Category Archives: Clinical Case Studies

Stuttering and Stammering

It gets quite uncommon nowadays to meet people who stutter. I used to see it a lot more on TV, and it’s not much presented nowadays. I wonder if people no longer suffer from this problem, or they just don’t get out there and socialise much (so we hardly get to meet them and talk to them). (It also seems that most children grow out of it anyway).

Till few months ago I received an email from a lady in her 20s. She said it was depression that she needs help for. At first, based on what she wrote, I was thinking she might be quite socially anxious. And towards the end, she casually mentioned that she also had stammering issues.

I, also, quite casually replied to her that if she’s keen, I can help her with her stammering issues, on top of her depression. Undeniably I was quite “eager” inside, I was thinking I finally might meet one whom I can put what I learnt into practice.

That was few months ago. Now she almost, no longer stutters. She told me sometimes she will still do it, deliberately, just because she was quite used to it (due to some techniques that I coached her to try), now it’s all under her control, she can do it or not based on her will (just like everyone of us?). She is a lot more confident than when I first saw her, a lot more socially active too. It wasn’t quite “depression”, hence her previous treatments (mainly medication) didn’t help her much.

I don’t think people generally seek help from psychologist for stuttering and stammering issues, but yes, psychotherapy will help, hypnotherapy too. So yes, please get in touch if you happen to be one or know someone who might need this probably-life-changing therapy.

 

Extra knowledge: Stuttering VS Stammering

Stuttering refers to the repetition of words or syllabus when one is speaking, while stammering is when one is unable to make out the sound while speaking.

#口吃 #结巴 #治疗 #催眠 #心理治疗

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.

How is Morbid Jealousy diagnosed?

Her son wants her to see me, thinking that the mother couldn’t let go of the past, and has always been picking fights so much that the home is never felt peace. So she came.

When I asked about her relationship with the husband, she said they are always fighting. “Which couple wouldn’t? We face each other 24/7. We live together, work together, go out and in together. It’s normal right (that they fight all the time)?” I tried to imagine, being married for about 40 years, facing each other 24/7, yea, perhaps she’s kind of right (deep inside I still don’t feel right, especially if there is only “fight” between them). So we continued to talk about her children, grandchildren, work, neighbour, leisure etc. And I figured that her life is all about this family for the past few decades, she’s never seen the world outside, and she feels miserable in the family, that she’s sacrificed so much for the family but is not treated fairly and nicely by the members in it. So I helped her to find out what she used to love when she was young, and wanted her to look into engaging in these activities again.

What concerns me took place during our second session. She said she has nobody to talk to about “these things” for the past so many years. “Even if I said it, nobody believed me, they all think that he’s a perfect dad.” She told me the husband is always flirting other women, including her own sister, their maid, neighbour, and now daughter-in-law. I was slightly shocked, because I’ve heard a lot about the family from the son, in my mind, her husband is a traditional but good dad, except that he’s bad tempered and uses swear words when he’s angry. But I listened on.

She gave examples. She told me a few incidents that she observed. She even questioned the husband when things happened. But that only led to arguments, as the husband always denied it, and the children always sided their father. She felt alone, unfairly treated, and disappointed. (What do you think at the point?)

Some of the incidents she observed are: the husband peeping the maid while the latter is taking shower; the husband’s hand gesture was very close to the daughter in law’s face which she deems very inappropriate as a (asian, traditional) father-in-law; the husband used very gentle voice to speak to the daughter in law; the husband was chatting up with her sister. It’s mainly surrounding in themes of this sort.

She has told me not to tell her son or anyone about these. She doesn’t want to spoil their father’s image, and she knows nobody would believe what she says anyway, because they are never really there, she’s the one who spends so much time with him. She also thinks the husband will “lose face” if these things are broken out in the family.

When I was listening, I had “morbid jealousy” (read more here) in my mind. But at the same time, I know it’s also possible that the husband is really “that kind of person” (sorry for being judgmental, I’m a woman, haha). It’s not quite possible to confirm either way, unless I have a third party in the family who can tell me more, but I’m not allowed to share these with the members in the family since that would break confidentiality and trust.

