Category Archives: Clinical Case Studies

Should you listen to your shrink’s advice?

Clinical Case Studies, Issues & Debates

I have been writing for so many years, but I think this is the first time I’m using the word “shrink” (a.k.a. psychiatrist)?

At the first glance the answer is obvious, of course! You are seeing a psychiatrist, what is the point of seeing one if you do not listen to his/her advice? Right?

I remember when I first started to practise, this lady Ms Ana told me that she no longer see Dr X, and was still regretting the advice he has given her, including leaving her job and boyfriend. I remember this very well, as she was my first few clients. And I remember in school we were taught not to make decision for our patients. So whenever possible, we guide them and provide them with good grounds to make informed decisions (whenever possible).

Two months ago, I came to know that an old client has decided to quit his college study. I know how much the boy loves and struggles to study (it was complicated given his backgrounds and childhood experience). The father didn’t agree, but the boy insisted that it’s a final decision. Few days later, the boy contacted me saying that he’d like to have an online session with me. I was hoping that this is what he would like to discuss – the decision of giving up study.

“That decision is final. I want to see you today to discuss my future options as I’m feeling a bit lost now” He made that clear from the beginning. But I brought the topic back, since his current problems of “feeling lost now” is completely related to this decision, and should be part of the considerations when making THE decision.

As I explored things with him, I came to realise that it’s his psychiatrist who told him that “If you don’t stop studying, your condition is going to be worse. You are going to be taking more and more medications. You should just stop now, you can’t handle the stress.” He told me he had to stop because of what he was advised.

I was surprised, immediately Ms Ana is in my mind. And that is another Dr X there, who is making life decision for his patient. Instead of showing the patient what options he has, he was telling him what to do without the next step. I don’t mean that this is a bad advice, I know this boy is under a lot of stress and he’s getting overwhelmed, but the decision is not his. He didn’t “own” the decision, he only thought that’s what he was told to do.

I quickly helped him to recall some other decision he has made based on the shrink’s and the mother’s advice, which he told me he has regretted some time ago. I told him that’s what going to happen some time later, “You are going to come back and tell me – I didn’t want to quit, but the shrink told me to do that! I paid the school fees! I love studying!” He was quiet, knowing that is true.

“He even told me that if one day I regret, I can go back to blame him.”

Of course you can go back to blame him, he doesn’t lose a hair from being blamed. But what about you? Your life change completely… Because of what he said.

There is always an easier path, which is quitting (giving up). Whatever you are doing right now that gives you a lot of stress, be it studying, working, exercising, running full marathon, HIIT, baking a birthday cake, getting a driving license, seeing someone romantically, raising a child etc, whatever I mean whatever, there is always another easier route – To QUIT. And you know what, it’s easier to advice anyone else to quit, to take the easier paths, because the paths laid ahead are easier to be taken (compare: prepare someone to take up a huge challenge vs prepare someone to stay relaxed and do nothing). But I often try not to do so, because I know once I do that, now s/he has someone who verified his/her decision to give up, a professional someone, completely valid and reasonable to give up now.

Each day this professional someone can give 10-20 advices like this, just so their patients get better mentally, experience less stress. It’s not wrong for them to do that, but you need to recognise that it’s your life, not theirs, they can ask 20 patients to give up their studies every day without feeling anything, but when your life is permanently transformed and your life history completely changed, you are the one who should be responsible for it, not anyone else, not even your parents. So be an adult and OWN your decision, you can listen to everyone else’s advice, but the final decision is yours, you can go back to blame them when you regret, but that’s not going to change the fact at all.

Life Coaching

Clinical Case Studies, Treatment Approaches, , , , , , , ,

This young lady approached me around July last year, telling me that she didn’t think she has major psychological problems, but she needed help. When I first saw her, she said she’d like to resit some SPM papers, but really lack the motivation. And it’s been 2-3 years that she didn’t get this done.

I wasn’t used to taking clients/patients who are “well”. Normally my clients score really highly on any depression/anxiety or emotional distress scales. But at that time I thought I’d like a mixture of different clients, so we started to work together, on her problems like procrastination, handling negative emotions like anger and fear, handling worries and negative thoughts, setting up a routine and practice following it through, also some impulsive behaviour issues.

