a “conversation”.

I am not sure if it’s right for me to call them “love-less”. But there does not seem to be anything else, other than complains, arguments, resentment, and even hostility. Sometimes I feel like they are hating each other.

Whenever I try to shift the topics to something else, within a short while, and often without me realising, the topic is again back to the partner, what s/he has done, how s/he hates him/her doing that etc. I observe “loathing” on their faces when they talk about their partner.

“Hmm.. Ok. It appears that you two dislike each other very much, and dislike spending time with each other, and will start arguing once you talk. How about separation? Have you guys considered —” (Normally I don’t get to finish what I intended to say)

“No la! This is normal what! Don’t be silly la! You know how old we are now… It’s normal la, spending time together and arguing. You are young, you don’t know just yet”

Deep down most of them admit that they are no longer able to live the life on their own, without that partner who has been with them for many decades, whether with or without children. “Divorce” never crosses their minds, it can’t be mentioned, they don’t even consider it, as if it will lead to some disaster, socially, familial, morally etc. But they feel miserable with this life of retirement, it was never what they imagined to be (free, joyful, enjoyable etc). Even when they go on holidays, they can argue non-stop.

Other than listening to them, I’m not sure what I can do to help them. They don’t need any medication. They do need some counselling or psychotherapy, but they are not keen to stick to doing homework and learning new skills to communicate better, to manage anger better etc., they think they know better.

But normally, if both are relatively healthy, I’d at least recommend them to spend more time separately, look for their own interests and circles of friend, develop purpose of life of their own. This usually helps, as it indirectly enhances the quality of time they spend together. What say you?

Free and Alive – An email from a reader

My work email (hello@huibee.com) does receive emails quite frequently, from people seeking psychological helps, worried family members, potential clients, advice seekers, existing psychology students etc. However, this one is quite unique!

I’ve got the permission of the reader to share this email that he’s written to me last week.


Hi,

There is a story I want to tell You, I hope this letter reaches you and you’ll have some time to read it.

I’m a 21 yo guy from Hungary. 
A few years ago somehow, somewhere on the internet I stumbled on this post:
http://huibee.blogspot.hu/2012/09/behavioural-experiment-for-social.html?m=1
I don’t remember how I actually managed to find such a thing, but It was haunting my mind for years. “You should go take a banana for a walk, that would be fun”
I was daydreaming about it a lot more than I’m proud to admit
Not because it’s something foolish to think of, but because I haven’t done it for years, even though I wanted to and could’ve.
I even put in on my bucket list to make sure I’ll do it one day.
Then I realized that every day could be that “one day”. I don’t have to wait for it, not a single day.
So one day, on april 8th, 2018 I went for a walk with my banana, called “bobo” (I assume it’s not protected by copyright, right?)
It was amazing. People were laughing, smiling all the time around me. Someone even stopped to pet the banana, while other took pictured of it (and me). Since it’s 2018, it’s not a common thing to see someone taking a walk with their banana.
Of course there were some grumpy people who just didn’t get it and looked at me with that judgemental, disgusted face
I’m never affected by such things, I didn’t care about how they thought that i’ve lost my mind or whatever, all I cared about is the smile on the faces when walked past me.
It was a wonderful feeling. The sun was shining, it wasn’t too cold nor too hot, everything was just right.
I wish I could do other things with such a “free” spirit. Do you know any other ideas that are similar to this in some way? You know, that day for that 3-4 hours I felt really alive, which I haven’t felt for a long time. I’ve been trying to find my place in this mess called “world”, but it’s really difficult if you are entirely different than everyone else.
Honestly I really wish that you would understand how big impact that post had on my life.
If you have some free time, I would like to continue emaling for a while, if you don’t mind.

Thank You,


The post he mentioned was written during the time when I was in the UK and doing a diploma with Donald Robertson. You can also read it here (I moved my blog over in 2013, but the old link he provided has got a video of us doing it).

I’ve never thought that my blogpost would reach someone that far away, and influenced him in such special way. I mean, seriously, we can never imagine how things may turn out. I’m so glad that he took the effort and initiation to look for my contact (wasn’t available in my old blog) and got in touch with me.