So I’m going to continue digging without causing suspicions in the family. I’ve seen quite some cases of morbid jealousy in the past few years, the diagnosis is always confirmed with the statements of the spouse and/or family. Is this diagnosis possible without presence of another party?

Do email/whatsapp me if you suspect that you or your partner might have the condition, or you would like to know more about the treatment. There is also a quiz you can do here!

N.B. I’ve noted this else where in my blog, but I think it’s important to again emphasise that all cases under my “Clinical case studies” category are written either agreed by the patient and family OR modified/combined so that it’s not possible to trace back to the person. 

Positive Symptoms of Schizophrenia: A Patient’s View

She was referred to me by a consultant psychiatrist, diagnosed as schizophrenia, and taking some medication for the past few years. She is compliant with the medication, even though the medication makes her struggle to wake up every morning. She has a job. She completed a degree few years ago, and has been able to hold her job most of the years despite her illness.

I remember during our first session we talked quite a lot about the symptoms of schizophrenia. She used to have paranoid delusion (suspecting that a fellow friend from the uni is following her and trying to do her harm etc), but now has only auditory hallucination (hearing voices of the ex-coursemate).

The consultant psychiatrist and I always thought that she had good insights into her symptoms and illness. Until it was the 4th session, she disclosed that she never thought she had any illness. Why was she taking the medicine? Because it helps her emotionally, feel calmer. I suddenly realised that it was true in her case, because her antipsychotic drugs have never reduced/ceased her voices.

Sometimes it seems that the voice is like a friend to her. We have discussed that if there is no way to remove the voices right now, how she can live with the voices, and she seems ok with it (sometimes). But after more discussion, I realised that her problems with this voice is because the voice broadcasts her thoughts. She always thinks that others can read her mind, and it’s due to this voice. She can live with this voice if there is no way to get rid of it, but she can’t live with this voice telling everyone else her thoughts…… (she gave quite some good examples of others knowing her thoughts and responding accordingly, and she thinks all these were too much a coincidence).

She believes that the voice in the mind is machinery operated, and this machine is controlled by the ex-coursemate. Once during a breakdown, she even went to confront the person, and the person denied having done that to her. Now when she’s relatively well, she thinks there is no point to confront the person, because the ex-coursemate would surely deny (and she wouldn’t believe that).

From the Psychology’s perspective, both delusion and hallucination are common positive symptoms of schizophrenia. They also tend to happen together.

From the client’s perspective, it’s more complicated than that. Because she doesn’t think they are two separate symptoms of an illness. They are one thing, the voice (hallucination) broadcast her thought (mind being read – delusion).

I surely didn’t attempt to argue with or convince her that it was just her illness. I’m not being irresponsible or denying my job and role as her therapist (I can and will still help her in many other ways), but consider this carefully, is there any point at all to do that in her case? (especially that she’s almost fully functional and is taking her medicine regularly and attending therapy session monthly). After all, who knows she might be right and I might be wrong? Who says everything I learnt in my degrees must be right when the so-call anti-psychotics are not ceasing/reducing her positive symptoms? Who is the expert in one’s illness?

 

Additional knowledge:

Positive symptoms of schizophrenia: Delusion, Hallucination, Racing thoughts

Negative symptoms of schizophrenia: apathy, lack of emotion, poor or non-existent social functioning

Cognitive symptoms of schizophrenia: disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems

Peeping Tom on social medias

No matter how much we study, learn, read, practice (see clients), we barely feel what we learnt is enough. As the world advances, as new technology becomes common, new psychological problems appear too.

They were married last year after being in courtship for 5 years. It all seems fine, their marriage, their relationships, their marriage, their families, their sex lives. Until half a year ago, she realised that her husband was peeping the lady living next door, a married woman with two children. The husband would use every opportunity to peek at her, apparently after understanding her routine, like when she’d be hanging clothes at the balcony, when she’d leave home for work etc. Sometimes they are having meals, the husband notices the timing that the neighbour is coming home, he’d go upstairs to peek. This is his current status.

