The year 2020 saw a rise in uncertainties. Many have experienced anxiety, job loss, a strain on finances and family relationships due to the impact of the pandemic. By default, couples need to adjust to working from homes, with blurred boundaries between work and family, lesser personal space and challenges in new routines. They may not have readily communicated effectively about their roles, given the constant changes in adjusting to tightening and lifting measures. Coupled with the labour crunch, families may find it increasingly formidable or costly to hire a helper to care for children, who are required to stay home for home-based learning or the care of elderly parents who may be weak and frail. This may inevitably lead to unresolved conflicts between the couple due to the stress and demands of constant transition and change. In 2020, a survey for mums showed that 60% of the participants rated their stress level at a 7 out of 10. In addition, 3 out of 10 of the participants felt sad most of the time.
Children and young people are not spared from the raging wave of anxiety. According to a survey conducted by Focus on the Family, kids are more anxious about exams than Covid 19 (The Straits Times, 18 Sep 2020). However, in an international study of 72 countries (including Singapore), only 6% of teens share their problems with their families (Impact of the Pandemic on Family Life Across Cultures 2020, Namad Bin Kalifa University). No wonder the CEO of the Institute of Mental Health says that “Gen Z faces different forms of stress, maybe more anxious, depressed than others before them (Today, updated on 1 Mar 2021).” President Halimah also urged Singapore to step up efforts to protect children’s mental health early (The Straits Times, 2 Dec 2020).
Given the tremendous stress that kids and adults are facing, families are stretched very thinly. Therefore, they ought to rise above their concern of seeking a mental health facility to deal with their issues early, so that family members can get the professional help they need.
It is timely for the family to consider attending family therapy to address and deal with the mental well-being issues, be it stress or anxiety collectively.
You may have some questions about family therapy, and here are some FAQs that seek to answer your questions.
Why Family Therapy?
Having to deal with unhealthy family dynamics constantly puts a toll on one’s mental wellness.Family therapy focuses on improving family communication; it deals with family conflicts, seeks and creates better functioning and environment. It provides family members with an opportunity to talk about how they think and feel, being affected by the issue they face. It enhances skills to facilitate healing. Therefore marriage and family therapy are essential.
Family therapy shifts the focus from blame, diagnostical lens, linear causality, and looks at circular causality in an issue. For example, a teen who exhibits school refusal may be staying home because of his worry and caregiving role to his mum, who is in chronic health and has a strained marital relationship with her spouse. It helps the family understand the issue confronting them in the family context and the larger contexts, i.e. the pandemic.
Family Therapy is often used to help treat an individual’s problem that has dire effects on the entire family, i.e. depression, anxiety and behavioural issues. This type of psychotherapy is also helpful in addressing family-centric problems, i.e. conflicts between spouses, siblings, parents and children.
What is Family Therapy?
Family therapy is psychotherapy designed to identify family patterns that may have contributed to behavioural or mental well-being concerns. The idea is to help family members break those habits as the family therapist involves the family in discussion and problem-solving.
What can I expect when my family and I attend a Family Therapy session?
During family systems therapy, the family therapist works individually and collaboratively to resolve their issue, which directly affects one or more family members. Each family member has the space to say what they think and how they feel as the issue affects them. For example, when a teen has anxiety issues, a family member gets to talk about how this issue impacts them.
How long is each session and how long is the therapy period?
1.5 hours per session over a period of 4-8 sessions, subject to review with your family therapist. Family therapy is a specialised counselling process. No one is a miracle worker. It takes time and commitment for the family to work through their issues.
Are family therapists trained?
Yes, systemic family therapists are trained with a Masters in Family and Systemic Psychotherapy, a specialised skills competency in systemic couple and family work. It draws on systems thinking and views the family as a unit. It evaluates the parts of the system (individual) in relation to the whole (family) and examines how an issue of one or more members of the family affects the whole family. It suggests that a family member’s behaviour or issue may be embedded in the family dynamics and influenced by the family of origin issues.
Family Therapists would have undergone at least 560 hours of academic instruction and supervised clinical practice, accompanied by years of experience.
When should my family and I attend Family Therapy?
It is always helpful to seek family therapy early before the issue snowballs and becomes more difficult or complicated to manage at the later stage.
Who should attend Family Therapy?
Immediate Family members in a family nucleus should attend Family Therapy, i.e. couples, parents, children (includes teens and adult children) siblings.