It didn’t take long or many sessions. Most of the therapy goals were achieved. I contacted her recently, she said she’s doing her barista work while waiting for the SPM results.

I realised this is like what I do with many clients towards the end of their treatment (when they are a lot more stable), or when they have been taking medication and are referred to me by the psychiatric consultants (so their symptoms had eased a lot when they first see me). I also think this is what a lot of people need, before they accumulate so many problems that they can’t solve, feeling worse and worse about themselves, and starting to fall into depression or other problems.

So I have decided to write this piece on “life coaching”, as it can work almost like a prevention, using hypnotherapy, mindfulness-based CBT and ACT (acceptance and commitment therapy).

Do leave a comment or get in touch (email hello@huibee.com or whatsapp 0172757813) if you’re hoping to achieve some of those:

  • Becoming more confident generally
  • Becoming more confident in a specific area/situation
  • More motivation to study/work
  • Clarifying your goals in life/career/future
  • Tackling procrastination!
  • Solving specific problems in your life
  • Becoming a better problem solver generally
  • Clarifying your life values/directions
  • Starting to take actions towards your goals
  • Becoming more emotional resilient
  • Handling negative emotions and thoughts and worries
  • More focus and better control on your attention (expanding your attention span)
  • Better communication
  • Better expression of emotions and feelings
  • Being accountable to your fitness and diet plans to maintain or lose weight
  • Tackling all sorts of fear (e.g. talking to boss/authority, darkness, height, dating etc)
  • Speaking up your mind & defending your rights
  • …and more

Addiction to Pornography (and masturbation in Muslims)

Anxiety Disorder, Clinical Case Studies, Issues & Debates, Treatment Approaches

Disclaimer: I’m writing this post with a lot of compassion (i.e. acknowledging the suffering of certain group of people and hoping to help them to reduce their suffering). In no way I intend to belittle or criticize any person or religion. If you’d like this post to be removed, please be in touch hello@huibee.com

I previously came across a 20 year young man who wrote to me asking about therapy for addiction to pornography. When we first met for an assessment, this is his “addiction” – he watched porn and masturbates for about 1 to 1.5 hours a day, almost every day, other than that he has been functioning pretty normally with his work and sports activities. He doesn’t experience any urges or problems in the day. When I was attempting to validate his experience, saying that many people of his age have much stronger urges and if it isn’t affecting his life, perhaps he shouldn’t see it as an addiction. Then he revealed his guilt as in his religion, masturbation is not allowed, at all. (I’m sorry to have been so insensitive, not knowing that masturbation is prohibited in Islam). He also understands that some of his friends did this when they were younger, not so sure about now.

He never talks to anyone about it, even to his religious mentor or his father. But he has been suffering in pain for few years, trying various ways including throwing all his gadgets away so that he has no access to porn. But normally it came back much stronger when he managed to suppress it for few days. So he fell into this vicious cycle of urge → reacting to the urge → guilt → suppress → stronger urge → reacting → more guilt → trying harder to suppress → even stronger urge……….. I believe it must have been so much pain that he finally made up his mind to seek help from a Chinese therapist. In the beginning, there was some “conflicts” regarding the client’s goal, as he’s looking for “complete termination”, whereas I see it as something natural and normal so a reduction will be more appropriate (yes I subsequently realised my mistake. Therapy is about the client, not about the therapist).

In the end we have come into a conclusion of the goals and some tasks. I’m now working with him on self-compassion, and we are using techniques from aversive therapy for the “addiction”. For the past few months it has been going well.

If you’re also a Muslim who’s suffering from similar issues (porn watching & masturbation, compulsive or not), and if you’re willing, please get in touch, I can connect you guys virtually (online, without meeting each other) to support each other to go through this together.

Stuttering and Stammering

Anxiety Disorder, Clinical Case Studies, , , ,

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?

Basic & General, Clinical Case Studies, Issues & Debates, Treatment Approaches,

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?

Clinical Case Studies

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.