Previously he has been peeping her on social medias. He searched for her and followed her online, few times a day, he would visit her page just to look at her posts and activities. She is not the only target, according to the wife, he also peeks at a few other women, all beautiful ladies, including the wife’s colleague, a lady that works in the same building with him, . He doesn’t chat with them, but only “watching” them online, few times a day.

Initially he denied it when the wife confronted him. But when all the evidence is showing up, he admitted that he has always had this fetish, for a long time, before they even met each other. But he said he loves her, he only peek at them, he doesn’t and wouldn’t do anything else. He promised to change, but was soon caught by wife to be doing it again, and again.

The wife is confused. What problem does he have? Personality problems? A hidden bad habit? Psychological disorders? OCD? Sexual disorder? She searched through the internet trying to figure it out. But there laid no answer.

Indeed, it surely is an unhealthy behaviour peeping into other’s lives (through social medias) few times a day, every day. So undeniably it’s a psychology disorder, one that’s appearing following technology advancement, as when facebook wasn’t available we can’t peep into one’s life the way we do now on facebook, instagram, twitter etc, right?

The closest I can get to, is Obsessive Compulsive Disorder (OCD). There is certainly compulsive behaviour that he does, though we don’t know the obsessive thought underlying these behaviour/rituals based on the wife’s description. It also does seem that, like many other OCDs, that the problem is worsening.

How does this differ from “traditional” peeping tom / voyeurism? Are they under the same category? Does doing it digitally or online make it less severe and obstructive? Should the treatment differ? How about digital or porn addiction? Aren’t they similar in some ways too?

Problem-Focused & Emotion-Focused Copings

She didn’t think that she would need any professional mental help. That’s why she only came after quite a few months her colleague introducing our clinic to her. She realised that she is talking to herself, cursing, mumbling, and in this persistent low yet agitated mood.

It’s not difficult to understand why she’s in such state. She has a job herself and has four children, the second child is epileptic and can’t tolerate western medication, so she suffers from recurrent and unprovoked seizures. She lives with the husband and his family, including the mother in law, who doesn’t get along with her and is always criticising her. The husband’s brother works for the husband, and has recently moved in to their house with the wife and two dogs. She wasn’t happy that nobody sought her opinion regarding this. What’s worse is the brother in law and wife who never take proper care of the dogs’ hygiene. They live there for free, and never help out in any house chores. Sometimes they even use her car to take the dogs out, leaving the car seats with fur without cleaning. The mother in law would get in the way if she tried to say anything to the brother in law.

How about the husband? She’s been married to the husband for over a decade. The husband doesn’t care about all this. He usually comes home late, and is often drunk. She said he has been found to have mistress many times, some lasted for few months, some years. So this has left her in such paranoid state, is consistently suspicious that husband has another mistress yet again, and is always trying to track and check everything. So she lives in this house with her children, with almost no support and help, and with people who seem to always make life difficult for her.

What do you think? …? …?

My first reaction was fairly direct, “Why is she still there?” Yes she did mention that when outsiders look at her, most would think that she seems to lead such a happy and complete life. Is she?

Has she recognised what her problems are? Is she able to solve these problems effectively? Perhaps she can solve some of these, how about the remaining issues? Can she cope with them? Can she see the way out at all?

I do not think medication is going to do her much good, if any. I’d say this is why everyone should learn problem-focused coping strategies and emotion-focused strategies. Have you heard the famous inspirational by Reinhold Niebuhr,

Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

For me, it is telling us to solve the problems that are within our control (effective problem solving!), and for those stressors that we can do nothing about, we accept it (building psychological resilience, mindfulness, thought defusion, acceptance of negative emotions etc). And of course, what comes before, is the insight, the wisdom to identify the problems in your life and know to which category they belong to!