Does my whole family need to attend? What happens if I am unable to get all my family members to attend Family Therapy?
It will be helpful if your family can attend therapy together. However, it is okay if not all family members can turn up for therapy. The family therapist will collaborate with the members who come for therapy sessions.
How do I prepare for Family Therapy?
Discuss with your family members about attending therapy together. Think and write down what you want to discuss before each session. Then, ask your family therapist how you want to improve the communication in the family.
Is there confidentiality?
Yes, the session is confidential under the Singapore Data Protection Act 2012 (“Act”).
Winifred Ling, spoke with thehomeground.asia about failing marriages. Read on to find out her thoughts in the article below.
In Singapore, the law states that there is only one reason for divorce to be granted – the irretrievable breakdown of marriage. Currently, this must be proven by one or more of five facts: adultery, unreasonable behaviour, desertion, separation of three years with consent, or separation of four years without consent.
A sixth fact was recently introduced as a proposed amendment to the Women’s Charter, divorce by mutual agreement of the irretrievable breakdown of the marriage.
This amendment enables couples to take joint responsibility for the breakdown of their marriage. Mr Ivan Cheong, a partner in family and divorce law at Withers Khattarwong, notes that the changes would benefit more couples who wish to go their separate ways amicably, and do not want to have to find fault with the other party’s behaviour to obtain a divorce.
“Often, the act of having to list out the faults of the other party as a means of seeking dissolution of the marriage increases animosity, and may result in each party trying to pin fault on the other,” says Mr Cheong.
While Mr Cheong welcomes the development, he adds that he doesn’t think divorce rates would increase simply because of the introduction of the option. “This option does not make it easier for parties to get a divorce, or render divorce as the default option simply because parties have minor disagreements in their marriages”, he says, pointing out that certain safeguards will be put in place.
So, how do you know when it is worth fighting for your marriage, or when it is truly time to think about splitting up?
Red flags in a marriage
The late American author and journalist Mignon McLaughlin once said, “A successful marriage requires falling in love many times, always with the same person”.
But what if that fails to happen?
Dr Edmund Wong, principal family life educator, and Ms Chang Mun Lan, senior family life educator at TOUCH Integrated Family Group, says that some common problems that married couples go through include unrealistic and unmet expectations, unmanaged conflicts, relationships with in-laws, financial matters, and personality or cultural differences.
These recurring problems could even get worse, if left unacknowledged. Here are some warning signs to look out for.
1. Total breakdown of communication
Arguments happen in all marriages, even healthy ones. But there may be situations where the couple can no longer spend time together without constantly getting into arguments and would rather be physically apart from each other as much as possible, says Mr Cheong.
“It’s a major red flag where couples refuse or are unable to talk civilly with each other, preferring to spend as much time away from the other spouse as possible and where they start keeping separate households, either by living physically apart or in separate bedrooms.”
2. Lack of physical closeness and companionship
A lack of physical intimacy and physical affection, including hugging, kissing and holding hands, can be signs of greater problems to come. It could start off with reasons such as busy work schedules, being preoccupied with the children or household matters, or even a major event such as the loss of a close family member.
However, these could easily lead to spouses getting habituated to the momentary dry spell, and start feeling increasingly distant from one another. Over time, either spouse may begin to experience abandonment issues.
3. Being emotionally checked out
Another major red flag is a lack of awareness, interest and knowledge in what your spouse is doing. Ms Winifred Ling, a couples therapist and relationship coach with Winslow Clinic, Promises Healthcare, says that when you have checked out emotionally, you are “living a parallel life and see nothing wrong with it”. The person may feel alone in the marriage and yearn to regain independence by cutting off emotional connection with his or her spouse. “You stop making the effort to take the initiative to be kind. Instead, you engage in a ‘waiting and comparison’ game where you refuse to be the one to reach out to your partner but you want your partner to make the first move’.”
In such cases, Ms Ling adds, the couple has forgotten why they share a life together – and they engage in negative communications such as criticisms, contempt, defensiveness and stonewalling.
4. Violence or abuse
Abuse does not necessarily have to be a slap or a kick in the stomach. Besides physical abuse, there may be instances where a spouse controls, bullies, or even threatens the other party. Some signs include blaming the other for everything that goes wrong, throwing things when angry, constantly yelling at the other to make him or her feel small, threatening loved ones, or controlling the other party’s expenses, as well as who he or she goes out with.