Be kind, be grateful, and live your life to the fullest. Try out different things, embrace new experience.

He also attached the picture of his pet, Bobo, at the end of the email.

banana

Watching the Mind-Train

Meditation Exercise: The Mind-Train

Following my favourite Leaves on the Stream (see here), I am introducing another mindfulness exercise. It is an eye-closed exercise (though possible to do it with eyes opened when you are familiar), so please read the instruction first.

Imagine you are standing at a railway bridge gazing down at three sets of train tracks. A slow mining train is on each set of tracks moving away from you. Each train is composed of a string of little coach/car. Seemingly endless, all three chug slowly along underneath the bridge.

Now, as you look down, imagine that the train to the left carries only ore composed of sensations, perceptions, and emotions (e.g. sounds you hear, hot sensation you feel, sweaty palms, sadness you notice, itchiness you feel etc). The middle train carries only your thoughts (your evaluations, predictions, and self-conceptualisation etc). The train on your right carries your urges to act (e.g. your pull to look away, your urge to scratch your face or stop the exercise, your efforts to change the subject). Looking down on these three tracks can be seen as a metaphor for looking at your mind.

Now, find a comfortable chair to sit in for a while in a spot where you won’t be disturbed and you can be quiet. Begin the exercise by thinking of something you’ve been struggling with lately, then close your eyes and picture the three tracks. Your job will be to stay on the bridge and gaze down at these three trains moving away from you. Take at least 3 minutes just to watch what comes up for you.

Mind train. (Forgive my very basic skills, it's not as simple in my imagination!)

Mind train. (Forgive my very basic skills, it’s not as simple in my imagination!)

Are you a jealous person?

Think that you are always jealous? Think that your partner is always overly jealous and controlling? Obsessively checking his/her facebook/instagram? Always fighting because of “unimportant” persons? Constantly wondering what s/he is doing when he doesn’t reply to your message?

Here is a quiz on jealousy, it is possible to do it “on behalf of” your partner when you suspect that your partner might not be “healthily jealous” in your romantic relationship (yes, some level of jealousy is good and healthy to your relationship, but not when it turns detrimental to your relationship).

I do want to apologise that the questionnaire has assumed that every person is in a heterosexual relationship.

 

N.B. Feel free to contact me regarding the results by leaving your email in the form or leaving a comment below. However, I would say that the result of the questionnaire is not the main thing, instead, look at those items and find out if your partner’s or your jealousy is detrimental to your relationship, and if the answer is yes, do get in touch to find out what can be done.

Statistics: Smoking Status Among Malaysian Adults

  • In 2015, about 22.8% of Malaysian adults (aged >15) were smokers. (That’s more than 1 in every 5 adults!)
  • In 2011, 23.1% of Malaysian adults smoked, so yes, it had reduced slightly.
  • 43% of men and 1.4% of women smoked.
  • The prevalence among female smokers has increased from 1.0% in 2011 to 1.4% in 2015.
  • Among the smokers, a third (34.9%) smoked 25 or more cigarettes, 24.2% smoked 14-24 cigarettes, 18.5% smoked 10-14 cigarettes, 16.4% smoked 5-9 cigarettes and 5.9 smoked less than 5 cigarettes a day.
  • Among the three main races, the Malays had the highest prevalence at 24.6%, followed by the Indians at 19.7% and the Chinese at 15.4%.
  • Overall, 37.1% of Malaysian adults were exposed to secondhand smoke at home (not including children yet!)
  • More than half (52.3%) of adult smokers had tried to quit smoking in the past 12 months.
  • Smokeless cigarettes used has increased from 0.7% in 2011 to 10.9% in 2015.
  • (Worldwide) Tobacco use, a major preventable cause of premature death and diseases, kills 6 million people worldwide annually, 10% of these deaths were among non-smokers who were exposed to the second-hand cigarette smoke.

Unless otherwise stated, all these data were reported in 2015, retrieved from National Health & Morbidity Survey 2015.