5. Presence of a third party
Infidelity is a clear warning sign that the marriage is on the rocks. But third parties can come in other forms. Addiction – be it social media, alcohol, gambling, video games and so on, can easily become a third party in the marriage. You may find that your scrolling through Facebook and Instagram is putting a dent in your couple-time and relationship, or that you are constantly sneaking or making excuses to get a drink. If these actions make you feel guilty and make you feel like you are cheating on your spouse, it’s a huge red flag and a sign that your relationship needs help.
Is it time to say goodbye?
There may be situations where staying in the marriage is more detrimental to the psychological and emotional health of both individuals. Ms Ling explains that it can be exhausting for the couple to be “living a fake life”. “The dishonesty and inauthenticity will take a toll on them emotionally,” she says.
In addition, it can also affect other members of the family. There may be cases where the couple fights so much that the mental well-being of the children is compromised and they grow up in a high-conflict environment. “Some parents may also feel guilty about giving the wrong impression to their children of what a marriage should be,” Ling adds.
It remains to be seen whether the introduction of the option for couples to mutually agree to divorce will have an impact on divorce rates. But experts seem to agree that the change would be beneficial in that a long-drawn, acrimonious divorce process could be avoided. With the new option, the two parties would file as applicant and respondent, compared to the current proceedings where they would file as plaintiff and defendant.
Mr Cheong says he had previously received feedback from parties and other family lawyers that “having to recount past conflicts and play the ‘blame game’ by finding fault with the other party’s behaviour as a reason for the breakdown of the marriage causes further animosity between the parties.
Even more importantly, NUS sociologist Tan Ern Ser is of the view that a simplified track would surface what could have ended up hidden. He says, “It reduces the acrimony or the prospect of having to put up with a broken, through apparently intact marriage.”
He also adds one could argue that a broken marriage would lead to a divorce in any case, the only difference is not in the “divorce statistics, but in causing further hurt and pain”.
Recognise when you need help
But it doesn’t necessarily mean that your marriage is doomed, even if you have ticked off one, or more, of the above warning signs.
Research has shown that marital relationships can be repaired if both parties are willing to put in the effort to make things work, by addressing the hurt and pain, understanding each other’s perspectives and taking active steps to hear each other out.
Dr Wong and Ms Chan add that marriages need consistent effort and nurturing. They recommend a marital health check on a regular basis, for instance, once every two years, or in preparation for transitions in life, such as parenthood or career changes. It could highlight the areas of growth in the relationship and guide couples towards areas that may be causing tensions, and help nip any potential issues in the bud.
Research shows that couples wait an average of six years of being unhappy before getting help – by which time a lot of hurt and resentment has built up. Ms Ling urges couples to seek help at the first sign of trouble. “This can be as early as the first year of marriage when you notice that there are perpetual issues that keep surfacing and you simply can’t find ways to resolve them.”
If you think a divorce is the best option for you, seek professional help in guiding you through the process. Look at the motivation and reasons for the split and assess if the situation is salvageable or not, she says.
“Divorce doesn’t just affect the couple, it affects the extended family as well”.
Therapy is an indispensable tool to recovery, or in helping one gain deeper insights and achieve self-actualisation. In light of the ongoing COVID-19 pandemic, traditional face-to-face therapy has been forced to take on various forms, including sessions conducted via telephone or through video-calling platforms. Of course, therapy serves the same purpose, regardless of whether it is conducted in person or otherwise. However, there is definitely something restorative about being able to connect with a therapist physically. Humans are innately social creatures after-all, and sometimes when things get tough, a little more human interaction and comfort can go a long way.
Physical presence in therapy certainly provides a deeper sense of connection, in contrast with virtual therapy where one might feel more distant and detached. It may seem bearable at the very beginning, but as you progress through the sessions, having to interact with your therapist through a screen all the time can get frustrating. Similar to how students may have trouble coping with online school and home-based learning, virtual therapy has some form of hindrance when it comes to relationship-building with your therapist. For most psychotherapy methods, it is indeed possible to shift them online. However, for others such as psychodrama, it may not be entirely ideal. How expressive and comfortable can you get, when you’re struggling to follow your therapist’s directives through the small screen and having to deal with technological lags?
Seeing your therapist in person also allows for him/her to detect any subtle body language and somatic movements. These are all non-verbal cues that may be lost through telecommunication. Non-verbal cues are just as important as verbal ones, and can provide your therapist with greater insights. Non-verbal signals can serve to convey your feelings along with what is being said, and can either reinforce or contradict verbal messages. Ignoring them would be very much a failure to be fully engaged in a conversation. Moreover, seeing you in person provides therapists with the ease to identify any form of dissociation. During the session, clients may not necessarily attune well, and may not be fully present in the moment. The client may be engaging with the therapist, but seemingly thinking about something else that is going on in their life at the same time. This does not mean that the session is unhelpful or “boring”. While this could simply be attributed to the lack of presence, it could also point towards other concerns regarding the client’s state of mind. Fragmentation can occur especially when one is recovering from a past trauma and can be brought to the forefront, causing incomprehensive emotional reactions when triggered. Fragments of self are usually suppressed, often attributed to the lack of a sense of safety when it comes to expressing their inner needs or desires. When these feelings start to show during therapy, therapists can identify them through common tell-tale signs such as a switch into dissociation, noticeable body movements (twitching, scrunching of fingers or toes etc.). Body language is not definitive, but can offer clues about one’s thoughts and feelings. With telecommunication, it is more often than not impossible to see the client below shoulder-level, thus making it difficult for therapists to assess any somatic movements that may be occurring.
Another issue with telecommunication is the lack of control over the therapeutic environment. In a traditional face-to-face session, the clinician has considerable control over the environment, and is able to ensure a private, safe and quiet space for the entire duration of the session. This limits the number of distractions and allows for both the therapist and the client to concentrate on psychotherapy. Moreover, in a clinical setting, furniture is often set up in particular ways to facilitate clinician-patient interactions. For instance, seats may be arranged such that the clinician would be facing the client at an angle of 45 to 90 degrees, and approximately 2 to 3 feet away. Facing the client directly can feel somewhat threatening for some, and this angle allows for the client to feel more at ease. Additionally, it allows for both parties to break eye contact naturally (intermittently) without seeming antisocial or distracted by having to do so actively. In contrast, having a session online or through telephone allows for less control over interactions and the client may be more exposed to external distractions or undesirable interruptions. This also leads us to our next point, where teleconsultations also increase the risks of privacy breaches.
Due to the lack of environmental control, having a consultation via telecommunication methods can be a challenge especially for those who do not have access to their own private space. For individuals living with others, there could be situations that compromise client confidentiality, including potential eavesdropping or having others walk in on them. Not only does this make the session extremely disruptive, it can be a huge concern for many considering that mental health concerns are sensitive topics. Clients must make the extra effort to find a suitable place and time for them to speak with their therapists freely and with ease. As such, physical presence in a controlled clinical setting may have the upper hand.
Nevertheless, this article in no way aims at undermining the efficacy of tele-health, nor to allude that tele-therapy is ineffective or pointless. Considering the need for physical distancing during the pandemic, telecommunication is undeniably crucial in limiting the spread of the virus. Putting that aside, traditional in-person therapy can have its barriers too, limiting people from attaining the mental health support they need. Individuals with disabilities may find accessibility to be a significant problem at hand, and find it difficult to travel for therapy without having others to rely on. Others include parents who are unable to find suitable childcare options, all while juggling work and mental health care. For those struggling with social anxiety and agoraphobia, it can also be extremely intimidating and overwhelming for them to step out. In fact, some research has shown that virtual and in-person therapy, depending on the treatment goal, can be equally effective. In adults, cognitive behavioural therapy was shown to be similarly effective both in vivo and virtually (Khatri et al., 2014). There is also evidence that youth with anxiety disorders respond positively via telehealth (Khan et al., 2020). Traditional face-to-face therapy and tele-therapy both have their perks, and we acknowledge that it also boils down to individual preferences. If you’re unsure as to which treatment option to opt for, do feel free to contact us.
Brenes, G. A., Ingram, C. W., & Danhauer, S. C. (2011). Benefits and Challenges of Conducting Psychotherapy by Telephone. Professional psychology, research and practice, 42(6), 543–549. https://doi.org/10.1037/a0026135 (Accessed 06/09/2021)
Khatri N., Marziali E., Tchernikov I., Shepherd N. Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: A pilot study. Clinical Interventions in Aging. 2014;9:765. (Accessed 09/09/2021)
Khan, A. N., Bilek, E., Tomlinson, R. C., & Becker-Haimes, E. M. (2021). Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19. Cognitive and behavioral practice, 10.1016/j.cbpra.2020.12.002. Advance online publication. https://doi.org/10.1016/j.cbpra.2020.12.002 (Accessed 09/09/2021)